Cynthia Boyd, MD, MBA

“Any economist will tell you that diversification is the key to a secure portfolio. Any geneticist will tell you that diversification is key to maintaining hardy species of plants and animals. But somehow, when it comes to racial politics, the virtues of diversity are lost. Diversity in healthcare is not about fair representation – it is about saving lives.”

– Commissioner George Strait, Associate Vice Chancellor for Public Affairs,

University of California, Berkeley

A more diverse physician workforce is critical in health care and medical education in order to further promote excellence in medical education and accessible, quality health care, particularly to those populations that are underserved and bear the greater burden of health disparities.

For purposes of this discussion the Association of American Medical Colleges (AAMC) and Sullivan Commission definition is used of racial and ethnic diversity in the health care workforce.  This encompasses several characteristics including: (1) the representation of all racial and ethnic groups from the community served within a given health care agency, institution, or system; (2) the system-wide incorporation of diverse skills, talents, and ideas from those racial and ethnic groups; and (3) the sharing of professional-development opportunities and resources, as well as responsibilities and power among all racial and ethnic groups and at all levels of a given agency, institution, or system. [1]

While the basic concept of “diversity” among human beings encompasses numerous dimensions and characteristics such as socioeconomic status, gender, sexual orientation, race, ethnicity, religion, and disabilities, the specific focus of this discussion is to address the problematic state of racial and ethnic diversity in the physician workforce and to highlight practices at the medical school admissions level that could facilitate expansion of diversity within this workforce. Accordingly, diversity is defined here quantitatively as the numeric representation of all racial and ethnic populations.

The following is a quantitative summation of the state of diversity in today’s physician workforce with an overview of the current race and ethnicity demographic trends in medical education. Overall, numbers of racial and ethnic minorities among medical school applicants, matriculants, graduates, as well as full-time faculty, have remained relatively stable over the past five years.  The 2015 medical school acceptance rate is 41.1%. Acceptance rates differ among select racial and ethnic subgroups. White (44%), Asian (42%), and Hispanic or Latino (42%) applicants all have comparatively similar acceptance rates. African American or Black applicants have a lower acceptance rate of 34%.[2]

The figures below from the AAMC highlight both single year data from 2015 and longitudinal data over time to provide a more robust understanding of diversity and inclusion medical education trends.  While Whites are 47.8% of applicants, the percentage of accepted White applicants is 51.2%. This reflects, in Figure 1, a 44% acceptance rate for White applicants. Asians are 19.6% and Hispanics or Latinos are 6.3% of accepted medical students. Asian and Hispanic or Latino applicants both have a 42% acceptance rate. Blacks or African Americans make up 6.4% of accepted applicants, a decline from 7.8% of all applicants. The Black or African American acceptance rate of 34% is lower than White, Asian, and Hispanic or Latino acceptance rates.[3]

boyd_figure 1

                                                    Figure 1: AAMC 2016

The medical school acceptance rate is a pivotal data point for applicants, undergraduate advisors, medical school admissions committees, and medical education policymakers.  Percentages of medical school graduates by race and ethnicity have remained consistent over time. Whites (58.8%) and Asians (19.8%) continue to represent the largest proportion of medical school graduates, with the two groups composing more than three-quarters of medical students graduating in 2015. Also for 2015, Whites make up 47.8% of applicants and 51.2% of matriculants and remain the majority of graduates. As noted in Figure 2 below, the 2015 medical school graduates comprise 5.7% Black or African Americans and 4.6% Hispanic or Latinos. [4]

boyd_figure 2

Figure 2: AAMC 2016

Medical school applicants, students, and graduates are not the only stakeholder groups for which medical education leaders wish to increase diversity, inclusion, and equity. The medical education professoriate must also strive to become more diverse. An increase in female medical school graduates has been met with a rising number of full-time female medical school faculty.

                

boyd_figure 3Figure 3: AAMC 2016

Currently, 39% of full-time faculties are female; however, as noted in Figure 3, female faculty from some racial and ethnic minority groups continue to be underrepresented in academic medicine. Only 4% of full-time faculty identify as Black or African American, Latino or Hispanic, Native American or Alaska Native, or Native Hawaiian or Pacific Islander females.  This stark racial and ethnic disparity among full-time faculty is mirrored at the department chair level, with women of color representing only 3% of department chairs in academic medicine.[5]

It is clear from these very disparate data that the leadership of our academic institutions have a responsibility and must be held accountable as key stakeholders in improving the diversity of the physician workforce.  The admissions process and Admissions Committees at our medical schools represent the gateway to medicine.  It is the initial and most critical step in determining who will have the opportunity to become a future physician and who will not.  Admissions committees play a very important and significant role in identifying and developing meaningful policies, procedures, and strategies for increasing the racial and ethnic diversity in the student body.

Here are some of the key elements and components that medical school admissions committees should employ and utilize as a foundation in order to enroll a more diverse student body:

  • The medical school’s leadership and other key stakeholders are vital in connection with efforts to achieve diversity goals
  • Making certain that enrolling and training a diverse class of medical students is central to one’s medical school’s educational missions
  • Developing policy statements that articulate the benefits associated with a diverse student body, including with respect to race and ethnicity
  • An admissions committee mission statement that is aligned with that of the medical school;
  • A diversity statement that defines the diversity and inclusion goals of the committee
    • A committee membership that broadly represents the diverse interests of the medical school, including representation of basic scientists and clinical faculty members, men and women, and based on institutional policies other persons, including students, residents and community members at large.
    • And, since a diverse student body makes up a core value in medical education, the admissions committee should also include groups underrepresented in medicine
  • Policies and procedures that support the diversity goals of the medical school, including holistic review
  • Ongoing review of data related to the students who are enrolled (or not) at the medical school

It takes time and patience to implement many of these changes.  The holistic review in admissions process requires ongoing education and training.   As noted in the AAMC’s Roadmap to Diversity, “effective development of and implementation of diversity-related policies depend in part on a clear articulation of policies designed to advance those goals and a process of continual examination regarding the educational goals medical schools seek and the ways in which race or ethnicity policies advance these goals.”[6]  In my work as dean for admissions and recruitment I am fortunate to assist in the enrollment of some incredible students who are committed to addressing and improving health disparities and making a difference in the lives of  individuals who are underserved in our local communities and our nation.  I continue to strive to do everything I can possibly do to contribute and to make certain that the gate is open as widely as possible when they are ready to take that next crucial step towards a career in medicine.

Dr. Cynthia Boyd is vice president for corporate compliance and chief compliance officer at Rush University Medical Center. She is associate professor of medicine on the faculty at Rush Medical College of Rush University and currently serves as the dean for admissions and recruitment for Rush Medical College.

 


[1] Missing Persons: Minorities in the Health Professions – A Report of the Sullivan Commission on Diversity in the Healthcare Workforce 2004 and AAMC Underrepresented Definition: https://www.aamc.org/initiatives/urm/

[2] Diversity in medical education: facts and figures2016.  Washington, DC: AAMC;2011,2015 http://www.aamcdiversityfactsandfigures2016.org/report-section/section-3/

[3] ibid

[4] ibid

[5] Lautenberger D, Moses A, Castillo-Page LC. An overview of women full-time medical school faculty of color.

AAMC Analysis in Brief. 2016;16(4):1-2.

[6] Roadmap to Diversity: Key Legal and Educational Policy Foundations for Medical School, AAMC 2008

Subscribe to our newsletter




Leave a Reply