Although the United States is becoming increasingly racially and ethnically diverse, this trend doesn’t extend to its health care workforce. As of 2019, Black, Latinx, and Indigenous Americans are particularly underrepresented in nursing and physician professions.
Evidence shows having a workforce that reflects the diversity of the communities they serve improves access to health care, builds stronger physician-patient relationships, and provides culturally relevant care. This suggests creating a more representative health care workforce can improve access to and use of health care services for these communities, which is acutely critical now, as these same groups are experiencing disproportionate adverse health care outcomes during the COVID-19 pandemic.
Over the past few decades, federal and state policymakers, along with national professional associations, have made efforts to increase the number of Black and Latinx nurses and doctors through loan repayment programs and medical school accreditation standards (PDF) that call for broadening student diversity. But so far, they have not yielded significant increases in the number of diverse staff in the health care workforce.
To investigate what strategies could help improve diversity in health care professions, the Urban Institute conducted a study examining pathway programs (also known as pipeline programs) designed to provide academic, financial, and social supports to encourage more students of color to enter nursing and medical schools and remain in these professions. As part of this study, we conducted focus groups with Black and Latinx health care students and professionals to learn about their experiences with pathway programs and perspectives on how to improve them.
Our conversations underscored the importance of having a supportive institutional culture to underpin programs. Increasing diversity isn’t enough; institutions must have policies and practices in place that support equity and inclusion for students and staffers.
Nursing and medical school students and staff of color experience hostility and discrimination
Overall, focus group participants pointed to a need for nursing and medical schools to create a more supportive and inclusive environment for students and staff of color.
Several students reported feeling like schools enroll them just to fulfil a diversity quota while providing no supports after they enroll. Students shared painful experiences that made them feel unsupported and unwelcomed, including encounters of hostility, discriminatory statements from faculty and peers, and discouragement from pursuing their desired career tracks.
The experiences of discrimination and microaggressions from their instructors, supervisors, and peers extended from school into students’ training and workplaces. In particular, focus group participants highlighted toxic training and workplace environments that hurt trainees, nurses, and doctors and fueled a culture of distrust and bullying. Some interviewees even cited these experiences as a factor in their decision to leave the health care profession altogether.
Both nursing and medical students reported the need for more social and emotional support in schools and workplaces—particularly from mentors and teachers of color—to help them navigate classes, workplace culture, and career paths.
Strategies to support health care students and professionals of color
These findings highlight the need for academic and health care institutions not only to focus on increasing student enrollment and hiring faculty and staff from underrepresented racial and ethnic groups, but also to create learning and workplace environments where all students, faculty, and staff feel welcome, valued, and respected. In other words, diversity isn’t enough—it must be coupled with policies that advance equity and inclusion.
Medical and nursing schools and health care institutions can take a few concrete first steps to transform culture:
- Investing in strategies to increase retention. Supports such as diverse faculty mentorship, affinity groups, and workshops on navigating school and career paths were all flagged as essential programs for the retention of diverse students and trainees.
- Aligning their missions, practices, and policies with diversity, equity, and inclusion principles. These efforts could include medical institutions addressing the structural barriers that students of color face in medical training and professional development and advancement for faculty and staff of color.
- Creating accountability for addressing structural barriers for students of color. One example of this work is the Racial Equity Task Force created by the Vanderbilt University Medical Center, which developed an actionable plan for addressing racial bias in their medical education. Other accountability efforts include codifying policies that encourage leadership, faculty, and staff to uphold DEI principles (PDF).
As academic and health care institutions begin or continue the work of increasing diversity of the US health care workforce, administrators should keep equity and inclusion at the center of such efforts. Doing so is essential to ensure that everyone in the United States has access to quality and culturally relevant health care.
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The Urban Institute podcast, Evidence in Action, inspires changemakers to lead with evidence and act with equity. Co-hosted by Urban President Sarah Rosen Wartell and Executive Vice President Kimberlyn Leary, every episode features in-depth discussions with experts and leaders on topics ranging from how to advance equity, to designing innovative solutions that achieve community impact, to what it means to practice evidence-based leadership.