Karen S. Williams, M.D., Chair
Committee on Professional Diversity

ccording to Diversity in the Physician Workforce: Facts & Figures 2006, published by the Association of American Medical Colleges, 50 percent of the U.S. population will represent racial and ethnic minorities by the year 2050, including 25 percent Hispanic. Only 6.4 percent of graduates from U.S. allopathic medical schools, however, represent Blacks, Hispanics/Latinos and Native Americans in 2004. This is in distinct contrast to their 26 percent proportion of the U.S. population in 2000 census data. Asian physicians represented the largest proportion of ethnic minority graduates (5.7 percent) from U.S. allopathic medical schools in 2004. Asians also represent the largest increase in growth of all ethnic minority physicians from 1950-2004 and 50 percent of ethnic minority physicians younger than 34 years.¹

Many studies document that disparities in the quality of and access to various types of health care continue to exist in diverse and low socioeconomic communities.² Increasing diversity in the physician workforce has been cited by many landmark reports as one avenue to decrease these disparities and improve patient satisfaction.^3,4 Improved diversity also increases cultural sensitivity to gender, sexual orientation, religion, national origin, socioeconomic status and disabilities. Racial and ethnic diversity broadens the cultural awareness of all medical students by challenging their assumptions, expanding their ideas and improving their intellectual and social outcomes.^5-11

Asians represent the largest proportion of all minority applicants to medical school (18.8 percent). Blacks, Hispanics, Native Americans/Alaska Natives and Native Hawaiians/Other Pacific Islanders total 15.3 percent of the minority applicant pool.¹² Approximately half of all minority applicants are accepted into medical school, and the percentage of women acceptances now surpasses their male counterparts in most minority groups.¹² Women also represented 46 percent of all graduates from medical schools in 2004. The number of practicing minority male physicians continue to outnumber the number of minority women physicians by approximately 27 percent for all minority groups except Blacks, where women represent 62 percent of all Black graduates since 1990. The number of White male graduates has decreased by 38.3 percent since 1980.¹

The leading practice subspecialties for minority U.S. physicians are internal medicine, family/general practice, pediatrics, obstetrics/gynecology, general surgery and anesthesiology, with similar percentages among all ethnic groups practicing anesthesiology (5 percent) when compared with other primary care subspecialties as of 2004 [Table 1, page 36]. The percentage of men in racial and ethnic groups who specialize in anesthesiology and general surgery consistently outnumber women, whereas women tend to outnumber men in family medicine, obstetrics/gynecology and pediatrics. Of note, Native American and White physicians also favor emergency medicine and Asians favor ophthalmology versus their White counterparts choosing orthopedic surgery as popular subspecialties. Psychiatry represents approximately 4 percent of all ethnic subspecialties except in the Asian population, where the percentage is significantly less.¹



Of particular concern, racial and ethnic physician representation among medical school faculty is critically low. Overall, minority faculty members are concentrated at the assistant professor level. Men of ethnic and racial minorities far surpass their female counterparts as full professors. Furthermore, 70 percent of women faculty are concentrated at the lowest academic ranks of instructor and assistant professor, with minority women being most prevalent at the instructor level.¹³ This constitutes a very disturbing problem in our medical educational system, impeding cross-cultural experiences in research, didactics, role models and clinical training.

Racial and ethnic minority physicians tend to practice in communities that have a higher proportion of racial and ethnic patients. This trend is expected to continue since approximately 51 percent of Black, 41 percent of Native American/Alaska Native and 33 percent of Hispanic graduating medical students report their intentions to practice in underserved areas.¹² Only 18.4 percent of White physicians reported such intentions. Diverse patients reportedly prefer physicians of their own racial and ethnic groups, even after controlling for office locations and language proficiencies. Some reasons cited are trust, culture and strong beliefs about racial discrimination. Diverse physicians and females are more likely to treat patients of low socioeconomic status and Medicaid recipients. Patients identified as medically indigent are particularly more likely to have Asian and Black physicians, in spite of gender, specialization or location.¹

ASA is an educational and subspecialty medical organization committed to fostering and mentoring and the inclusion of diverse members of all cultural, ethnic and gender venues. ASA is dedicated to the education and promotion of medical students through postgraduate members to enhance their potential as physicians, mentors and leaders. While there are shining examples of women in leadership positions — such as Rebecca J. Patchin, M.D., who has recently been appointed Secretary of the American Medical Association Board of Trustees, and Candace E. Keller, M.D., M.P.H., ASA’s Speaker of the House — there is no current, formal mechanism within ASA to consistently capture and monitor, beyond age and gender, the racial and ethnic diversity of our membership or committee appointments or to monitor the leadership potential of our diverse members.

Hence the Committee on Professional Diversity is devoted to identifying organizational and professional opportunities to enhance the diverse representation of our subspecialty at all levels. We hope to accomplish this goal in several ways. First, we look forward to proposing a formal mentoring program within the Society to enhance the professional development and leadership potential of our multicultural subspecialty. Second, we would like to enlist the collaboration of multiple levels of anesthesiology associations (from academia through private practice and ASA executives) to provide highly visible models of culturally enhancing and gender-enhancing paradigms.

As an organization known for promoting positive, measurable change, ASA, in collaboration with the Committee on Professional Diversity, hopes to identify and enhance advantages and measurable outcomes of promoting diversity awareness regarding racial, ethnic, cultural, gender, sexual orientation, national origin, religious beliefs, socioeconomic status and disability. Third, we will continue to provide educational programs that broaden the knowledge of our membership of the changing face of America in order to provide role models, leaders and a diverse physician workforce that more closely mirrors the cultural shifts in our patient population. Fourth, we seek to develop one reliable database within ASA in order to accurately capture current and future trends in a broad number of diversity measures that impact the business of our organization and the working environments of our members. Finally, ASA will strive to work collaboratively with our academic programs to increase the diverse representation of medical school faculty at all academic ranks in order to replenish our subspecialty and appropriately train our medical students and residents in preparation for our multicultural nation.

References:
1. Association of American Medical Colleges, Division of Diversity Policy and Programs. Diversity in the Physician Workforce: Facts & Figures, 2006.
2. Agency for Healthcare Research and Quality. 2005 National Healthcare Disparities Report. Rockville, MD: U.S. Department of Health and Human Services; 2005.
3. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Healthcare. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press; 2003.
4. Sullivan Commission on Diversity in the Healthcare Workforce. Missing Persons: Minorities in the Health Professions. The Sullivan Commission, 2004.
5. Whitla KD, Orfield G, Silen W, et al. Educational Benefits of Diversity in Medical School: A Survey of Students. Acad Med. 2003; 78:460-466.
6. Cohen JJ. The consequences of premature abandonment of affirmative action in medical school admissions. JAMA. 2003; 289:1143-1149.
7. Astin AW. What Matters in College? Four Critical Years Revisited. San Francisco, CA: Jossey-Bass; 1993.
8. Gurin P. The compelling need for diversity in higher education: Expert testimony in Gratz, et al. v. Bollinger, et al. Michigan J of Race & Law. 1999; 5:363-425.
9. Smith DG & Associates. Diversity Works: The Emerging Picture of How Students Benefit. Washington, DC: Association of American Medical Colleges and Universities, 1997.
10. Antonio AL, Chang MJ, Hakuta K, et al. Effects of racial diversity on complex thinking in college students. Psychological Science. 2004; 15:501-510.
11. Nemeth CJ, Wachtler J. Creative problem solving as a result of majority vs. minority influence. European J of Social Psychology. 1983;13:45-55.
12. Association of American Medical Colleges, Division of Diversity Policy and Programs. Minorities in Medical Education: Facts & Figures, 2005.
13. Magrane D, Clark V, Yamagata H, et al. Women in U.S. Academic Medicine: Statistics and Medical School Benchmarking. Washington, DC: Association of American Medical Colleges; 2004.

Karen S. Wiliams, M.D., is Associate Professor of Anesthesiology, George Washington University Medical Center, Washington, D.C.