Reform, training needed to increase race parity in health care workforce
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Race parity in the science and health care workforce remains a challenge, but opportunities for reform exist at the trainee, faculty and leadership level, according to a speaker at the virtual American Heart Association Scientific Sessions.
Steps to increase diversity and inclusion in academic and clinical medicine are not only the right thing to do; they are also the smart thing to do, Lisa A. Cooper, MD, MPH, the James F. Fries Professor of Medicine at Johns Hopkins Schools of Medicine and director of the Johns Hopkins Center for Health Equity, said during a presentation. Data show racial and ethnic concordance is associated with important outcomes, including improved academic and workforce environments, increased access to care and reductions in health care disparities. Patients and physicians, too, report better communication and higher satisfaction with care, as well as better adherence to therapies, when there is increased diversity among staff and leadership, Cooper said.
“There is no question that there is an excellence imperative, yet due to structural racism, we are far from where we need to be to meet this imperative,” Cooper said.
The AHA, on Nov. 12, issued a call to action with steps to be taken to address structural racism as a driver of health disparities. The presidential advisory statement outlines existing barriers to equitable care for traditionally underrepresented groups in the U.S. and its current activity to address them and proposed a five faceted strategy for eliminating systemic racism in the future. (Read Healio’s coverage here.)
Underrepresentation in medicine
According to 2018 data from the Association of American Medical Colleges, Black adults make up 13% of the U.S. population, yet represent only 6% of medical school matriculates and graduates and 4% of physicians and medical school faculty, Cooper said. Similarly, Asian and white men make up approximately 35% of undergraduate medical degrees and 43% of biomedical doctorates, yet 83% of full professorships in academic medicine.
“In contrast, there is a striking loss of scientists from underrepresented backgrounds as we move across the career spectrum,” Cooper said.
Diversity among hospital leadership is also lacking and, in some cases, worsening, Cooper said.
“Although minorities make up about 32% of patients in the health care system that were part of [an] American Hospital Association survey, [minorities] only held 11% of executive leadership positions in these hospitals in 2015,” Cooper said. “Minority representation in every C-suite position has either decreased or remained flat, except for chief diversity officer positions.”
Leadership in academic medicine reflects these same low proportions, Cooper said. At the root of such disparities are individual and structural racism; institutions must practice more transparent and diversity-sensitive recruitment, promotion and networking policies, as well as stronger mentoring, she said.
“People know that this is going on, and this has an impact on the mental and social wellbeing of our faculty,” Cooper said.
Addressing patient, workplace bias
In a small, single-center study surveying a sample of 50 faculty members and medical students who identified as women, underrepresented minorities or gender nonconforming, respondents reported that biased behavior from patients ranged from patient refusal of care to making explicit sexist, racist or homophobic remarks or jokes, Cooper said. Targeted persons reported exhaustion, self-doubt and cynicism; bystanders also reported distress about uncertainty in how to respond.
“The participants recommended that they need more training in how to address these issues and more institutional policies to address these biased behaviors in health care settings,” Cooper said.
Black leaders at academic medical centers have similarly reported isolation, disrespect, and overt and covert biases, as well as a devaluing of research regarding community health and health care disparities, Cooper. Leaders from underrepresented groups have also cited the “added responsibility of leading diversity efforts, for which they receive little or no credit toward advancement.”
“Some fear that articulating their concerns will limit their advancement, or even lead to termination,” Cooper said. “We can see that, at all levels, the climate for diversity is impacting physicians of color.”
‘Attitudes play a role’
In a survey of cardiology fellowship training program directors that assessed perceptions on diversity published in the Journal of the American Heart Association earlier this year, one-third of program directors responded that they were “uncertain” if diversity improves health care quality. Two-thirds responded that diversity efforts did not need improvement in their program and only 6% of respondents rated diversity as a “top 3” priority when listing what they felt was most important, Cooper said.
“We really have to work at the level of individual leaders as well as on institutional policies and procedures,” Cooper said. “Attitudes play a role.”
Promising programs and strategies exist, Cooper said. At the leadership level, diversity and inclusion efforts must be integrated into broader efforts by establishing goals and metrics and holding leaders accountable. All search committees should undergo implicit bias training and focus on intervention, not just bias recognition. In training, offer leadership internships that target underrepresented groups, and leverage existing resources and networks to develop a more robust database of leadership diversity, Cooper said.
“Although many challenges remain regarding achieving racial parity in the science and health care workforce, several opportunities exist to address these challenges,” Cooper said. “Diversity, inequity, equity and belonging are everyone’s responsibility, not only persons from underrepresented groups.”
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Cooper LA. Structural racism as a public health crisis. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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