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An overview of the modern health care workforce reveals a concerning disparity in the amount of African American medical professionals.
An overview of the modern health care workforce reveals a concerning disparity in the amount of African American medical professionals. A 2021 study conducted by the University of California, Los Angeles, found that the number of Black physicians in the United States had increased by only 4% in the past 120 years. As of 2023, only 5.7% of doctors in the US identified as Black or African American. This landscape set the stage for James E.K. Hildreth, MD, President and CEO at Meharry Medical College in Nashville, Tennessee (the oldest and largest historically Black academic health science institution in the nation), to deliver a poignant address on how his institution is working to address this issue at Modern Healthcare’s Social Determinants of Health Symposium last fall.
While Dr. Hildreth’s institution and other Historically Black Colleges and Universities (HBCU) that offer medical programs have made inroads to feed the pipeline of Black medical professionals—through education and training—significant challenges remain. Of note, only 6 historically Black colleges and universities currently operate medical schools. Dr. Hildreth shared that while these institutions have educated half of the total practicing Black physicians, there remains a significant disproportion of Black providers compared to their White counterparts.
A 2019 study conducted by researchers at the University of Pennsylvania’s Perelman School of Medicine revealed that while the number of Black and Hispanic physicians have increased, the physician workforce does not represent the shifting demographics of the US population. With continued disproportionate representation, Dr. Hildreth asked attendees to evaluate why such disparities still exist. He discussed how his path to becoming a physician differs from most non-Black physicians but is one that other Black providers can relate to. According to Dr. Hildreth, one critical challenge is the lack of champions to support Black youths to pursue their dreams of a career in medicine through representation, encouragement, education, finances, and other resources.
Dr. Hildreth wagers that people from underrepresented communities are more likely to serve populations with significant health disparities and are best placed to promote health equity initiatives. He stated that with the elimination of Affirmative Action, the applications to his institution and the medical schools at other HBCU’s have seen a drastic increase, which has led to increased competition to gain acceptance. This phenomenon is also supported by recent studies showing an overall steady increase in the enrollment of nonwhite medical students over the past decade. Dr. Hildreth anticipates this trend will continue; however, it will not translate to a marked rise in the number of Black medical professionals. Although the current acceptance rate for medical school is 6.30%, rates across HBCU programs are trending at a much lower rate: 1.19% for MeHarry Medical College, 1.31% at Morehouse College, and 1.09% at Howard University. Dr. Hildreth predicts that those who graduate under such competitive conditions will likely accept employment positions at specialized institutions offering higher compensation.
In health care, it is important to employ professionals who understand the community they serve. More diversity fosters greater understanding, collaboration, and cultural competence within the workforce. Further, patients are more inclined to trust health care professionals who share their racial and cultural backgrounds. Studies have shown that promoting diversity in health care is critical, because having a physician with a similar racial or ethnic background can make a substantial difference for a patient, contributing to increased patient satisfaction, participatory decision-making, and improved communication. This often translates to a reduction in health care disparities, improved patient access, optimized care delivery, more effective patient-provider communication, improved health literacy, and better health outcomes.
“Do not underestimate the value of a diverse [medical] workforce... We must hire and deploy a workforce that is trained to implement a care plan for individuals and communities that address the social forces that impact and undermine their well-being.” - Dr. James Hildreth
The need for diversity in health care extends beyond the medical practice. In clinical research, there is an immense underrepresentation across different ethnicities for both researchers and participants in the studies. Building on Dr. Hildreth’s sentiments, Michellene Davis, president and CEO of National Medical Fellowships, argued that the significant underrepresentation in clinical research produces uncertainty around the safety, efficacy, and side effects of treatment options for ethnic populations impacted by genetic, socio-economic, and geographical factors. Thus, health care institutions must take steps within their organization toward creating a diverse workforce. This starts with offering job shadowing opportunities to students and professionals to help spread awareness and provide invaluable exposure to various health care roles and environments. When prospects see knowledge, skill, and passion in action, it may influence career choice. Many health care providers, including Dr. Hildreth, choose medicine due to a positive shadowing experience.
Additionally, institutions should develop and implement a robust Diversity, Equity, and Inclusion (DEI) employee recruitment and retention program to attract diverse staff members. A formal DEI culturally competency training initiative can educate staff about recognizing unconscious biases and challenging assumptions, while also serving to generate more assignments that stimulate career growth. Implementing these strategies will aid in understanding and addressing structural inequities and biases at the institutional level.
Medical programs must also work to recruit and retain more Black educators in academia. According to Dr. Hildreth, Meharry College is exceptional at leading students to on-time graduation, helping them obtain positions afterward, and encouraging 75% of them to return to urban or rural communities to serve others by providing medical or dental services. Howard University College of Medicine has the largest concentration of Black faculty in the country. In working to delivering equitable, next-generation care, medical programs must also evaluate their curriculum to ensure it mimics real-world and cross-cultural scenarios.
An important consideration before, during, and after the enrollment in universities is the availability of financial and social support for minorities. Not only are more Black, Hispanic, and American Indian and Alaska Native students more likely to face challenging economic barriers, they tend to have more debt following graduation due to a lack of financial assistance. Further, the development and implementation of minority mentoring programs that involve both educational and practice environments can help to connect minority health care professionals with mentors they can identify with and learn from.
Institutional change is achieved through purposeful action and an increase of 4% in 120 years, suggests enough of that has not happened in the health care workforce. In recognition of February as Black History Month, education and health care systems can begin the work required to develop a workforce that is representative of the population it is expected to treat. So come next year, when the theme for Black History Month is: African Americans and Labor, the pipeline for African American physicians in the workforce will be considerably stronger than it has ever been.