Abstract
The COVID-19 pandemic coupled with health disparities have highlighted the disproportionate burden of disease among Black, Hispanic, and Native American (ie, American Indian or Alaska Native) populations. Increasing transparency around the representation of these populations in health care professions may encourage efforts to increase diversity that could improve cultural competence among health care professionals and reduce health disparities. To estimate the racial/ethnic diversity of the current health care workforce and the graduate pipeline for 10 health care professions and to evaluate whether the diversity of the pipeline suggests greater representation of Black, Hispanic, and Native American populations in the future. This cross-sectional study used weighted data from the 2019 American Community Survey (ACS) to compare the diversity of 10 health care occupations (advanced practice registered nurses, dentists, occupational therapists, pharmacists, physical therapists, physician assistants, physicians, registered nurses, respiratory therapists, and speech-language pathologists) with the diversity of the US working-age population, and 2019 data from the Integrated Postsecondary Education Data System (IPEDS) were used to compare the diversity of graduates with that of the US population of graduation age. Data from the IPEDS included all awards and degrees conferred between July 1, 2018, and June 30, 2019, in the US. A health workforce diversity index (diversity index) was developed to compare the racial/ethnic diversity of the 10 health care professions (or the graduates in the pipeline) analyzed with the racial/ethnic diversity of the current working-age population (or average student-age population). For the current workforce, the index was the ratio of current workers in a health occupation to the total working-age population by racial/ethnic group. For new graduates, the index was the ratio of recent graduates to the population aged 20 to 35 years by racial/ethnic group. A value equal to 1 indicated equal representation of the racial/ethnic groups in the current workforce (or pipeline) compared with the working-age population. The study sample obtained from the 2019 ACS comprised a weighted total count of 148 358 252 individuals aged 20 to 65 years (White individuals: 89 756 689; Black individuals: 17 916 227; Hispanic individuals: 26 953 648; and Native American individuals: 1 108 404) who were working or searching for work and a weighted total count of 71 608 009 individuals aged 20 to 35 years (White individuals: 38 995 242; Black individuals: 9 830 765; Hispanic individuals: 15 257 274; and Native American individuals: 650 221) in the educational pipeline. Among the 10 professions assessed, the mean diversity index for Black people was 0.54 in the current workforce and in the educational pipeline. In 5 of 10 health care professions, representation of Black graduates was lower than representation in the current workforce (eg, occupational therapy: 0.31 vs 0.50). The mean diversity index for Hispanic people was 0.34 in the current workforce; it improved to 0.48 in the educational pipeline but remained lower than 0.50 in 6 of 10 professions, including physical therapy (0.33). The mean diversity index for Native American people was 0.54 in the current workforce and increased to 0.57 in the educational pipeline. This study found that Black, Hispanic, and Native American people were underrepresented in the 10 health care professions analyzed. Although some professions had greater diversity than others and there appeared to be improvement among graduates in the educational pipeline compared with the current workforce, additional policies are needed to further strengthen and support a workforce that is more representative of the population.
Highlights
Key Points Question Are Black, Hispanic, and Native American populations underrepresented in the health care professions in the US, and does the educational pipeline show greater representation of these groups in the future health care workforce? Findings In this cross-sectional study of 2019 data from the American Community Survey and the Integrated Postsecondary Education Data System, Black, Hispanic, and Native American people were underrepresented in the 10 health care professions analyzed
This study found that Black, Hispanic, and Native American people were underrepresented in the 10 health care professions analyzed
This unequal burden extends to health care workers; studies have revealed that Black, Hispanic, and Native American frontline health care professionals have been disproportionately affected by COVID-19.8,9
Summary
Recent reports describing the health disparities faced by racial/ethnic minority groups during the COVID-19 pandemic has added to decades of literature demonstrating differential access to health care services and health outcomes by race and ethnicity.[1,2,3,4,5,6,7] This unequal burden extends to health care workers; studies have revealed that Black, Hispanic, and Native American (ie, American Indian or Alaska Native) frontline health care professionals have been disproportionately affected by COVID-19.8,9A substantial body of literature suggests that fostering a diverse and inclusive workforce is critical to increasing access to care and improving aspects of health care quality among underserved populations.[10,11,12,13] Studies have demonstrated that physicians and dentists from underrepresented minority groups are more likely to practice in high-need specialties and in underserved communities.[14,15] Student body diversity has been associated with better overall student preparation to care for minority populations and an endorsement of equitable access to care.[16]. Literature on patientphysician concordance suggests that diversity may be important for quality of care with regard to patient communication, preventive care, and patient satisfaction.[18,19] A diverse workforce with a broader set of experiences in leadership roles can aid in shaping research and policy agendas.[20]
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