January 02, 2019, 09:06 am Michael Devitt – The AAFP has long recognized the growing diversity of the U.S. population and, together with organizations such as the Association of American Medical Colleges, has for years highlighted the importance of ensuring the physician workforce more closely resembles the general population.
The goal of optimizing patient health has been a key driver of this effort. A working paper published by the National Bureau of Economic Research in 2018, for example, found that black male patients who were randomized to receive care from either a black or a non-black male physician were more likely to discuss personal health issues and more willing to receive the flu vaccine if they were seen by the black physician.
Other research has shown that physicians from racial and ethnic minorities are more likely than white physicians to offer primary care in economically disadvantaged areas and to practice in medically underserved areas.
Two articles in the November-December edition of the Journal of the American Board of Family Medicine (JABFM) examined the rate at which the specialty has diversified over the past three decades. The results indicate that the workforce has become more diverse over time, but that much work remains for the specialty to better reflect the makeup of the population at large.
In a policy brief titled "Board Certified Family Physician Workforce: Progress in Racial and Ethnic Diversity," researchers reviewed racial and ethnic data provided by family physicians who applied to take the ABFM's Family Medicine Certification examination between 2013 and 2017. Examinees were asked to select one race from the following options: American Indian or Alaska native, Asian, black or African American, Native Hawaiian or other Pacific Islander, and white. They also were asked to select an ethnicity from these options: non-Hispanic and Hispanic or Latino.
First, the researchers calculated the relative percentage of each category, crossing it with physicians' year of initial certification. They then compared those data with Census Bureau estimates of the U.S. population as of July 1, 2017. Altogether, they matched 66,542 family physicians who were initially certified between 1987 and 2017.
Results showed that ABFM diplomates who first certified in 2017 were more than three times as likely to be Asian and more than twice as likely to be native Hawaiian or other Pacific Islander compared with the general population. But they were only about half as likely to be black or African American, or Hispanic or Latino.
By contrast, the percentage of ABFM diplomates certifying that year who were non-Hispanic whites -- about 61 percent -- was nearly identical to that seen in the general population.
That's a far cry from 1987 figures, when more than 90 percent of family physicians who initially certified that year were white. During that same three-decade period, the percentage of Asian family physicians increased considerably, and noticeable gains also were seen in the percentages of black or African American and Hispanic or Latino family physicians. Yet despite those gains, the latter two groups remain substantially underrepresented compared with the general population.
"Our results indicate that efforts to increase diversity seem to have been effective for some groups but not all," the study authors wrote. They suggested that medical schools work more closely with universities to increase the number of minority student applicants and ensure that such students are adequately prepared for the challenges medical students face. They also suggested boosting the number of pipeline programs currently available to build a more diverse base of medical school applicants.
In an accompanying commentary, Kendall Campbell, M.D., associate dean for diversity and inclusion and interim senior associate dean for academic affairs at East Carolina University's Brody School of Medicine in Greenville, N.C., noted the importance of having a diverse workforce.
"Family medicine is a primary care leader in racial/ethnic diversity, and limited diversity in the specialty impacts care for underserved populations, threatening the health of families and communities," Campbell said.
A less diverse workforce also could have a chilling effect on achieving the triple aim of reducing costs, improving the patient experience of care, and improving population health -- something Campbell said cannot be ignored.
To encourage members of underrepresented minority groups to consider a career in medicine -- especially family medicine -- Campbell recommended a number of approaches that should be considered in addition to existing pipeline and outreach programs. These include
"There is much ground to cover to increase numbers of underrepresented groups in medicine and to continue promoting equity for these groups," Campbell wrote. "The future of health care for families and communities depend on it."
In 2017, the AAFP established the Center for Diversity and Health Equity (CDHE), an initiative focused on addressing the social aspects of health care. Danielle Jones, M.P.H., the CDHE's manager, explained the center's role in addressing workforce diversity to AAFP News.
"As an organization, we aim to incorporate diversity and inclusion into AAFP policies that are supported by our members representing various constituency groups," Jones said, highlighting approaches the Academy has taken to help increase diversity in the family physician workforce.
For example, the AAFP funds local programs such as the Tour for Diversity in Medicine, a grassroots mentoring program that connects high school and undergraduate college students with currently practicing minority family physicians and other health care professionals. The Academy also provides support for minority students to attend the National Conference of Family Medicine Residents and Medical Students via a scholarship program.
Looking forward, Jones told AAFP News that in 2019, the Academy will release a new position paper on workforce diversity. The paper will include a strategy that outlines CDHE's plans for making family medicine, as well as the medical profession in general, more diverse.