When the health care workforce represents the broader population, everyone benefits. But in the US, this is still a distant goal. Less than 12 percent of US physicians identify as Latinx or Black, even though these groups together make up more than 30 percent of the US population. American Indians, Alaska Natives, Native Hawaiians, and other Pacific Islanders are also underrepresented in medicine relative to their shares of the population.
And these trends aren’t improving. For more than 100 years, the share of physicians who are African American has been consistently lower than the African American share of the overall population. The number of Black women in medical schools has gradually, if unsteadily, increased in the last 40 years, but their representation is still substantially lower than their share of the total population. Meanwhile, the number of Black men enrolled in medical school decreased between 1978 and 2014, and in 2019, Black men represented just 2.9 percent of medical students.
Improving the diversity of the health care workforce is crucial to supporting the career interests of the increasingly diverse young adult population in the US, and growing evidence indicates that diversifying the health care workforce is crucial to improving access to and the quality of care in communities of color. African American and Latinx physicians are more likely to provide services in communities of color and to treat Medicaid-eligible and uninsured patients as well as those who have complex cases because of poverty and unmet social needs. Also, patients who are the same race or ethnicity as their providers report better outcomes and are more likely to be prescribed preventive care. And patients whose providers speak their own language are more likely to report receiving quality care and better communication.
Diversity—or the lack of it—among medical students and professionals affects not only how physicians deliver care and make clinical decisions but how faculty develop and deliver medical school curriculum and how medical research is conducted. So how can institutions ensure a more diverse health care workforce?
Pathway programs can play an important role
The underrepresentation of Latinx and African American physicians results from barriers and challenges that face aspiring physicians from systemically and structurally excluded groups. To examine these barriers and identify potential ways to overcome them, the Urban Institute conducted a national study of health care pathway programs, particularly those directed to Latinx and African American medical and nursing students.
Urban’s research found that pathway programs (also known as pipeline programs) that provide academic, financial, and social supports to underrepresented students are essential for achieving health care workforce diversity. This finding confirms a growing body of evidence (PDF) about the supports necessary for underrepresented students in medical and nursing settings.
Urban and others have found that constructive components of pathway programs include
- providing social supports—particularly mentorship by diverse faculty, professionals, and older students—to help students face educational demands, navigate professional development opportunities, and deal with microaggressions and implicit bias;
- exposing students to supportive networks (such as recent graduates) that can help them navigate challenges and raise their awareness of educational and career options that align with their interests;
- and showing sensitivity to the financial constraints that underrepresented students are more likely to experience and that may affect their ability to enroll and stay in medical school.
The Urban report also identified challenges to the effectiveness and reach of pathway programs, including insufficient and unstable funding, the looming prospect of anti–affirmative action policies, and a lack of institutional buy-in. The study also found that it is important for pathway programs to be part of a leadership-supported institutional commitment to developing more students and faculty from underrepresented groups, backed up by system-wide implementation (PDF) of policies and practices to eliminate racism and discrimination.
Workforce diversity is just part of the solution
It’s important to keep several cautions in mind regarding health care workforce diversity. First, we must guard against the notion that providers from underrepresented groups should be trained primarily to serve communities of color. Some students interviewed for the Urban study reported having been discouraged from pursuing certain specializations or advanced training opportunities by well-meaning mentors who wanted to steer them toward what they perceived to be easier pathways, reinforcing existing biases.
We should also guard against the idea that white practitioners cannot adequately serve patients of color. Such a simplistic assumption is likely to widen gaps in access to and quality of care given the disproportionately low representation of Latinx and African American health professionals. This is one of the reasons why embedding health equity in health care education is critical.
Finally, we must recognize that improving the diversity of the physician workforce is a necessary but insufficient step for achieving health equity, because so many factors (PDF)—including income and wealth and other social determinants of health, racism and discrimination, individual behavior, and biology—affect people’s health. In particular, understanding structural factors, such as the role that systemic racism plays in segregating society and limiting opportunities for health and well-being, is essential to advancing health equity.