Abstract
Increasing diversity in the physician workforce is a fulcrum for reducing health disparities. Efforts to increase the diversity in the internal medicine (IM) workforce may improve health equity among an increasingly diverse population with increasing prevalence of chronic disease. To assess diversity trends in the academic IM workforce and evaluate how well these trends reflected medical student diversity and the changing demographic composition of the general population. This secondary analysis of a cross-sectional study analyzed data from January 1, 1980, to December 31, 2018, from the Association of American Medical Colleges Faculty Roster and Applicant Matriculant File, which capture full-time US medical school faculty and matriculants, respectively, and population data through 2017 from the US Census Bureau. The study calculated the proportions of women and individuals from racial/ethnic groups that are traditionally underrepresented in medicine (URM) among IM faculty and faculty in all other clinical departments. These data were compared with the proportions of female and URM matriculants in US medical schools and the proportions of women and individuals from underrepresented racial/ethnic groups in the population. The analysis was stratified by sex, race/ethnicity, and intersections of sex and race/ethnicity. From 1980 to 2018, the absolute number of full-time IM faculty increased from 10 964 to 42 547. Although IM was the department classification with the most women faculty, in 2018 it continued to have a lower proportion of women (n = 17 165 [40.3%]) compared with all other clinical departments (n = 48 936 [43.2%]). Among IM faculty, the percentage of URM faculty members more than doubled during the study period (from 4.1% to 9.7%) but still made up only a small portion of faculty members. The percentage of female matriculants among medical school matriculants increased steadily (from 28.7% in 1980 to 51.6% in 2018) and was nearly identical to their population representation in 2017 (50.7% compared with 50.8%). Although the percentage of URM matriculants had nearly doubled since 1980 (from 11.3% to 18.1%), it still lagged far behind the proportion of individuals in the US population who are members of underrepresented racial/ethnic groups (18.1% vs 31.5% in 2017). This cross-sectional study found that progress has been made in diversifying academic IM faculty; however, it does not yet reflect the diversity of medical students or the US population. Continued efforts to increase the diversity of the academic IM workforce are needed.
Highlights
By 2060 the US population will have undergone significant demographic changes
This cross-sectional study found that progress has been made in diversifying academic internal medicine (IM) faculty; it does not yet reflect the diversity of medical students or the US population
Continued efforts to increase the diversity of the academic IM workforce are needed
Summary
The US Census Bureau projects that between 2014 and 2020 the population will have increased by nearly 100 million people, reaching 417 million, and the number of adults 65 years and older is expected to increase by nearly 75% between 2020 and 2060 (from 56.4 million to 98.2 million).[1] The racial and ethnic makeup of the US population will change as it becomes a minority-majority nation, with racial/ ethnic minorities constituting 56.4% of the population by 2060.1 Another anticipated change is an increase in the number of adults with multiple chronic medical conditions,[2,3] and patients with multiple chronic conditions use more health services than other individuals and account for approximately 83% of all health care spending.[4,5] Taken together, these projected changes will bear directly on the health and economy of future generations, and a larger, more diverse physician workforce focused on the prevention and management of complex chronic disease (such as internal medicine [IM] and its subspecialties) could help meet the nation’s increasing health care needs and lead to improved patient outcomes.[6,7,8,9]. We examined these trends through the intersection of sex and race/ethnicity
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