Look in any healthcare media outlet and you’ll hear mentions of diversity and cultural competence. But many of these conversations omit a piece from the conversation puzzle: clinician diversity. A diverse healthcare staff – and that includes full representation across ethnicity, disability, class, race, and sexual orientation – means a significant advantage not only in the quality of patient care but in patient engagement.
You might think this is a goal already on its way to crossing the finish line. Most hospitals, healthcare systems, and medical schools offer messages of inclusivity in their websites and newsletters, after all. But without intentional effort, trickle-down diversity doesn’t work. There were actually more Black male medical students in 1978 than in 2014. Despite a growing cultural acceptance of gender and sexual minorities, one study of LGBTQ medical students found that 44% feared discrimination in medical school, and more than 30% concealed their sexual identity in medical school.
Diversity, Equity, and Inclusion (DEI) can’t be just a buzzword slapped on a website. DEI efforts need to be orchestrated, consistent, and tenacious, extending from human resource departments to admissions offices to the unit floor.
Why Clinician Diversity Matters
All patients bring with them a range of backgrounds and cultural factors. That’s true whether they present at a tier one medical center, rural roadside clinic, or student health center. Their social values, lifestyles, finances, race, and cultural beliefs can play a strong role not only in their medical status but their engagement with healthcare systems. In turn, clinicians can bring their own cultural beliefs and unconscious biases to their practice.
What happens in that intersection can worsen healthcare disparities – or it can improve outcomes.
That’s where clinician diversity can tilt the scales, increasing the likelihood of positive healthcare interactions in several ways.
A diverse staff can better understand patients’ belief systems and values. Cultural competency training is valuable, but it will never foster the same immediate understanding between two people of the same background, cultural values, lifestyles, or spiritual beliefs.
Diverse staff help build trust and engagement. Patients who never see providers from their background or culture may distrust healthcare systems. This is especially true for populations with historical trauma or exploitation from the medical industry. But a vibrant cross-section of providers increases the likelihood that patients will connect with a clinician who shares some commonality. Communication flows more easily; trust follows. One study showed that Black men were more likely to take preventive health measures when those actions were recommended by Black physicians compared to measures recommended by white physicians.
New perspectives mean new innovation. Adding a mix of perspectives to clinical and academic environments can introduce fresh ideas – and avoid the stagnation that results from echo chambers. A diverse group is more likely to break through rigid or myopic mindsets because they automatically have an intersectional lens. This is particularly helpful in medical and nursing schools, helping students build empathy and deepen awareness. Cross-cultural interactions can also prepare students to serve diverse populations later in their career.
Underserved patients feel encouraged to enter the healthcare field. “You can’t be it if you can’t see it” is a common refrain in DEI programs. Patients who rarely see clinicians who look like them may assume healthcare isn’t a possible career path. But when they do see healthcare professionals who share their background, they’re more likely to become interested in that industry – creating a “diversity snowball effect.”
Homogeneity in the American Provider Pool
So, what does our current clinician population look like? In an ideal world, both medical school and hospital staff would reflect the general makeup of the society – but as we know, they often don’t.
Here’s where we are today:
- Socioeconomically, most medical students come from affluent backgrounds. An Updated Look at the Economic Diversity of U.S. Medical Students found that more than 75% of medical students come from families in the top two quintiles for household income.
- Women are catching up to men in the medical field. True, the 2019 gender distribution among doctors showed that nearly two-thirds of physicians are male – but females now outnumber males in US medical schools.
- Physician race and ethnicity don’t reflect their patient populations. More than half of practicing physicians are White; 17% are Asian, 6% are Hispanic, and 5% are Black. According to the Association of American Medical Colleges, fewer than 1% of medical students are Native American, and 43% of medical schools have no Native students at all.
- Data on sexual orientation and gender identity (SOGI) is limited but the Association of American Medical Colleges (AAMC) found that as of 2019, 3.8% of graduating medical students identified as gay or lesbian, 5% identified as bisexual, and .7% identified as transgender. While these numbers mostly reflect the current LGBTQ population, the pressure to stay closeted at work can erase visibility.
5 Ways to Diversify the Healthcare Talent Pipeline
Diversifying any industry, let alone healthcare, can seem like a Sisyphean task – but these five initiatives offer a strong start.
- Start pipeline programs in elementary school. A lack of academic support in disadvantaged communities often leaves students underprepared for higher education. These students may have professional potential, but get diverted by poverty, unstable housing, food insecurity, or early parenthood. Healthcare systems can partner with schools to create pipeline programs that keep children on the path to academic success.
- Practice intentional recruiting. Some organizations implement merit-based hiring processes to avoid biased hiring. But this only solves half the issue, with many still struggling to attract more diverse candidate pools. One solution is to overhaul recruiting and candidate sourcing strategies. Do recruiters need to expand the variety of places they source from? Are job ads unconsciously tailored to a certain demographic? The idea is to ensure that all qualified candidates can see themselves in your medical school or hospital.
- Hire from underserved communities. Clinicians who understand a community’s challenges are the best positioned to make a lasting difference in disparities and outcomes. Healthcare systems can enrich the pipeline by hiring junior staff from underserved communities and supporting their healthcare career aspirations. Tuition reimbursement and educational support can help them pursue degrees in nursing, advanced practice, or other clinical paths.
- Adapt healthcare cultures. Even a small hospital can create a Diversity, Equity, and Inclusion (DEI) program. Survey your staff on their experiences and ask for their suggestions on improving your culture. Schedule implicit bias and cultural humility training for all employees. Also consider your company messaging. A boilerplate statement on inclusivity is going to ring hollow to candidates who’ve experienced discrimination at other hospitals that made the same promise. Take a critical look at your website, recruiting materials, scripting, and events, and solicit feedback on how much genuine appreciation they show for different cultures and backgrounds.
- Build targeted mentorship programs. Some programs connect undergraduates to mentors and have them shadow clinicians across a variety of specialties. One example: the Ohiyesa Premedical Program from Harvard Medical School for Native American students in community or Tribal colleges. In addition to faculty mentorship, students attend interactive workshops for building procedural skills and applying to medical school.
Building Health Equity Through Clinician Diversity
The movement to build a more equitable healthcare system can’t just focus on patients. It has to include healthcare professionals as well. We won’t get there overnight, but every hospital can take incremental steps toward recruiting skilled and enthusiastic clinicians who can enrich the healthcare world. As with every system, healthcare is best transformed from within – and that means filling the medical talent pipeline with clinicians who represent the communities they serve.