Physician Diversity is Key to Health Equity

Promoting the importance of a diverse physician workforce can sometimes strike a nerve among those who believe the only important quality in a physician is their credential.

Certainly, the credential is important. But the data clearly demonstrate that health outcomes improve when race or ethnicity of the patient are the same as the physician.

A recent study randomly assigned 1,300 Black patients to Black or non-Black primary care physicians and found that patients cared for by Black doctors received 34% more preventative services1. Studies show that when physicians and patients share the same race or ethnicity it improves trust, time spent together, medication adherence, shared decision-making, wait times for treatment, patient perceptions of treatment decisions and reduces implicit bias 2.

Another study revealed that too many White doctors still believe Black people don’t feel pain in the same way as White people - and that it had an effect on care, with Black and Hispanic patients less likely to receive medication to ease acute pain. One study showed that for the same ailment, such as a broken bone, a Black patient is 41% less likely to receive pain medication and more likely to receive inferior treatment for the same injury3.

Black Americans make up 14% of the US population but only 4% of physicians are Black. Latinx and Hispanics make up about 19% of the US population and less than 6% of physicians are Latinx or Hispanic. 5.6% of adults identify as LGBTQ but there is little data on how many physicians identify as LGBTQ due to fears of homophobic reactions, discrimination, and increased risk of violence. The lack of diversity in our physician workforce makes it difficult for patients to find a doctor who shares their race or ethnicity, and the numbers are so low, many physician groups struggle to introduce any diversity into their team.  

Why? Reasons include lack of opportunity, the high cost of medical education, implicit and explicit bias, lack of encouragement, lack of role models and mentors and college counselors who discourage Black and brown people from pursuing medical careers. There is also a critical lack of awareness and understanding of the importance and benefit of what is called patient provider concordance.  

Dr Nwando Anyaoku, a Black pediatrician says that from her 20 years of clinical experience she knows how difficult it is to build and sustain a diverse clinical team. She says that it starts in middle school where non-majority students are discouraged from STEM subjects and the obstacles continue from there. 

Dr. Anyaoku says many minority physicians struggle to be included and to feel they belong for their whole self in medical school and in their practice. Minority students have higher rates of leaving medical school and residency than White students. The trouble she says is that our system defaults to uniformity and conformity and if people don’t fit that model, they have a hard time being integrated into the team and it can feel like a bridge too far.  

There are things healthcare organizations can do now to build an increasingly diverse workforce to offer the best care for their communities:

• Create opportunities and activities to expose students to careers in medicine early. Connecting with potential physicians as early as possible can help reduce some of the barriers to becoming a physician. Encourage physicians to engage in their communities to guide, support, and mentor high school and undergraduate students interested in medicine.
• Increase opportunity for mentoring and sponsorship programs specifically targeted at minority physicians. Building effective mentoring programs drives inclusion and helps retain and grow minority physicians.  
• Make diversity an actionable value and priority. Increase the diversity of the c-suite and board to reflect the community served and the commitment of the organization. Create inclusion programs which support diversity as an asset that enriches the experience of all physicians and staff, not only those of color.  

Build an inclusive environment and reduce social isolation. Create a diversity committee; adopt a diversity action plan; conduct diversity, equity and inclusion training for physicians and leaders; evaluate leaders based on their effectiveness in achieving diversity-related objectives; and promote inclusive social gatherings and resource groups.

To improve the quality of healthcare we must decrease barriers to building a diverse provider workforce. Diversity leads to better care by ensuring all backgrounds, beliefs, ethnicities, and perspectives are represented and understood so that each patient can be met where they are at. That is health equity.