Closing persistent health disparities among women and minorities requires the increased presence of these groups as practitioners in medical specialties, a recent study suggests. The research out of Johns Hopkins University in Baltimore paints a grim, but promising, picture of the medical education landscape at a time when minorities are inching closer to being a majority of the U.S. population.
Researchers found that that women accounted for less than half of the 16,835 medical school graduates in 2012 and just 14 percent of the students from minority groups, including black and Hispanic students, completed their studies in the same year. The same remained true among the more than 115,000 trainees in internships and residencies. Low enrollment for these groups translated into some segments of the health care industry — just 30 percent of women and 9 percent of minorities, for example, were practicing physicians in 2012.
“Minority physicians continue to provide the majority of care for underserved and non-English speaking populations,” Dr. Curtiland Deville, of Johns Hopkins University in Baltimore, told Reuters Health. “First is the need to increase the available pipeline of diverse medical students. This is especially the case for Blacks, Hispanics, and other underrepresented groups. In parallel, is the need to ensure that female, black, and Hispanic medical students are exposed, prepared, and engaged to join all medical specialties.”
Some of the issue may stem from implicit racial bias — attitudes that lead doctors, teachers, and researchers to unconsciously treat minority groups differently.
If left unabated, this type of bias can adversely hamper recruitment of students and practitioners from diverse backgrounds. A study in the New England Journal of Medicine attributed implicit bias to a 20-year decline in medical school admission among black students. Even those accepted into these institutions aren’t safe from microaggressions — brief, daily exchanges that can make the academic experience difficult for people of color by sending them denigrating messages about their identity.
Implicit stereotypes about how different groups deserve to be treated may also affect the health care that minorities and women receive. Studies, for example, have shown that African-American patients are prescribed less pain medication than white patients with similar complaints. During childbirth, women often experience “poor treatment….including abusive, neglectful, or disrespectful care,” a report published in the Public Library of Science revealed. A 2014 survey of 2,000 women highlighted how out of tune doctors can be with their female patients when they experience pain. Forty-five percent of respondents, for example, said their doctor told them “the pain is all in your head.”
Deville, along with many of his colleagues in the medical field, say that attracting and retaining female and minority student will require some institutional changes. Implicit bias workshops, an effort spearheaded by the Association of American Medical Colleges (AAMC), aim to help decision makers in the health care field better understand how their underlying prejudices, and the choices borne out of those attitudes, might preclude them from exposing students to diverse professional opportunities. Such blind spots may discourage women and minorities from pursuing some medical specialties. The study, published in JAMA Internal Medicine, said these groups are underrepresented in radiology, orthopedics, and otolaryngology — an area of medicine related to the ear, nose, and throat — for this reason.
Previous studies have connected the presence of minority medical practitioners to the improvement of health outcomes among members of their affinity groups, especially those living in low-income communities. First, women and minorities are more likely to serve the needs of those who look like them upon completing their studies. Secondly, patients often feel more comfortable disclosing sensitive medical information to those who share their racial background or speak the same language. These relationships ultimately create public trust in the health care system, allowing doctors and patients to successfully collaborate in preventing or mitigating chronic illness.
Despite some setbacks, women and people of color do have significant representation in at least some medical fields. In 2012, women accounted for more than 80 percent of trainees in obstetrics and gynecology and 72 percent in pediatrics. Women also dominated dermatology, family medicine, pathology, and psychiatry. Research also showed that black medical students tended to choose family medicine and gynecology.
“I do think there is a role for hospitals and medical schools to make sure that their environments are as inclusive as possible,” Marc Nivet, chief diversity officer at AAMC, told Reuters Health. “A minority or a woman shouldn’t look at a particular field like orthopedics and say, ‘Well, that’s not for me.’ There should be training that’s happening for the graduate medical education leaders (and) for the faculty members of institutions to make sure that they are exposing all students to different opportunities so they can make the right choice for themselves.”