Diversity in MedicineThe Leadership Imperative

Karen E. Heiser, Ph.D. :: Nationwide Children’s Hospital, Columbus, Ohio

When I Look at You, What Do I See?

Physician Workforce, 2000

Source: AMA (2002)

U. S. Population, 2000

Source: U.S. Census Bureau

NCH Staff Diversity

Gray means in 2006, 2007 Asian included Hawaiian or Pacific Islander. Two or more races was not tracked.

13.27,20616.36,79314.66,55614.85,822Totals

29.04456.025Two or More Races

0301Pacific Islander

29.64727.16163.23566.73

Not

Coded/Reported

01634.5136.91623.113Native American

16.525623.221625.019724.1187Asian

15.314220.412014.210520.578Hispanic or Latino

14.995721.691218.688217.9762African American

12.55,74114.85,44513.55,32113.84,779White

Turn. %

Incumbent

sTurn. %

Incumbent

s

Turn.

%

Incumbent

sTurn. %

Incumbent

s

2009200820072006

Conversational Definitions •Diversity–numbersofunderrepresentedgroups Underrepresented(inmedicine)Minority(URM)-Non-HispanicBlack, MainlandPuertoRican,MexicanAmerican,andNativeAmerican

•Inclusion–havingaculturethatengagestheheartsandmindsofdiversegroups

Diversityisthemix,andinclusivenessismakingthemixworkwell together.Leadersassumeaccountabilityforboth.

Diversity Increases Education Quality

639 Students @ Harvard & UCSF

Alternativeviewpointsdiscussed(87%)Greaterintellectualengagement(45%)

Greaterunderstandingofmedicalconditions&treatments(77%)

AcademicMedicine,2003;78:460-466

Medicine is Not Unique

Health Professions Profile (2001)

1.23.29.333.952.0Nsg aides &

orderlies

1.07.66.719.465.0Lab Techs

0.314.23.46.276.0Pharma-

cists

4.05.73.09.282.0Nurses

0.17.13.85.573.0Physicians

Native

American

Asian-

American

LatinoAfrican-

American

White

Is Academic Medicine Better?

• URM physicians entering academic medicine

– 10.7% in 1981 v. 6.6% in 1993

• Medicine similar to higher education in general

– 3% faculty in top 25 universities African Americans

• Full Professors (2002 AAMC Data)

– <10% URM v. 30% non-minority faculty full professors

– Disparities remain even when controlled for degrees,

types of medical school, & receipt of NIH awards

It Makes a Difference for Our

Patients

Diversity in Medical Education: Facts & Figures 2008

In 2007, 50% of American Indian and Alaska Native and 45.3% of Black or African American graduatesplanned to practice in an underserved area (see Figure 30).

Association of American Medical Colleges

31.6%

50%

45.3%

15.3%

19.1%

21.2%

21.8%

7.1%

10.4%

36.2%

36.5%

33.4%

46.6%

42.9%

44.3%

48.5%

44.4%

45.4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Hispanic or Latino

American Indian and AlaskaNative

Black or African American

Asian

White

All Graduates

race&ethnicity

percentage of graduates

Yes No Undecided

Figure 30: Percentage of Medical School Graduates Planning to Practice in anUnderserved Area by Race and Ethnicity, 2007

52

Source: AAMC Data Warehouse, 2007 Medical School Graduation Questionnaire.

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AAMC Diversity in Medical Education 2008 Facts & Figures

From 2006 to 2007, the percentage of Black or African American and Hispanic or Latino applicantsincreased by 6.6% and 7.7%, respectively. Conversely, the percentage of American Indian and AlaskaNative applicants declined by 12.6% during the same period (see Figure 5).

Diversity in Medical Education: Facts & Figures 2008

Association of American Medical Colleges

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

year

numberofapplicants

White

Asian

Black or African American

Hispanic or Latino*

American Indian and Alaska Native

1977:White (32,210)

2007:White

(23,326)

1977:Asian (966)Black or African American (2,361)Hispanic or Latino (955)American Indian and Alaska Native (124)

2007:Asian (8,115)

Black or African American (3,035)Hispanic or Latino (3,041)

American Indian and Alaska Native (140)

Figure 5: Number of U.S. Medical School Applicantsby Race and Ethnicity, 1977-2007

21

Note: White, Asian, Black, and Native American, are Non-Hispanic. Since 2002, individuals have the option of reporting both their race and ethnicity alone or in combination with some other race orethnicity. In this figure numbers are reported for race alone.*From 1974-2001, includes Mexican American, Puerto Rican, and Other Hispanic. Since 2002, includes Cuban, Mexican American, Puerto Rican, Other Hispanic, and Multiple Hispanic.Source: AAMC Data Warehouse: Applicant Matriculant File, as of 12/11/2007.

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Diversity in Medical Education: Facts & Figures 2008

Medical School Accepted ApplicantsOf the 42,315 applicants to medical school in 2007, 18,858 were accepted (44.6%). Approximately 45% ofHispanics or Latinos and 43.7% of American Indians and Alaska Natives were accepted to medical schoolin 2007; however, 26.4% (29 of 110) of Native Hawaiians and Other Pacific Islanders and 37.9% (1,188 of3,133) of Black or African American applicants were accepted during the same year (see Figure 10).

Association of American Medical Colleges

44.6%

22.4%

56.7%

46.9%

46.8%

44.6%

37.9%

26.4%

43.7%

44.8%

47.1%

24.6%

60.1%

51.5%

49.3%

45.4%

41.7%

30.1%

47.6%

48.1%

0% 10% 20% 30% 40% 50% 60% 70%

All Applicants

Non-U.S. or PermanentResident (Foreign)

Other/Unknown

Multiple Race

White

Asian

Black or African American

Native Hawaiian and OtherPacific Islander

American Indian and AlaskaNative

Hispanic or Latino*

race&ethnicity

percentage of accepted applicantsYear 2006Year 2007

Figure 10: Pecentage of Accepted U.S. Medical School Applicants by Raceand Ethnicity, 2006-2007

26

Note: Categories are Non-Hispanic, with the exception of Hispanics and foreign/unknown citizenship. Since 2002, individuals have the option of reporting both their race and ethnicityalone or in combination with some other race or ethnicity. In this figure numbers are reported for race alone; those that reported more than one race are included under Multiple Race.* Includes Cuban, Mexican American, Puerto Rican, Other Hispanic, and Multiple Hispanic.Source: AAMC Data Warehouse: Applicant Matriculant File, as of 1/7/2008.

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In 2007, Black or African American (37.1%) and Native Hawaiian and Other Pacific Islander (39.3%) menaccounted for the lowest percentages of medical school matriculants within racial and ethnic minoritygroups (see Figure 13).

Diversity in Medical Education: Facts & Figures 2008

Association of American Medical Colleges

51.5%

51.0%

50.8%

45.9%

60.7%

49.8%

62.9%

49.6%

45.9%

48.5%

49.0%

49.2%

54.1%

39.3%

50.2%

37.1%

50.4%

54.1%

0% 20% 40% 60% 80% 100%

Non-U.S. or Permanent Resident(Foreign) (n = 326)

Other/Unknown (n = 312)

Multiple Race (n = 449)

American Indian and AlaskaNative (n = 61)

Native Hawaiian and OtherPacific Islander (n = 28)

Hispanic or Latino* (n = 1,277)

Black or African American (n =1,139)

Asian (n = 3,535)

White (n = 10,632)

race&ethnicity

percentage of matriculants

WomenMen

Figure 13: Percentage of U.S. Medical School Matriculantsby Gender and Race and Ethnicity, 2007

29

Note: Categories are Non-Hispanic, with the exception of Hispanics and foreign/unknown citizenship. Since 2002, individuals have the option of reporting boththeir race and ethnicity alone or in combination with some other race or ethnicity. In this figure numbers are reported for race alone; those that reported morethan one race are included under Multiple Race.*Includes Cuban, Mexican American, Puerto Rican, Other Hispanic, and Multiple Hispanic.Source: AAMC Data Warehouse: Applicant Matriculant File, as of 1/8/2008.

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In 2007, Black or African American, Hispanic or Latino, American Indian and Alaska Native, and NativeHawaiian and Other Pacific Islander graduates combined were 14.8% of all medical school graduates.Whites and Asians held the highest percentages at 67.2% and 21%, respectively (see Figure 15).

Diversity in Medical Education: Facts & Figures 2008

Association of American Medical Colleges

0

2,000

4,000

6,000

8,000

10,000

12,000

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

graduation year

numberofgraduates

WhiteAsianBlack or African AmericanHispanic or Latino*American Indian and Alaska NativeNative Hawaiian and Other Pacific Islander**

2007:White (10,848)

2007:Asian (3,344)

Black or African American (1,120)Hispanic or Latino (1,115)

American Indian and Alaska Native (130)Native Hawaiian and Other Pacific Islander (35)

1995:White (11,052)

1995:Asian (2,543)Black or African American (903)Hispanic or Latino (879)American Indian and Alaska Native (61)Native Hawaiian and Other Pacific Islander (1)

Figure 15: Number of U.S. Medical School Graduatesby Race and Ethnicity, 1995-2007

31

*Hispanic or Latino includes Mexican American, Puerto Rican, and Other Hispanic or Latino.**Prior to 1995 data is not available for Native Hawaiian and Other Pacific Islander.Source: AAMC Data Warehouse: Student_IND, as of 1/08/2008.

373820TEXT:373820TEXT 10/10/08 12:25 AM Page 31 Fewer DiverseFaculty

Fewer DiverseProfessors

In 2007, while White faculty represented the highest proportion of medical school full professors (nearly30%), faculty from racial and ethnic minority groups were concentrated at the assistant professor rank(See Figure 19).

Diversity in Medical Education: Facts & Figures 2008

Association of American Medical Colleges

3.0%

6.1%

13.7%

2.3%

2.3%

4.3%

2.3%

13.1%

18.9%

16.5%

11.7%

15.1%

13.9%

9.8%

56.4%

50.4%

54.4%

51.0%

55.0%

51.7%

35.8%

15.4%

13.7%

8.8%

18.5%

17.6%

17.0%

23.1%

12.1%

10.9%

6.6%

16.5%

10.0%

13.1%

29.0%

0% 10% 20% 30% 40% 50% 60%

Multiple Race (3,012)

Other/Unknown (9,726)

American Indian and AlaskaNative**(351)

Hispanic or Latino* (5,269)

Black or African American(3,768)

Asian (16,426)

White (86,022)

race&ethnicity

percentage of facultyProfessorAssociate ProfessorAssistant ProfessorInstructorOther

Figure 19: Percentage of U.S. Medical School Facultyby Rank and Race and Ethnicity, 2007

35

Note: The race and ethnicity categories in this figure reflect how the data were collected since 2002. Individuals have the option of reporting both their race and ethnicity alone or in combinationwith some other race or ethnicity. In this figure numbers are reported for race alone; those that reported more than one race and ethnicity are included under Multiple Race.*Includes Mexican American, Puerto Rican, Cuban, Other Hispanic, and Multiple Hispanic.**Includes American Indian and Alaska Native, and Native Hawaiian and Other Pacific Islander.Source: AAMC Faculty Roster, as of 3/6/2008.

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Diversity in Medical Education: Facts & Figures 2008

Medical School FacultyAs of 2007, there were 124,777 medical school faculty members. The percentages of Hispanic or Latino,Black or African American, American Indian and Alaska Native, and Native Hawaiian and Other PacificIslander medical school faculty totaled 7.5% (See Figure 18).

Association of American Medical Colleges

Other/Unknown 7.9% (9,872)

Multiple Race 2.4% (3,012)

Black or African American3.0% (3,773) American Indian and Alaska

Native 0.1% (134)

Native Hawaiian and OtherPacific Islander 0.2% (217)

White 69.0% (86,039)

Asian 13.2% (16,458)

Hispanic or Latino* 4.2%(5,272)

Figure 18: Percentage and Number of U.S. Medical School Facultyby Race and Ethnicity, 2007

34

Note: The race and ethnicity categories in this figure reflects how the data has been collected since 2002. Individuals have the option of reporting both their race and ethnicity alone or incombination with some other race or ethnicity. In this figure numbers are reported for race alone; those that reported more than one race and ethnicity are included under Multiple Race.*Includes Mexican American, Puerto Rican, Cuban, Other Hispanic or Latino, and Multiple Hispanic.Source: AAMC Faculty Roster, as of 3/3/2008.

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“ To create one’s own world takes courage ” – Georgia O’Keefe