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There is no data about how many patients lack access to specialty care. But there are roughly 35 million uninsured Americans and millions more who are underinsured or on Medicaid. All of those people potentially could have difficulty getting specialty care should they need it. There also is no national data that shows the cost to health systems when poor patients do not go to see a specialist when they need to. What is known is that inpatient care and emergency room treatment are more expensive than outpatient office visits with specialists, and yet for health care providers the current payment system acts as a disincentive to providing specialty care to the poor. A 2013 National Institutes of Health study found that the average cost of a visit to the emergency department in the United States was $2,168. Many specialists charge at least $350, and office visits that involve procedures can cost more. Leroi Hicks, now vice chair of the department of medicine at ChristianaCare Health System in Delaware and author of the Harvard study, said the main problem is systemic. "Even now, with all the changes we're going through with health care, we still operate under a system where specialists are operating under a fee-for-service model and not a plan for the patient's overall health," he said. Because of that, "we shouldn't be surprised that doctors who don't get reimbursed for a service don't provide care to people without insurance."

Dr. LeRoi Hicks, chair of ChristianaCare's department of medicine and a study organizer, said they've started to realize that only a small amount of what is done in hospitals and clinics actually improves the health of communities. "We need much more information about what occurs outside of hospitals, particularly for those most vulnerable populations, which include people from high-stressed communities and communities that are traditionally under-resourced," Hicks said.

UMES' pass-rate record is among the nation's best, a fact not lost on Dr. LeRoi Hicks, the commencement speaker, who said he was impressed by graduates' performance he discovered while doing homework on the program.

LeRoi S. Hicks, M.D, MPH, FACP of ChristianaCare has been appointed Hugh R. Sharp Jr. Chair of Medicine and physician leader of ChristianaCare’s Acute Medicine service line.

LeRoi Hicks, now vice chair of the department of medicine at ChristianaCare Health System in Delaware and author of the Harvard study, said the main problem is systemic.

Leroi Hicks, now vice chair of the department of medicine at ChristianaCare Health System in Delaware and author of the Harvard study, said the main problem is systemic.