Here's The Baseline For Efforts To Boost Diversity In Health Professions

Black, Hispanic, and Native Americans are underrepresented in major health professions, researchers found, and they urged that steps be taken to improve the situation.

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"Underrepresented minorities are more likely to practice in underserved areas and serve underserved populations," said Edward Salsberg, MPA, a senior research scientist at the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University in Washington, D.C. "Some good literature shows that having a more diverse class of cohorts of health profession students increases the cultural sensitivity and awareness of all the students, so there's a benefit to the education process as well -- and then just the value of increasing access to well-paying, generally rewarding careers in terms of equity for the population in general. So we think there are benefits to the community at large."

The "Diversity Index"

In their study in JAMA Network Open, Salsberg and colleagues analyzed data from 10 healthcare occupations -- advanced practice nurses (APNs), dentists, occupational therapists (OTs), pharmacists, physical therapists (PTs), physician assistants (PAs), physicians, registered nurses (RNs), respiratory therapists, and speech-language pathologists -- and compared the diversity of each profession with the diversity in the overall working-age population. They also compared health professionals in the "pipeline" (i.e., recent graduates) with the diversity in the population ages 20 to 35.

In each case, they developed a "diversity index" -- for example, 12.1% of the current working-age population is Black; if 12.1% of a particular health profession's practitioners were Black, its diversity index for Black members would be 1, but if only 6% were Black, the index would be 0.5. "I want to be clear; we're not suggesting you need to have exact representation for every group in every profession," said Salsberg. "But we think that we really should be far closer to parity for social justice and equity reasons."

The group's analysis used federal data from the 2019 American Community Survey and the 2019 Integrated Postsecondary Education Data System. They focused on the 10 largest healthcare professions defined by the Bureau of Labor Statistics' Standard Occupational Classification as being "health diagnosing and treating practitioners who require a postsecondary degree," the authors explained.

Mean diversity index values for all professions (overall/"in the pipeline") were as follows:

Black: 0.54/0.54

Hispanic: 0.34/0.48

Native American: 0.54/0.57

"For Hispanics, we definitely saw progress in nine of 10 professions," said Salsberg. Because the overall current workforce diversity index for Hispanics is 0.34 while the index for Hispanics in the pipeline was 0.48, "we can say 'Yes, there are more Hispanics in the pipeline and there will be more Hispanics in workforces in the future,' but on the other hand, it is still less than one-half their representation in the U.S. population, so we have a long way to go."

Variation by Profession

Diversity rates varied greatly by specific profession. For example, 13.7% of the overall U.S. population ages 20 to 35 was Black, whereas the percentage of new Black graduates in health professions ranged from 3.1% for PAs to 14.2% for APNs. Similarly, Hispanic people accounted for 21.3% of the 20-to-35 population, while their percentages ranged from 6.6% of pharmacists to 19.0% of respiratory therapists.

Salsberg said he was surprised that recent Black graduates were not more numerous. "I know that in medicine and several professions there has been increased awareness of the importance of a diverse workforce, and I just had expected that we would have seen improvement."

"I wonder if some of the challenge here is that several professions have been increasing the educational requirements for entry, and if one of the unintended consequences of that has been that it's more difficult for some of the underrepresented minority groups," he suggested.

He cited PAs as an example. "PAs really started after the Vietnam War, when we were taking medics from Vietnam and training them to be PAs, so it was a profession people could enter based on their experience or even at the associate degree level," Salsberg said. "Then they moved more to a bachelor's degree ... and basically you need a master's now. So PAs were more diverse, and they are now getting less diverse." In addition, PTs, OTs, and speech-language pathologists have all moved to requiring a doctoral degree, and all have seen a decrease in diversity, he said.

On the other hand, APNs have the most diverse pipeline for Black people, "and I think that one of the reasons ... may be that for nursing, there are some clear career steps," Salsberg said. "You can enter the profession as an RN with an associate degree, and so many go on for a baccalaureate degree in nursing, and many go for a master's ... and if you're a hospital nurse or working for a healthcare organization, you may have an employer willing to support you for a doctorate or advanced training."

Improving the Federal Government's Response

As for what the federal government can do to promote diversity, programs such as the National Health Service Corps (NHSC) -- which provides grants and loan forgiveness to doctors who agree to serve in underserved areas for a certain period of time -- are an important strategy, Salsberg said.

However, "one of the issues with NHSC is that for different reasons, most of the NHSC is via loan repayment, which does help get practitioners into underserved areas, but when it started, it was almost all scholarships, and scholarships may be a better approach to help disadvantaged individuals get into health professions," he said. "I think the federal government can do more in helping identify strategies and initiatives to support underrepresented minorities in the health professions."

Salsberg and colleagues plan to continue their work in this area. "We want to put out a whole series of reports on a regular basis," he said. "We will produce this data annually or biannually, and come back and say, 'How are the professions doing?' And publish it at the school level. We want to encourage schools and professions to do more, and regular reports are part of the transparency and accountability strategy."

Study limitations included the fact that "although the American Community Survey is a nationally representative sample survey .... the estimates by race/ethnicity reflect small samples and may be subject to sampling error," the authors noted. In addition, the diversity index -- which was designed to adjust for changes over time across states that have very different racial/ethnic makeups -- may mask a wide range of performance within a profession by institution and in different regions of the country.

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