Study Confirms Persistence of Diversity Problems in Academic Medicine

A survey study believed to be one of the first efforts to put hard numbers around long-held beliefs about diversity in medical school faculties has affirmed that awareness and sensitivity to racial and ethnic diversity are believed by most faculty to be poor and even poorer among faculty who are members of underrepresented minorities.

The survey, conducted at the Johns Hopkins University School of Medicine, is likely a reflection of diversity issues thought to persist at academic medical institutions across the country, says principal investigator Lisa Cooper, M.D., a professor of medicine in the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health.

“What we are seeing at Johns Hopkins is likely to be the case in medical schools everywhere, namely that enhancing racial and ethnic diversity in medicine in general, and in academic medicine in particular, remains a challenge,” Cooper says. The study results appear in the January issue of Academic Medicine.

The medical professions have long recognized that diversity among health care providers can improve the health of patients among racial and ethnic minorities and majorities alike, says Cooper. She adds that studies have demonstrated that minority physicians are more likely to practice in underserved areas and to care for patients of their own racial or ethnic group, as well as low-income patients, Medicaid-insured and uninsured patients, and patients with poorer health status. Studies also suggest that minorities welcome practitioners who are part of their communities and sensitive to their cultures.

Cooper states that medical schools have strived to increase diversity among the physician workforce by implementing programs that increase the number of minority medical students, such as targeted recruitment efforts and scholarships.

But though minority faculty at medical schools serve as important role models for their students and recruitment magnets for minorities, diversity among faculty continues to lag, Cooper says. Previous studies have shown that minority faculty have lower job satisfaction than majority faculty.

Cooper says the new study, prompted by serious efforts at Johns Hopkins to recruit and retain more minority faculty, was designed to quantify the differences in racial and ethnic perceptions that contribute to this disparity.

The study was led by Cooper and Eboni G. Price, M.D., M.P.H., now assistant professor of medicine at Tulane University, who was a fellow in general internal medicine at Johns Hopkins during the time of this work. Along with their colleagues, Cooper and Price surveyed 703 tenure-track physicians at the Johns Hopkins University School of Medicine from 2004 to 2005. The researchers focused on physicians in clinical departments that had at least one member of an underrepresented minority, defined as black, Hispanic (Mexican American and mainland Puerto Rican), or Native American. They sent surveys by mail to both majority and minority faculty. Of the 352 physicians who returned their surveys, 30 were underrepresented minorities. At Johns Hopkins School of Medicine, whites make up 74.6 percent, blacks/African Americans 3.8 percent, Hispanics 2.9 percent, Asians 18.6 percent, and Native Americans 0.8 percent of the overall faculty.

The survey, which comprised 80 items, asked respondents to rate their level of agreement with a series of statements, such as, “Faculty are recruited to my department in an unbiased manner,” and “At Hopkins, networking opportunities for career advancement tend to include ethnic minorities.” Overall, the statements were intended to measure perceptions of bias in five areas: department or divisional activities, professional satisfaction, career networking, mentorship, and intentions to stay in academia.

Results showed that fewer than one-third of all the respondents reported experiences of bias in their own department’s or division’s activities. However, when asked whether they believed overall faculty recruitment was unbiased, only 21 percent of underrepresented minority faculty agreed, compared to 50 percent of majority faculty.

Only 12 percent of underrepresented minority faculty were satisfied with the institution’s racial and ethnic diversity, compared to 47 percent of majority faculty. Underrepresented minority faculty were also three times less likely to believe that networking opportunities included minorities.

Notably, more than 80 percent of all groups of respondents believed they would be in a career in academic medicine in five years. However, only 42 percent of underrepresented minority faculty said they would still be at Johns Hopkins in five years, compared to 70 percent of majority faculty.

Cooper says it’s unclear whether underrepresented minority faculty planned to leave because of negative experiences or whether they believed that other promising opportunities would be available elsewhere.

Either way, Cooper says, there is work to be done at Johns Hopkins and other academic medical centers to increase job satisfaction for all faculty and for underrepresented minorities in particular. More transparent and diversity-sensitive recruitment practices and increased networking opportunities are needed, along with more studies like hers to quantify the problem and attempt to solve it.

Other researchers who participated in this study include Neil R. Powe, M.D., M.P.H., M.B.A., David E. Kern, M.D., M.P.H., Sherita Hill Golden, M.D., M.H.S., and Gary S. Wand, M.D.

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