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In what some are calling a “persistent failure” of medical schools to improve diversity, a comprehensive new analysis going back 40 years shows the number of students from the most underrepresented groups in medicine — Black males and Native American and Alaskan Native men and women — has declined.
While Black male medical students accounted for 3.1% of the national medical student body in 1978, in 2019 they accounted for just 2.9%. Without the contribution of historically Black medical schools, just 2.4% would be Black men. The number of Native American students also declined, accounting for just a fraction of 1% of the nation’s roughly 22,000 medical students in 2019.
“It is absolutely dismal and appalling and quite frankly unacceptable,” said Demicha Rankin, an anesthesiologist who serves as associate dean of admissions for The Ohio State University Wexler Medical Center, where 25% of students come from underrepresented minority groups. The report was published Wednesday in the New England Journal of Medicine.
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While U.S. medical schools have talked for years about their efforts to enroll more students of color, the new data underscore how little progress has been made and should serve as an urgent call to action, said physicians working to increase diversity. “Everytime I see stark numbers like these, I have a moment of depression,” Siobhan Wescott, an Alaskan Native physician who co-directs the Indians into Medicine program at the University of North Dakota, told STAT. “But they remind me how much work there is to do.”
The coronavirus pandemic has highlighted the deeply embedded medical inequities facing the nation — and the need for a more diverse medical workforce. The National Academy of Medicine is among many groups concluding that increasing racial and ethnic diversity among physicians would markedly improve care, access, and life expectancy for minority populations. African American males have the lowest life expectancy of any population in the United States. Studies show access to care and health outcomes improve when physicians more closely represent the patients they care for, partly because of increased trust. One study in Oakland showed Black male patients fared better with Black physicians because they were more likely to undergo preventive care procedures and accept flu shots.
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“I’m calling for a new beginning,” said Valerie Montgomery Rice, president and dean of the Morehouse School of Medicine, “because everything we’ve done in the past has not worked.”
In an editorial accompanying the new report, Winfred Williams, a nephrologist at Massachusetts General Hospital and NEJM’s deputy editor, called the statistics “grim” and noted that the racial gap that medicine has been trying to close was actually widening. The study, he wrote, “shows a disturbing lack of progress and no serious, intentional effort on the part of medical school admissions committees to rectify these inequities.” He added, “the medical establishment must be held accountable.”
STAT contacted a number of medical schools that ranked lowest in diversity in U.S. News and World Report rankings to ask why they had enrolled so few students from underrepresented minority groups and what changes they were instituting to increase diversity. Many said they were taking aggressive steps to improve and agreed their numbers had been poor, often because their admissions committees were not diverse or welcoming, they relied too heavily on MCAT scores to rank candidates, or because students of color they accepted chose to attend other schools.
The number of Black, Hispanic, Native American and Hawaiian or Pacific Islander physicians remains far below their percentages in the general U.S. population. A study released this month shows the percentage of doctors who are Black male physicians has not budged in 80 years. The fact that these groups remain underrepresented in medical school populations as well shows achieving the goal of a physician workforce that represents the nation will take years.
“The data speak for themselves,” said Eli Adashi, the new study’s senior author and the former dean of Brown University’s Warren Alpert Medical School. “It’s a clarion call for action.”
Last August, the Association of American Medical Colleges and National Medical Association, which represents Black physicians, teamed up to take more aggressive action to fight what they said was historically entrenched systemic racism that was excluding people of color from medical school ranks.
“Even the National Academies have called this an American crisis and that’s not an overstatement. This is important for the health of our nation,” said Norma Poll-Hunter, the senior director of equity, diversity, and inclusion for the AAMC. Poll-Hunter, like many working in the field of diversity, said she had mixed feelings about the attention being given only very recently to an issue she has spent 15 years working on. “On one hand, we feel we’ve been saying this for how long and people are finally paying attention,” she said. “At the same time, we now have so many allies and we need to leverage this moment for the long haul.”
For the new study, Adashi and his coauthors analyzed more than 40 years of medical student data, from 1978 to 2019, from some 150 medical schools that had been collected by the AAMC. They included only U.S. citizens, which make up more than 98% of American medical students, because the information for that group included gender, race, and ethnicity and used categories that correspond to U.S Census Bureau conventions: White, Asian, Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or other Pacific Islander. (Data collection by the AAMC changed over time to allow students to select more than one race and to designate if they were of Hispanic origin, but Adashi said those changes did not affect the overall results of the study.)
The analysis showed medicine has achieved a measure of gender equity, with women now constituting half of all medical school students compared to less than a quarter in 1978. But gains have not been equal among all women. The number of white women in medical schools increased from 18% to 24% of all students, while the number of Asian women increased from 0.8% to 11.7%. The increase in the number of Black and Hispanic women medical students was more modest. Black women enrollees increased from 2.2% to 4.4%, while Hispanic women enrollees increased from 0.7% to 3.2%.
There was a marked decrease in the number of white men in medical school, from 61.2% to 25.7% and an increase in the number of Asian men from 2.1% to 10.7%. The number of Hispanic male medical students increased from 1.7% in 1978 to 3.4% in 1982 but has remained relatively stable since despite the large growth in the nation’s Latinx population since then.
While Black male medical students accounted for 3.1% of the national medical student body in 1978, in 2019 they accounted for just 2.9%. Without the contribution of historically Black medical schools, just 2.4% would be Black men. The number of Native American students also declined, accounting for just a fraction of 1% of the nation’s roughly 22,000 medical students in 2019.
“It is absolutely dismal and appalling and quite frankly unacceptable,” said Demicha Rankin, an anesthesiologist who serves as associate dean of admissions for The Ohio State University Wexler Medical Center, where 25% of students come from underrepresented minority groups. The report was published Wednesday in the New England Journal of Medicine.
advertisement
While U.S. medical schools have talked for years about their efforts to enroll more students of color, the new data underscore how little progress has been made and should serve as an urgent call to action, said physicians working to increase diversity. “Everytime I see stark numbers like these, I have a moment of depression,” Siobhan Wescott, an Alaskan Native physician who co-directs the Indians into Medicine program at the University of North Dakota, told STAT. “But they remind me how much work there is to do.”
The coronavirus pandemic has highlighted the deeply embedded medical inequities facing the nation — and the need for a more diverse medical workforce. The National Academy of Medicine is among many groups concluding that increasing racial and ethnic diversity among physicians would markedly improve care, access, and life expectancy for minority populations. African American males have the lowest life expectancy of any population in the United States. Studies show access to care and health outcomes improve when physicians more closely represent the patients they care for, partly because of increased trust. One study in Oakland showed Black male patients fared better with Black physicians because they were more likely to undergo preventive care procedures and accept flu shots.
advertisement
“I’m calling for a new beginning,” said Valerie Montgomery Rice, president and dean of the Morehouse School of Medicine, “because everything we’ve done in the past has not worked.”
In an editorial accompanying the new report, Winfred Williams, a nephrologist at Massachusetts General Hospital and NEJM’s deputy editor, called the statistics “grim” and noted that the racial gap that medicine has been trying to close was actually widening. The study, he wrote, “shows a disturbing lack of progress and no serious, intentional effort on the part of medical school admissions committees to rectify these inequities.” He added, “the medical establishment must be held accountable.”
STAT contacted a number of medical schools that ranked lowest in diversity in U.S. News and World Report rankings to ask why they had enrolled so few students from underrepresented minority groups and what changes they were instituting to increase diversity. Many said they were taking aggressive steps to improve and agreed their numbers had been poor, often because their admissions committees were not diverse or welcoming, they relied too heavily on MCAT scores to rank candidates, or because students of color they accepted chose to attend other schools.
The number of Black, Hispanic, Native American and Hawaiian or Pacific Islander physicians remains far below their percentages in the general U.S. population. A study released this month shows the percentage of doctors who are Black male physicians has not budged in 80 years. The fact that these groups remain underrepresented in medical school populations as well shows achieving the goal of a physician workforce that represents the nation will take years.
“The data speak for themselves,” said Eli Adashi, the new study’s senior author and the former dean of Brown University’s Warren Alpert Medical School. “It’s a clarion call for action.”
Last August, the Association of American Medical Colleges and National Medical Association, which represents Black physicians, teamed up to take more aggressive action to fight what they said was historically entrenched systemic racism that was excluding people of color from medical school ranks.
“Even the National Academies have called this an American crisis and that’s not an overstatement. This is important for the health of our nation,” said Norma Poll-Hunter, the senior director of equity, diversity, and inclusion for the AAMC. Poll-Hunter, like many working in the field of diversity, said she had mixed feelings about the attention being given only very recently to an issue she has spent 15 years working on. “On one hand, we feel we’ve been saying this for how long and people are finally paying attention,” she said. “At the same time, we now have so many allies and we need to leverage this moment for the long haul.”
For the new study, Adashi and his coauthors analyzed more than 40 years of medical student data, from 1978 to 2019, from some 150 medical schools that had been collected by the AAMC. They included only U.S. citizens, which make up more than 98% of American medical students, because the information for that group included gender, race, and ethnicity and used categories that correspond to U.S Census Bureau conventions: White, Asian, Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or other Pacific Islander. (Data collection by the AAMC changed over time to allow students to select more than one race and to designate if they were of Hispanic origin, but Adashi said those changes did not affect the overall results of the study.)
The analysis showed medicine has achieved a measure of gender equity, with women now constituting half of all medical school students compared to less than a quarter in 1978. But gains have not been equal among all women. The number of white women in medical schools increased from 18% to 24% of all students, while the number of Asian women increased from 0.8% to 11.7%. The increase in the number of Black and Hispanic women medical students was more modest. Black women enrollees increased from 2.2% to 4.4%, while Hispanic women enrollees increased from 0.7% to 3.2%.
There was a marked decrease in the number of white men in medical school, from 61.2% to 25.7% and an increase in the number of Asian men from 2.1% to 10.7%. The number of Hispanic male medical students increased from 1.7% in 1978 to 3.4% in 1982 but has remained relatively stable since despite the large growth in the nation’s Latinx population since then.
