Despite extensive research documenting the potential of diversity, health equity, and inclusion initiatives to improve outcomes for the most vulnerable patients, attacks on these efforts in both private and public sector health care institutions are proliferating. Given demographic trends in the United States, diverse health care teams are a strategic necessity to bolster the experiences and outcomes of marginalized patients, foster inclusive research and innovation, and lower health care expenditures. To create diverse health care teams, physicians and allies must deepen their understanding of the complexities of structural racism and address the socially imposed forces that persist and result in the loss of underrepresented minorities on the path to health careers. Practicing physicians and other health care professionals can individually and collectively contribute to the development, recruitment, and retention of a more diverse and inclusive workforce to serve all patients. Strategies that physicians can use to achieve this goal include making diversity core to the practice’s mission, focusing on retention, connecting with local school districts and colleges, and striving for more equitable policies and procedures.
Case 3. CM is a 16-year-old person of color presenting to the emergency department with burns on her back. When she explains how it happened, you become concerned about possible abuse, as the explanation does not make sense. You refer the case to the social worker on call for investigation.
A Strategic Necessity
Diversity, health equity, and inclusion are umbrella terms for policies and programming aimed at increasing representation and full participation in and access to health care by marginalized groups. With 65 anti–diversity, equity, and inclusion bills introduced in 38 state legislatures in 2023 and 2024, it is evident that these issues have become politicized and weaponized and are often regarded as buzzwords, moral imperatives, or barren statistics.1–3 Nevertheless, projected demographic changes in the United States and the potential of diverse teams to increase efficiency and effectiveness make diversity initiatives a strategic necessity in health care.
According to the US Census Bureau, by 2050, the portion of the US population that is non-Hispanic White will be less than 50% for the first time. By 2060, it is projected that 2 out of 3 children in the United States will be a race other than non-Hispanic White.4 Racial and gender diversity are on the rise among physicians, but recent data indicate that those numbers are not representative of the communities they serve. According to an Association of American Medical Colleges report, in 2022, only 6.3% of active physicians identified as Hispanic, Latino, or of Spanish origin (alone or in combination); 5.2% as Black or African American; and less than 1.5% as multiracial (of those, 1.3% as non-Hispanic), other (1.1%), American Indian or Alaska Native (0.3%), or Native Hawaiian or Other Pacific Islander (0.1%).5
Although far from ideal, family medicine has the most racially proportionate distribution compared with the general population6 (Figure 17,8). Additionally, family medicine has the most residency programs (13%), second largest proportion of total residents (11.5%), and most diverse geographical reach and patient population. Therefore, family medicine is in a unique position to lead health care toward building a representative physician workforce committed to pursuing more equitable health outcomes for the most vulnerable patients.9
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