Diversity in medicine necessary to meet needs of patients, provide ‘culturally effective care’

Key takeaways:

• Underrepresented racial/ethnic groups and women struggle to advance in academic medicine.
• Health care workers should be aware of their own biases to reduce issues linked to underrepresentation.

HONOLULU — More women and underrepresented racial/ethnic groups have entered into medicine, but bias and discrimination still exist, which can lead to poorer care, according to a presentation at the CHEST Annual Meeting.

In her presentation, “Racial and Gender Bias in Health care Systems,” Brooke Gustafson, MD, assistant professor of pediatrics in the division of pulmonary medicine at Nationwide Children’s Hospital, discussed underrepresentation in medicine over the years, challenges both women and individuals from underrepresented races/ethnicities face, as well as ways to reduce underrepresentation.

Prevalence of underrepresentation

According to the Association of American Medical Colleges, underrepresented racial/ethnic groups in medicine relative to the numbers in the general population include African American/Black, Native Hawaiian/Pacific Islander, American Indian/Alaska Native and Hispanic individuals, Gustafson said.

In pediatric pulmonology, Gustafson highlighted that only 12% of individuals working in this division are from one of the above underrepresented groups.

Furthering this point, she referenced a cross sectional study by Emma A. Omoruyi, MD, MPH, and colleagues — which Healio previously reported on — that spanned from 2000 to 2020 and compared the percentage of underrepresented faculty to the U.S. population for racially/ethnically concordant children.

Over these 20 years, there was an increase in the representation of individuals from these underrepresented groups; however, researchers concluded that pediatric faculty diversity at medical schools still did not reflect the growing diversity of patients.

When looking at who holds positions of power, women tend to be held back more frequently from advancement compared with men. In the State of Women in Academic Medicine 2008 to 2009 report, more men vs. women moved up from a new assistant or associate professor position after 7 years.

Gustafson further noted that the number of women holding department chair positions has increased over the past 10 years, but less than 20% of all department chairs are occupied by women.

From 2008 to 2018, the percentage of full-time women faculty from underrepresented in medicine groups only increased from 12% to 13%. According to the report, most of these women are ranked as assistant professors, Gustafson said in her presentation.

For full-time women faculty, there have been slight increases from 2009 to 2018 in women holding instructor (53% to 58%), assistant professor (42% to 46%), associate professor (31% to 37%) and full professor (19% to 25%) positions, but this shows that more than half of women are only at an instructor rank.

Notably, 75% of the women at the full professor level are white, Gustafson said.

“We’re missing advancement in those who are underrepresented in medicine and are women in terms of career advancement to more leadership positions within faculty,” she said.

Challenges, impact of underrepresentation

As evident from the data outlined above, challenges still exist for both underrepresented groups and women in terms of growth despite progress that has been made in the percentage of these groups who enter medicine, Gustafson said.

In addition to racial and gender discrimination, there are several contributing factors to these challenges, including salary inequities, work-life imbalance, greater burnout rates, lack of mentorship, bias and less support for research.

“There’s less research support … particularly for women looking at data from 2020,” Gustafson said. “About one-third of NIH funding went to women scientists and physicians and the remaining two-thirds went to men.”

As these factors continued to exist over time, achieving growth within academic medicine and the health care system will only be more difficult for underrepresented groups and women in medicine.

Further, Gustafson said underrepresentation has three big impacts: marginalization of groups, a lack of culturally competent care and poorer patient outcomes.

“We know that for those who come from ethnic minority groups, those physicians are historically at least more likely to provide care to those living in underserved areas,” Gustafson said. “So, recruitment, retention and promotion of women physicians and physicians from one of those underrepresented in medicine groups can certainly better serve the diversity needs of the U.S. patient population, and better meet their needs moving forward.”

To demonstrate poorer patient outcomes, she discussed findings from a cross-sectional study conducted in one hospital by Yusuke Tsugawa, MD, MPH, PhD, and colleagues, in which patient mortality and readmission rates were reduced if they received care from a physician who was a woman vs. a man.

Mitigating these issues

When working in health care, it is critical to take a step back to see if you are biased toward certain patients. According to Gustafson, biases come through many forms, including stereotypes, unconscious prejudice, attitudes and preferences, which can then create disparities, inequities and a lack of diversity if perpetuated.

“[Implicit biases] can influence our actions or perceptions and, in medicine, they can certainly alter the way we as physicians or as health care providers treat patients if we act upon these biases or we don’t recognize them,” Gustafson said.

One helpful resource she mentioned to help those in medicine recognize and understand their own biases is the online implicit association test by Harvard.

Another way to mitigate issues of underrepresentation is through mentorship and education because these can help underrepresented groups and women move up the hierarchy within academic medicine.

Making sure that those working in health care are both men and women and represent many different races/ethnicities, ages, sexual orientations and religions is key to stronger and more impactful care, Gustafson added.

“Diversity of the health care workforce is critical for the provision of culturally effective care,” she said. “And with that we can improve health outcomes, we can increase access to care and then enhance the population of medically trained professionals, policymakers and leaders that can then affect the trajectory of medicine in the future.”

References:

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CHEST Annual Meeting