Diverse Healthcare Workforce Research Articles

Women in Medicine: Call to Action.

A diverse health care workforce, across a variety of factors that include gender, is needed to meet the needs of the diverse US population. Yet, even as more women physicians enter the workforce, they face persistent challenges, including pay scale inequities, discrimination, and an imbalance between responsibilities at work and home.1–3 These inequities are often reflected in measured pay gaps, disparities in advanced leadership roles, and higher rates of burnout for women physicians when compared with their colleagues who are men.2–4 Furthermore, women physicians experience gender bias and discrimination in the workplace and report higher rates of imposter phenomenon compared with physicians who are men.5,6 These experiences are even more significant for women physicians who are Black, Indigenous, and/or people of color (BIPOC). Although progress has been made in getting more women into fields of medicine, the remaining equity issues are deeply rooted in organizational and societal culture, calling for an intentional and systemic approach to fostering change in the medical community.7To address these issues, in 2018, 6 leading US medical organizations formed an ambitious partnership around the inaugural Women’s Wellness through Equity and Leadership project (WEL).8 Led by the American Academy of Pediatrics (AAP), and in collaboration with the American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American Hospital Association (AHA), and American Psychiatric Association (APA), WEL brought together a diverse group of 18 early- to midcareer women physicians for networking, leadership training, and mentorship. Capitalizing on the collective knowledge of this broad group of medical specialties, the WEL consortium empowered women physicians to build cross-specialty relationships critical to address the myriad of issues facing physicians in the evolving US health care system.The WEL consortium continues to actively examine the culture of medicine and the complex interplay between physicians and their institutions and environments. As stewards of medicine, the WEL partner organizations have substantial opportunities to foster important change. Leveraging their collective memberships of >400 000 physicians, they can advance an agenda for equitable leadership opportunities, advocate with one voice, and forge an inclusive health care workforce. Furthermore, additional organizations are being recruited to the WEL consortium to broaden reach and enhance intersectionality of specialties.The following call to action targets the organizational and advocacy opportunities reflected from within this consortium and implores health care organizations and medical institutions to reflect on their own practices and potential.As a collective group, we believe that the profession of medicine should collaboratively and intentionally address the numerous, multifaceted issues that hinder women physicians from reaching their full potential and ability to positively influence the profession of medicine, including by the following: We look forward to continuing to engage in this important work together and in joining with our colleagues from other specialties to continue building more equitable and inclusive work environments for all physicians. Individually, our voices are strong; together, our voices can create authentic, sustainable change.

Organizational commitment to diversity, equity, and inclusion: A strategic path forward.

To describe an approach to diversity, equity, and inclusion (DEI) strategy development at a school of pharmacy aimed at stakeholder investment and infrastructure that can address systemic challenges in various healthcare settings. The UNC Eshelman School of Pharmacy utilized an organizational approach focused on infrastructure to produce a diverse and inclusive school community. The Office of Organizational Diversity and Inclusion (ODI) established vision and mission statements to represent the school's commitment and conducted a comprehensive environmental scan to compose a shared vision. Students, faculty, staff, and alumni participated in a series of retreats, symposiums, and focus groups to identify opportunities to cultivate a diverse and inclusive school community. A working group comprised of key leaders in the school developed and launched a 3-year DEI Strategic Plan along with initiatives and metrics for year 1. The plan's 3 priorities were (1) to recruit and retain diverse talent, (2) to prepare culturally intelligent professionals, and (3) to build an inclusive community. The ODI collaborated with internal and external stakeholders, which included students, faculty, staff, postdocs, alumni, and partners from health systems, industry, and other institutions and organizations, to initiate, implement, and monitor progress through an organizational approach to establish accountability and greater commitment. An organizational approach to DEI strategy through stakeholder engagement and infrastructure increased commitment and shared ownership among members of the school community. Applications in an organizational approach can be adapted to multiple healthcare settings to contribute to the cultural transformation necessary to develop a diverse and inclusive healthcare workforce.

Dreams Realized: A Long-Term Program Evaluation of Three Summer Diversity Pipeline Programs.

Purpose: Pipeline programs are a well-known approach to enhancing health care workforce diversity and reducing health disparities. Few evaluations of pipeline programs include long-term outcome; fewer still, if any explore perceptions of students after completing such programs, to elucidate factors that contribute to successful entry into the health professions. The authors conducted a program evaluation of three summer diversity pipeline programs in the Bronx, NY, investigating both long-term outcomes and participants' hindsight perspectives of the impact of these programs on their career trajectories.Methods: Investigators conducted a cross-sectional, long-term, mixed-methods survey study. The primary and secondary outcomes for the quantitative analysis were matriculation into biomedical programs to pursue MD or PhD degrees and Master's degrees, respectively, and associated demographic factors. Free-text questions explored the most valuable and influential components of the programs; responses were analyzed qualitatively.Results: Of 147 respondents, 107 (73%) were on-track or had entered a doctoral or master's program, achieving either the primary or secondary outcomes, respectively. Components cited as most valuable included clinical experience, mentorship, career exposure, and research opportunities. Three themes were identified from the free-text responses: (1) Dreams realized; (2) Professional identity formation; and (3) Addressing systemic inequities.Conclusions: These three pipeline programs achieved career outcomes similar to published data. Participants' insights highlight the value of relationships, direct exposure to the health professions, and the importance of such programs to address systemic barriers faced. Results can inform criteria both for participant selection, as well as benchmarks used to define individual and programmatic success.

Diversity of the National Medical Student Body — Four Decades of Inequities

SummaryA racially and ethnically diverse health care workforce remains a distant goal, the attainment of which is contingent on the inclusivity of the national medical student body. We examined the diversity of medical school applicants and enrollees over the past four decades with an eye toward assessing the progress made. Data on the gender and race or ethnic group of enrollees in all medical doctorate degree–granting U.S. medical schools from 1978 through 2019 were examined. The percentage of female enrollees doubled during this period, and women now constitute more than half the national medical student body. This upturn has been attributed largely to an increase by a factor of 12 in the enrollment of Asian women. The corresponding decrease in the percentage of male enrollees, most notably White men, was offset by an increase by a factor of approximately 5 in the enrollment of Asian men. The percentages of enrollees from Black, Hispanic, and other racial and ethnic groups that are underrepresented in medicine remain well below the percentages of these groups in the national Census.

Diversity, Equity, and Inclusion in Academic Nuclear Medicine: National Survey of Nuclear Medicine Residency Program Directors.

A diverse health-care workforce is a necessary component of equitable care delivery to an increasingly diverse U.S. population. In nuclear medicine (NM), there is a paucity of data on the numbers of women and members of racial and ethnic groups that are underrepresented in medicine in the United States (URiMs). This study sought to characterize the current state of women and URiMs in academic NM, describe the demographics of Accreditation Council for Graduate Medical Education (ACGME)-accredited NM residency program faculty and trainees, and assess the extent of NM exposure during medical school. Methods: This study was reviewed by the Institutional Review Board and deemed exempt. In this cross-sectional study, a link to an online 15-item survey was emailed to 41 ACGME-accredited NM residency program directors (PDs) in the United States. Data were collected between September 2018 and December 2018 using a secure web application that serves as an electronic data capture tool for research studies. Results: 23 of 41 (56.1%) PDs responded to the survey, 18 of 23 (78.3%) of whom were men and 5 of 23 (21.7%) women. Three of 23 (13.0%) PDs reported being URiMs. Of the 60 residents in the 23 NM residency programs whose PDs responded, 37 of 60 (61.7%) were men (7/37 [18.9%] URiMs) and 23 of 60 (38.3%) women (5/23 [21.7%] URiMs). Fourteen of 60 (23.3%) residents were U.S. medical school graduates (U.S. grads). PDs described demographics of 121 current NM faculty members: 86 of 121 (71.1%) were men (8/121 [6.6% URIMs] and 35 of 121 (28.9%) women (7/121 (5.8% URiMs). Sixty-five of 121 (53.7%) were U.S. grads. Sixteen of 23 (69.6%) divisional chiefs were men, and 7 of 23 (30.4%) were women. Four of 23 (17.4%) divisional chiefs were URiMs, and 7 of 20 (35.0%) NM PDs reported that NM was part of the medical school curriculum. Conclusion: Women and URiMs are underrepresented in NM training programs. This diversity gap is more pronounced among NM faculty and to an even greater extent in leadership positions. A greater proportion of NM trainees are international medical graduates compared with NM faculty members, suggesting declining NM recruitment among U.S. grads. NM is included in the medical school curriculum at fewer than one third of academic centers with NM residency programs, typically toward the end of medical school. Increased and earlier exposure to NM, especially for women and URiMs, may improve recruitment and mitigate diversity gaps.

Predicting Success in a Statistics Course Geared toward Allied Health Students

Statistics education is an important component of allied health education. Although success in statistics courses has been reported for students in fields such as business, nursing and psychology, there is a dearth of literature in students of other allied health science disciplines. As statistics is a gatekeeper course for many of these disciplines, understanding and addressing demographic predictors of success is a crucial step in helping to maintain a diverse healthcare workforce. In this study, ethnicity, gender, their interaction, age, and class format were used to predict 953 success outcomes in a retrospective dataset, with major being used as a random effect. Ethnicity alone predicted success, with students of other ethnicities having 0.6 times the odds of success as their Caucasian counterparts. As statistics is a potential gatekeeper course for success in health professions programs, academic instructors, administrators and other stakeholders should take steps to ascertain the incidence and nature of disparities in their settings, as it may play a role in maintaining a diverse healthcare workforce.

What Does It Mean for Medical School Admissions to Be Socially Accountable?

Health care workforce diversity is a critical determinant of health equity and the social mission of medical education. Medical schools have a social contract with the public, which provides significant financial support to academic medical centers. Although a focus on diversity is critical in the admissions process for health professions schools, most US medical schools have failed to achieve racial-ethnic or economic diversity representative of the general US population. This article discusses limitations of holistic admissions, structural challenges for diverse learners in medical education, and how to implement socially accountable admissions.

How Should Medical School Admissions Drive Health Care Workforce Diversity?

Over the past decade, holistic review has been implemented to motivate schools' compliance with state and federal laws about how to regard race in admissions processes and decisions. From clinical, ethical, and public health standpoints, physician workforce diversification is widely regarded as foundational to medicine's capacity as a profession to respond justly to the health care needs of a pluralistic nation. In response to a case, this commentary considers merits and limitations of holistic review's roles in advancing health professional workforce diversity and health equity.

Don’t ignore the tipping point: A framework to fuel diversity, equity, and inclusion efforts in health-care sciences

In the United States, social determinants of health have resulted in inequities in health care, particularly for communities affected by systemic forms of racism and oppression. Health-care professionals are essential in assisting participation in the health-care system. Building a more diverse health-care workforce can expand access to care, improve the quality of care, and increase health equity. However, many health-care professions have struggled to effectively recruit and retain individuals from diverse backgrounds. In the field of occupational therapy, leaders in diversity, equity, and inclusion worked together to establish a framework with nationwide initiatives to effectively recruit and retain a workforce that is more representative of the communities, in which health-care professionals serve. The initiatives and framework outlined below can be replicated to advance efforts to increase diversity and create systems that address justice, equity, and inclusion.

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Debt-Free Medical Education-A Tool for Health Care Workforce Diversity.

Debt-Free Medical Education-A Tool for Health Care Workforce Diversity.

Perceptions of support by nursing faculty of color.

Racial and ethnic minority faculty members within nursing academia are critical to the recruitment and training of a diverse health care workforce. Effective strategies and opportunities for the success of minorities within nursing faculty must be identified and explored. The purpose of this paper is to identify strategies for support being utilized by nursing faculty of color, and support systems that practicing faculty of color believe would aid their success in academia. This descriptive survey used an 18-item online survey distributed to faculty of color in nursing academic institutions throughout the United States. Of the completed surveys, 116 responses met inclusion criteria. Common themes from faculty of color emerged regarding the importance of mentorship, faculty development, networking and acknowledgement. Respondents noted their experience with successful support systems and strategies and support systems they found to be lacking. Strategies were recommended for promoting faculty of color in schools and colleges of nursing.

Abstract D039: Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC): A new program to increase underrepresented minorities in clinical cancer research careers

Abstract An eight-week intensive pipeline training program was designed to recruit and prepare underrepresented minority undergraduate students to pursue careers as clinical research professionals and obtain advanced degrees in cancer research to improve diversity and culturally responsive care in clinical cancer research. Cancer clinical trials are imperative to advance therapies and improve patient survival rates, yet barriers exist preventing underrepresented minorities (URM) from participating. There is a need to foster a diverse healthcare workforce who mirror the larger population, yet national statistics report sluggish growth in the recruitment of underrepresented minorities (URM) to scientific occupations. Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) is a newly funded five-year National Cancer Institute R25 education program recruiting URM, to become clinical research professionals (CRPs) or seek advanced degrees in clinical cancer research. The eight-week program immerses students in hands-on experiences framed by the Joint Task Force for Clinical Trials Competency Domains. Grounded in theory of experiential learning and culturally responsive teaching, 35 faculty and CRPs taught and served as student champions, spanning pediatric oncology, oncology pharmacy, surgical oncology, gynecologic oncology, genetics, palliative care and medical oncology. Scholars experienced first-hand the methods in which complex trials provide innovative precision cancer treatments. Scholars completed a ‘Wicked Problems’ research project on cancer health disparities. Analysis of SPARCC evaluation data and one-on-one exit interviews utilizes both qualitative and quantitative methods. Of 39 applications received, 62% (24/39) identified as URM and 77% (30/39) were females. All applicants were enrolled in undergraduate programs or recently graduated with a bachelor’s degree. Most were pursuing biomedical science majors (30/39) with interest to seek careers in healthcare (34/39). In June 2019, ten scholars were accepted (9 females, 1 male), 90% of the matriculating cohort identified as URM. Over 84 different workshops were facilitated, and Scholars participated in three, two-week practicum rotations. Workshop sessions were evaluated by students using free text, 5-point Likert scale questions rating efficacy, satisfaction, and skills of the facilitator and an overall ten-point rating. Wicked Problems projects focused on: stigma of prostate health among African American males, cervical cancer screening among Latinas, impact of food insecurities on cancer treatment, skin cancer prevention among African Americans, and improving enrollment of URMs in clinical trials. Evaluation data is forthcoming. SPARCC has paved the way as an innovative and pedagogically sound education training program for URM. By curating an experience integrating research methods, cancer epidemiology, and health disparities, Scholars have a passion for clinical cancer research. Citation Format: Kristina Kaljo, Robert Treat, Janet Rader. Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC): A new program to increase underrepresented minorities in clinical cancer research careers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D039.

Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic.

The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global spread have created unprecedented challenges to health care systems. Significant and sustained efforts have focused on mobilization of personal protective equipment, intensive care beds, and medical equipment, while substantially less attention has focused on preserving the psychological health of the medical workforce tasked with addressing the challenges of the pandemic. And yet, similar to battlefield conditions, health care workers are being confronted with ongoing uncertainty about resources, capacities, and risks; as well as exposure to suffering, death, and threats to their own safety. These conditions are engendering high levels of fear and anxiety in the shortterm, and place individuals at risk for persistent stressexposure syndromes, subclinical mental health symptoms, and professional burnout in the longterm. Given the potentially wide-ranging mental health impact of COVID-19, protecting health care workers from adverse psychological effects of the pandemic is critical. Therefore, we present an overview of the potential psychological stress responses to the COVID-19 crisis in medical providers and describe preemptive resilience-promoting strategies at the organizational and personal level. We then describe a rapidly deployable Psychological Resilience Intervention founded on a peersupport model (Battle Buddies) developed by the United States Army. This intervention—the product of a multidisciplinary collaboration between the Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the University of Minnesota Medical Center—also incorporates evidence-informed “stress inoculation” methods developed for managing psychological stress exposure in providers deployed to disasters. Our multilevel, resource-efficient, and scalable approach places 2 key tools directly in the hands of providers: (1) apeersupport Battle Buddy; and (2) adesignated mental health consultant who can facilitate training in stress inoculation methods, provide additional support, or coordinate referral for external professional consultation. In parallel, we have instituted a voluntary research data-collection component that will enable us to evaluate the intervention’s effectiveness while also identifying the most salient resilience factors for future iterations. It is our hope that these elements will provide guidance to other organizations seeking to protect the well-being of their medical workforce during the pandemic. Given the remarkable adaptability of human beings, we believe that, by promoting resilience, our diverse health care workforce can emerge from this monumental challenge with new skills, closer relationships, and greater confidence in the power of community.

Coronavirus disease 2019 pandemic: staged management of surgical services for gynecology and obstetrics

The coronavirus disease 2019 pandemic warrants an unprecedented global healthcare response requiring maintenance of existing hospital-based services while simultaneously preparing for high-acuity care for infected and sick individuals. Hospitals must protect patients and the diverse healthcare workforce by conserving personal protective equipment and redeployment of facility resources. While each hospital or health system must evaluate their own capabilities and surge capacity, we present principles of management of surgical services during a health emergency and provide specific guidance to help with decision making. We review the limited evidence from past hospital and community responses to various health emergencies and focus on systematic methods for adjusting surgical services to create capacity, addressing the specific risks of coronavirus disease 2019. Successful strategies for tiered reduction of surgical cases involve multidisciplinary engagement of the entire healthcare system and use of a structured risk-assessment categorization scheme that can be applied across the institution. Our institution developed and operationalized this approach over 3 working days, indicating that immediate implementation is feasible in response to an unforeseen healthcare emergency.

Developing Workforce Diversity in the Health Professions: A Social Justice Perspective

PurposePeople of color often face challenges in accessing equitable healthcare. Disparities in healthcare pose very real moral and ethical social justice dilemmas for society, and prevent efforts to improve the nation's health and manage escalating healthcare costs. A diverse healthcare workforce is necessary as a means to help care for an increasingly diverse patient population. MethodThis paper focuses on programmatic and research information that is a collaborative effort between a number of researchers and educators in schools of medicine and allied healthcare. The paper looks at the current state of racial and ethnic diversity in the health professions and describes the social justice implications of a representative healthcare workforce. Using a “pipeline to practice” model, the authors will present information spanning the pipeline from encouraging high school students of color to enter the allied healthcare professions to introducing undergraduate and graduate students in health professions program to responsive policy making and cross-cultural communication. The authors reviewed the research literature across multiple institutions and professional health programs, and include illustrative case studies. ResultsThe authors found that overall, the healthcare workforce is becoming more diverse however, with the majority of people of color in healthcare jobs remaining in entry-level and often lower paying jobs. The need to increase the diversity of the healthcare workforce in all fields of allied health is a continuing need. The most promising practices tended to be comprehensive programs that include a combination of social support, academic support, and financial support. DiscussionThis information has great significance for health professions education programs as they strive to diversify their student populations, retain students of color, and provide culturally responsive education and training. This interdisciplinary collaborative perspective illustrates what can be learned from varied health professional programs as well as making new connections across often disconnected practice settings.

Urologic oncology workforce diversity: A first step in reducing cancer disparities.

Urologic cancer disparities based on race/ethnicity and gender are well-documented across the cancer continuum. Patients cared for by physicians of similar race/ethnicity and gender report better communication, patient satisfaction, and care adherence which has the potential to translate into better health outcomes. We believe that ensuring a diverse Urologic Oncology workforce is an important first step toward eliminating cancer disparities due to the downstream effects of improved communication between concordant patient-physician dyads. In this essay, we review the demographics of the Urologic cancer patient population and Urologic Oncology workforce; describe current evidence supporting healthcare workforce diversity, especially related to race and gender-based concordant patient-physician relationships; and make recommendations for individual and institutional strategies to develop and support a diverse workforce in Urologic Oncology.

The need for greater diversity in the PA profession.

Leading organizations committed to improving health and healthcare in the United States agree that a more diverse healthcare workforce is needed to combat widespread disparities affecting underrepresented minority and underserved populations. Until the 1990s, a higher proportion of underrepresented minorities entered PA programs than other healthcare professions programs, such as medical school. However, in recent years, the PA profession has struggled to increase diversity among its ranks. This article reviews the rationale for greater diversity in the PA workforce, discusses the obstacles that underrepresented minority students and PA educators face, and makes recommendations to address diversity. The PA profession's rapid growth presents an opportunity to expedite change through community outreach, sustained commitment to diversity, research, and policy change.

3430 Promoting Stakeholder Research Competencies to Culturalize Health Science by the Miami CTSA: National Partnership for Training Community Health Workers in Patient-Centered Outcomes Research (PCOR) in 4 States

3430 Promoting Stakeholder Research Competencies to Culturalize Health Science by the Miami CTSA: National Partnership for Training Community Health Workers in Patient-Centered Outcomes Research (PCOR) in 4 States

Adelante (Moving Forward): An Innovative Program for Nursing and Prenursing Students.

The US population reflects a rich diversity of people that is not reflected in the health care workforce. This article describes the Adelante (Moving Forward) Program, an innovative model designed to increase nursing workforce diversity. Adelante was created to advance baccalaureate nursing students and prenursing students by using supportive developmental relationships and mentoring strategies. Graduates stated that they planned to advance their education. Further development of innovative programs for nursing students from diverse backgrounds is imperative to increase health care workforce diversity.