Diversity in American medicine is not keeping pace

BOSTON- According to a special report published in the New England Journal of Medicine (NEJM) led by Sophia Kamran, MD, radiation oncologist at the Mass General Cancer Center. While this analysis revealed some positive trends, the big picture suggests that U.S. academic medical programs need to not only recruit more underrepresented clinical candidates, but also find ways to support them throughout the academic pipeline to strengthen diversity at leadership levels in medicine, says Kamran.

Kamran’s interest in diversity in medicine stems in part from her experience as a Hispanic woman who was the first person in her family to attend college and then medical school. “I didn’t have many mentors, teachers, or role models in clinical medicine with similar backgrounds to help guide me,” Kamran says. In the NEJM report, Kamran and several colleagues assess trends in diversity among American medical schools over four decades. “We wanted to see where we came from, where we are and where we need to go,” says Kamran.

Along with his co-researchers, Kamran analyzed data compiled by the Association of American Medical Colleges (AAMC) for full-time faculty members in 18 clinical academic departments over the period from 1977 to 2019. The data represented the body clinical faculty, full professors, department chairs and deans. Faculty members were stratified by gender as well as race and ethnicity. The study then stratified faculty members who were underrepresented in medicine (URM), which the AAMC defines as people who identify as Black, Hispanic, non-Hispanic Native Hawaiian, or other Pacific Islanders, or non-Hispanic American Indians, or Alaska Natives.

Looking at the trends over the 42-year period, some positive news emerged. “Female representation has increased dramatically,” says Kamran. For example, the number of female clinical professors increased from 14.8% in 1977 to 43.3% in 2019. The proportion of female deans increased from zero to 18.3%.

However, although the proportion of CRUs in academic medicine also increased over the study period, these increases were much more modest. As a result, black and Hispanic women and men still make up a small portion of the total clinical faculty. Perhaps most concerning, AAMC data indicates that in general, the growth and representation of black men in academic medicine has stagnated or declined, particularly among clinical professors and department chairs, a trend that started about a decade ago. “This is an area that desperately needs study, as we need to reverse these trends in order to address the lack of black leadership at all levels of academic medicine,” Kamran says.

Also, some URMs are barely registered in databases. Across all faculty levels, non-Hispanic/Other Pacific Islander Native Hawaiians and non-Hispanic/Alaska Native American Indians comprised less than 1%.

Importantly, the NEJM The report compared AAMC figures with US Census data to come to a stark conclusion. The proportion of women in academic medicine today has increased enough over the past four decades to more accurately reflect that of the female population of this country. However, while U.S. Census data also shows that the country is rapidly diversifying, academic medicine is not keeping pace with the changing population: URM representation at all levels of academic medicine is more far from reflecting the American population today than it was in 2000.

Kamran’s findings are consistent with an earlier study by a separate group that found similar disparities among American medical students. “The American population will continue to diversify over time. We are sounding the alarm because we are clearly falling behind,” says Kamran, emphasizing the urgency for action: studies indicate that patients often have better health outcomes when cared for by doctors in similar backgrounds who can identify with their life experiences.

Kamran is heartened that institutions seem to be responding to these disparities, but says it’s not enough for medical schools to set quotas for diversity. “We also need to focus on retention and development,” says Kamran. “We need evidence-based initiatives that create inclusive environments that can support cultural change.”

Kamran is also an assistant professor of radiation oncology at Harvard Medical School.

About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is Harvard Medical School’s first and largest teaching hospital. the Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and includes more than 9,500 researchers working in more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the US News and World Report list of “America’s Best Hospitals”. MGH is a founding member of the Mass General Brigham Health Care System.


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Norma A. Roth