Abstract
Accurate racial/ethnic identity measurement is needed to understand the effectiveness of outreach, recruitment, and programs to support American Indian and Alaska Native (AIAN) people becoming physicians. To examine how changes in race/ethnicity data collection by the American Medical College Application System are associated with trends in applicants, matriculants, and graduates self-reporting as AIAN. In this cohort study, interrupted time series regression was conducted using data from the American Medical College Application system identifying medical school applicants and graduates between January 1, 1996, and December 31, 2017, who identified as AIAN. The number of students identifying as AIAN was compared before and after the American Medical College Application System changed how it collected race/ethnicity data in 2002. Data analyses were conducted between December 2019 and May 2019. Applicants could select only 1 racial identity from 1996 to 2001 and could select more than 1 racial identity from 2002 to 2017. Rates of AIAN groups before and after changing how race/ethnicity data were collected. Covariates were age, sex, and Medical College Admission Test scores. The total number of individuals identifying as AIAN in the study was 8361; the mean (SD) number of applicants per year was 380.0 (89.9) overall: 257.3 (39.6) in 1996 to 2001, with a mean (SD) age of 26.6 (5.5) years and 830 (54.0%) male individuals, and 426.1 (50.1) in 2002 to 2017, with a mean (SD) age of 25.5 (5.6) years and 3441 (50.5%) female individuals. Before the change, there was a decrease of 5% per year (relative rate [RR] of 0.95; 95% CI, 0.91-0.98; P < .001) in the rate of AIAN applicants. In 2002, the change in data collection was associated with an immediate 78% relative increase in applicants (RR, 1.78; 95% CI, 1.55-2.06; P < .001). From 2002 to 2017 there was a 10% increase in applicants per year (RR, 1.10; 95% CI, 1.06-1.14; P < .001). For matriculants, yearly trends indicated a nonsignificant 3% decrease before the change, whereas the change was associated with an immediate 62% relative increase in matriculants (RR, 1.62; 95% CI, 1.35-1.95; P < .001), with no difference in trend after the change. For graduates, a nonsignificant yearly decrease of 2% was found in the mean number of graduates before the change, whereas the change was associated with an immediate 94% relative increase (RR, 1.94; 95% CI, 1.57-2.38; P < .001), followed by no change in trend after the modification. Changing the method of race/ethnicity data collection captured more AIAN applicants, matriculants, and graduates. Yearly trends indicate concerning although nonsignificant differences after the change for AIAN graduates. These findings should inform diversity efforts.
Highlights
Efforts to diversify the physician workforce are crucial to meeting the health care needs in underserved communities across the US
Health disparities are problematic among American Indian and Alaska Native (AIAN) populations, which have been affected by socioeconomic determinants,[1,2,3,4,5] including higher rates of morbidity, mortality, unmet health care needs and lower health care use compared with other racial/ethnic groups, even when access to care is taken into account.[6]
American Indian and Alaska Native physicians are more likely to work with American Indian/ Alaska Native (AIAN) populations than their non-AIAN peers[2]; there is a paucity of AIAN people with medical degrees.[8,9,10,11]
Summary
American Indian and Alaska Native physicians are more likely to work with AIAN populations than their non-AIAN peers[2]; there is a paucity of AIAN people with medical degrees.[8,9,10,11] According to 2018 data, 2570 (0.3%) of the 918 547 physicians active in the US reported being AIAN alone or in combination with another race.[12] the number of US medical school applicants identifying as AIAN only decreased by 32% between 1980 and 2013.13 This negative trend appears to be accelerating, with a 70% decrease in AIAN-only applicants and a 63% decrease in AIAN-only matriculants to US medical schools between 1996 and 2016.13 These findings suggest that efforts to diversify the medical workforce for AIAN people are lacking, leading to deficiencies in the numbers of AIAN physicians and in racially concordant care.[2]
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