This week’s contributor is Samantha Artiga, Vice President and Director of the Racial Equity and Health Policy Program at Kaiser Family Foundation (KFF) and a member of the 2021 Tradeoffs Research Council. Her work focuses on the intersection of racism and discrimination, social and economic inequities, and health.

Work to address health and health care disparities and advance equity has long recognized the importance of diversifying the health care workforce. Research shows that increasing the racial and ethnic diversity of health professionals is associated with improved access to care, greater patient choice and satisfaction, and other benefits. One recent study, for example, found that Black newborns cared for by Black physicians had lower infant mortality rates,  illustrating the importance of increasing diversity for health outcomes. Yet, people of color continue to be underrepresented among health professionals. A 2020 KFF/The Undefeated survey found that Black and Hispanic adults are more likely than their white counterparts to say it’s difficult to find a doctor who shares their background and experiences and one who treats them with dignity and respect.

New research from Devin Morris, Philip Gruppuso, Heather McGee, Anarina Murillo, Atul Grover and Eli Adashi in the New England Journal of Medicine suggests that little progress toward greater racial and ethnic diversity in medicine has been achieved over the past four decades. The authors examined changes in the gender, racial and ethnic makeup of the national medical student body from 1978 to 2019.

They found the percentage of medical school enrollees who are women doubled since 1978, with women now constituting more than half the national medical student body (50.6%). The percentage who are Asian women grew by 12 times, with smaller increases in the shares who are white women (18.4% to 24.1%), Black women (3.6% to 4.4%) and Hispanic women (0.7% to 3.2%). The percentage of Asian men also increased (2.1% to 10.7%), while the share of white men decreased substantially (61.2% to 25.7%), and the shares of Black and Hispanic men stayed relatively stable. (The percentage of women and men who identify as American Indian or Alaska Native or as Native Hawaiian or other Pacific Islander remained at less than 1% throughout the period.)

The authors also compared the racial and ethnic composition of medical students to the U.S. population. Even with the increased enrollment of white, Black and Hispanic women over the period, these groups remain underrepresented relative to their shares of the total population, as do Black, Hispanic, American Indian and Alaska Native, and Native Hawaiian and other Pacific Islander men. 

Together these findings show that despite major strides in increasing the representation of women as part of the national medical student body, far more limited progress has been achieved in increasing its racial and ethnic diversity. The findings highlight the importance of continued efforts to increase the diversity of the medical student body and the value of disaggregating data when assessing progress, since improvements in diversity may not be equally experienced across racial and ethnic groups and gender.

The authors suggest that beyond revising admissions policies to facilitate greater diversity, other actions including investments and initiatives focused on pre-college and undergraduate students are important. At a broader level, achieving greater diversity will likely require addressing overarching structural racial inequities in education that have contributed to the longstanding underrepresentation of people of color in health professions.