4 of the Biggest Issues Limiting Diversity and Inclusion in Healthcare

As the ongoing pandemic and recent increased interest in social justice and reform have proven, men and women of color continue to be underserved by the healthcare system, receiving lower quality preventative care and incurring higher levels of illness and disease as a result.

While our healthcare system itself has numerous flaws relating to diversity, representation and inclusion, so too does the workforce that powers healthcare today. Despite some recent advances, doctors, nurses, academicians and researchers in the American healthcare system are still overwhelmingly made up of straight white men.

Data from the University of St. Augustine for Health Sciences reveals that 64% of American physicians today are male, and 56% are white.

The report shows that only 5% of physicians are Black or African American despite making up 13% of the population in the U.S. and “fewer than 6% of physicians identify as Hispanic, despite Hispanics making up about 19% of the U.S. population.”

While discrimination, limited job offers and uneven promotion opportunities continue to be among the factors holding back DEI efforts in healthcare, four studies published within the first months of 2022 also shed new light on some of the other leading factors behind these lagging advances.

Problem 1: Lack of Diversity in Healthcare Academics

While the number of women represented in healthcare education has increased significantly over the past few years, the presence of Black men in the field has decreased dramatically. That’s the takeaway message from a recent study published in the New England Journal of Medicine.

But even with those advances, we are nowhere near representative parity, says Sophia Kamran, a professor of medicine at Harvard Medical School. To conduct her study, Kamran analyzed the gender, race and ethnicity of faculty at the nation’s leading medical schools between 1977 to 2019. Over that 42-year period, she found that female representation did increase dramatically, jumping from 14.8% in 1977 to 43.3% in 2019.

However, while the representation of women did spike over that period, it was less pronounced for Black and Hispanic women. And for Black men in particular, representation over that period decreased.

In an interview with the Harvard Gazette, Kamran said the findings from her study show the continued need for medical schools and medical programs to increase efforts to recruit underrepresented populations into the field and to help those students develop not just into doctors and researchers but also academic leaders as well.

“This is an area in desperate need of study because we need to reverse these trends in order to address the lack of Black leadership at all levels of academic medicine,” Kamran said. “I didn’t have many mentors, teachers or role models in clinical medicine from a similar background as mine to help guide me. The U.S. population is going to continue getting more diverse as time goes on. We’re sounding the alarm because we are clearly falling behind.”

Problem 2: Limited Opportunities in Research Leadership

Just as Harvard’s Kamran found that white men still tend to hold a majority of academic teaching roles in healthcare academics, a study published in the Journal of Racial and Ethnic Health Disparities also recently revealed that many lead authors of medical studies published in two leading medical journals (the Journal of the American Medical Association and the New England Journal of Medicine) were white men. The study shows that less than 7% of the primary authors leading the research in these premier medical titles were Black and less than 4% were Hispanic.

The senior author roles for women of color were even more limited, with Black women authoring less than 3.6% of studies and Latina researchers heading less than 2.5% of studies. Representation for Indigenous populations was even lower, coming in at less than 1%.

While experts in DEI and healthcare have pointed out this perceived lack of representation for a number of years, this was the first study to provide concrete numbers for true representation amongst “senior” or primary authors on studies — the role normally filled by the person who serves as the figurehead for the research and who will benefit from it most in terms of publicity, academic tenure and leading industry job offers.

The study notes that the slow rate of change among primary authors on studies was more alarming than the low numbers.

Problem 3: The Overwhelming Cost of Healthcare Education

Regardless of race, most students enrolling in medical schools come from affluent backgrounds — an issue that severely limits socioeconomic diversity in the field. That’s the takeaway from a recent study published in the Journal of the American Medical Association Network Open.

In the study, data was analyzed from nearly 45,000 students who had recently enrolled in medical school. The research delves into the ethnicity of those candidates and the amount of money each student reported that their parents earned annually. The findings show that most of these students came from the nation’s top 5% of wealthiest families. More specifically, the study found that Black students were more than five times more likely to come from families making more than $270,000 per year, Latinx students were over six times more likely to come from parents with this level of wealth, and even white students were over four times more likely to have financially well-off parents.

While this may not be surprising considering that the Association of American Medical Colleges has estimated that four years of medical school can cost between $250,000 and $330,000, these types of wealth disparities can impact not just where these doctors choose to practice and what they choose to specialize in, but also the very way in which they interact and relate to their patients.

To overcome the issue, medical schools need to continue outreach to lower-income communities of color to bring them into the field while also offering more scholarship programs to offset their ever-growing costs.

Problem 4: Imbalances in Clinical Trials

Although not directly related to the gender, race or ethnicity of medical providers, the clinical trials that are used to help observe risk factors for illness and are essential in the development of everything from pharmaceuticals to vaccines have also long been a sore spot when it comes to diversity and representation. Despite ongoing efforts at inclusion, people of color and ethnic populations are still often woefully represented in these efforts, despite having a disproportionate risk for certain ailments. This absence reduces the amount of data available on whatever is being studied and can limit physicians’ knowledge of how to best treat different populations.

But there does appear to be some good news on the way. Pointing to the seriousness of the diversity disparities that exist in some clinical trials, the Food and Drug Administration (FDA) recently issued new guidelines including increased public outreach campaigns, educational materials, plus new collaborations and partnerships all designed to help enroll diverse populations within future studies. This could increase clinical trial diversity and broaden the type and amount of information healthcare providers will have for treating diverse populations.

“The U.S. population has become increasingly diverse, and ensuring meaningful representation of racial and ethnic minorities in clinical trials for regulated medical products is fundamental to public health,” said FDA Commissioner Robert M. Califf in a statement announcing the change in guidelines. “Going forward, achieving greater diversity will be a key focus throughout the FDA to facilitate the development of better treatments and better ways to fight diseases that often disproportionately impact diverse communities.”