‘Severe’ inequities persist among Asian American subgroups in health care workforce
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Key takeaways:
- Combining Asian American subgroups into one racialized group erased subgroup differences.
- Researchers noted diversity, equity and inclusion efforts in the health care workforce “rarely” address Asian Americans.
“Severe intragroup inequities” remain in health care workforce diversity among Asian American subgroups, according to study results.
The findings highlight the need for ongoing research examining “how historical and contemporary structural racism shape workforce representation for Asian American individuals and other ethnic groups,” researchers concluded.
‘Misperceptions’
“When leaders and policymakers discuss diversity, equity and inclusion in the health care workforce, they rarely address issues for Asian Americans,” Michelle J. Ko, MD, PhD, associate professor in the division of health policy and management at UC Davis Health School of Medicine, told Healio. “This leads to misperceptions of who is represented, in what profession, and why there may be differences. When we don’t have a fuller picture, we then run the risk of making incorrect assumptions, and designing policies and programs based on those assumptions. For example, conversations about affirmative action and discrimination with respect to Asian Americans is not well informed if we don’t know about the diversity among Asian Americans.”
Although Asian Americans comprise more than 40 ethnoracial subgroups, these individuals are commonly combined into one category when analyzing the health care workforce, according to study background.
For this reason, researchers conducted a serial cross-sectional study using American Community Survey data of population estimates of people reporting health profession occupations. They assessed the representation of Asian American subgroups in four major U.S. health care professions — physicians, registered nurses, nursing assistants and home health aides — between 2007 and 2022.
Workforce representation
In 2022, Asian Americans accounted for approximately 22% of the overall physician workforce, 10% of registered nurses, 8.3% of home health aides and 4.8% of nursing assistants.
Results showed that the largest subgroup of Asian American physicians as Indian Americans (mean percentage, 40.6%), followed by Chinese Americans (mean percentage, 18.9%). Researchers observed the highest relative representation among Pakistani (mean representation quotient [RQ], 8.9) and Indian Americans (mean RQ, 7.8), and the lowest relative representation among Cambodian and Hmong Americans (mean RQ, 0.2 for both).
Results also showed Filipino Americans as the Asian American subgroup with the highest relative representation among registered nurses (mean RQ, 5.6) and nursing assistants (mean RQ, 2.9).
Researchers found that Bangladeshi (mean RQ, 4.1) and Chinese American (mean RQ, 2.66) subgroups had highest relative representation among home health aides.
“The growing numbers of Chinese and Bangladeshi Americans in the home health workforce point to a potential source of major income gaps in our communities,” Ko said. “This really pushes back on the stereotype of Asian Americans as ‘successful,’ and also points to our ongoing need to raise wages for the direct care workforce.”
Future research
Based on these findings, Ko and colleagues are now exploring the role of historical factors in more detail — policy in particular — in shaping Asian American representation in the health care workforce.
“With respect to physicians, we have seen particular inequities in professional advancement for Asian American women, so it would be important to examine subgroup differences for gender as well,” she said. “Physicians should understand that the Asian American population is far more diverse than is represented in medicine, and we need to account for major differences across subgroups, particularly for Southeast Asian communities who are highly underrepresented and experience multiple health inequities.”
For more information:
Michelle J. Ko, MD, PhD, can be reached at mijko@ucdavis.edu.
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