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Taking Stock of Diversity and Inclusion in the Health Care Workforce

Key findings

  • To improve the quality of care, the health care workforce should mirror the communities it serves with regard to race/ethnicity, gender, sexual orientation, immigration status, physical ability and socioeconomic status
  • Some medical schools, residency programs and nursing programs are making progress toward racial/ethnic diversity, but much more needs to be done, and all marginalized groups need better representation in faculty and leadership positions
  • It is insufficient for organizations to assign one person to oversee diversity efforts; the organization must regard diversity as central to its mission and consistently ask underrepresented groups their perception of its progress toward that goal

The terms "diversity" and "inclusion" have only recently entered discussions within the health care industry. But it is critical that individuals from across the spectrum of health care not only recognize these words and understand the difference between them, but also address them. To improve the quality of care and reduce health disparities, the health care workforce should mirror the communities it serves with regard to race/ethnicity, gender, sexual orientation, immigration status, physical ability and socioeconomic status.

In the Journal of the National Medical AssociationFatima Cody Stanford, MD, MPH, MPA, an obesity medicine physician-scientist at the Massachusetts General Hospital Weight Center, gives examples of nascent efforts toward improving diversity and inclusion in the health care workforce and proposes strategies to achieve genuine success.

Sample Efforts

Dr. Stanford and her colleagues examined efforts by medical organizations such as the Liaison Committee on Medical Education (LCME) and the Institute of Medicine (IOM) to identify opportunities to improve diversity and inclusion in medicine as a whole. Efforts they studied included, but are not limited to, the following cohorts:

Medical Students

In 2009, the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA) mandated that allopathic medical schools engage in systematic efforts to attract and retain students from diverse backgrounds. The numbers of female, Black and Latinx matriculants at U.S. medical schools did increase. Still, in 2017, only 7% were Black, compared with 14% of the population, and only 9% were Latinx, compared with 17% of the population (published in JAMA).

Residents

In 2016, the Accreditation Council for Graduate Medical Education (ACGME) conducted a nationwide survey of internal medicine residency program directors (published in the American Journal of Medicine). According to 70% of respondents, more than 10% of patients cared for by residents had limited English proficiency. Yet 19% of these programs provided no education on caring for such patients. In addition, 30% of respondents said their faculty could not adequately evaluate residents on practicing culturally competent care.

Nurses

In 2010, the National Academy of Medicine (then named the Institute of Medicine) called for more racial/ethnic and gender diversity among nurses. A 2015 study determined the number of nurses from racial/ethnic minority groups had increased to about 20%, but that is still far short of the 37% of the U.S. population considered racial/ethnic minorities at that time (published in the American Journal of Nursing).

Tangible Strategies

There are several strategies health care organizations can use to embody the communities they serve and ensure true diversity and inclusion:

  • Make diversity and inclusion integral to the mission and outputs within the organization
  • Ensure that all stakeholders, especially people from underrepresented groups, are included in discussions about enacting and maintaining diversity and inclusion efforts
  • Share successes and failures with similar organizations; this discourse will allow the organization to reflect on strengths and weaknesses in previous diversity and inclusion strategies
  • Start young—engage with local communities and schools to ensure that people from underrepresented groups get early exposure to fields in medicine

It is insufficient for organizations to assign one person to oversee diversity efforts. The organization as a whole must value diversity and inclusion as central to its mission and consistently ask diverse groups their perception of its progress toward that goal.

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