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Scope: Parity story

Closing racial gaps in medical residencies could take decades

A new study shows that increasing Black and Latino representation in medical residencies to match U.S. population representation could take decades.

A new collaborative study from Stanford emergency medicine physicians Christopher Bennett, MD, and Maame Yaa Yiadom, MD, offers insight into how the relative lack of Black and Latino medical residents has shown little improvement over time.

If the trend continues, it could take 50 to 90 years for Black and Latino residents to reach parity -- the point at which their representation in medical training is equal to the overall representation in the U.S. population, projected the study, published Feb. 24 in the Journal of General Internal Medicine.

Maame Yaa Yiadom, MD

Reaching a representative balance in health care is crucial to a workforce reflective of the overall community. Previous research shows that patients have better health results when their doctors have backgrounds similar to their own.

To better understand the challenge, Bennett, assistant professor of emergency medicine, and Yiadom, associate professor of emergency medicine, collaborated with researchers from Brigham and Women's Hospital and Harvard Medical School to examine data from 20 of the largest medical resident specialties, such as internal medicine, anesthesiology, surgery and pediatrics, from 2007 through 2018.

After evaluating more than 180,000 records, the researchers found that, during those years, no Black or Latino populations reached equal representation in any of the medical residency specialties included in the study when compared to the U.S. population.

Christopher Bennett, MD

In 2018, at the end of the study period, total medical school enrollment of students in the United States who identified as Black or African American was 7.1% compared to 13.4% representation in the general population. Enrollment of those identifying as Hispanic, Latino or Spanish was 6.2% compared to 18.5% of the general population.

"We are all very much aware that the physician population is not reflective of the general population ... but we didn't know it was this bad," said Bennett, lead and corresponding author of the study. "Given the diversity and inclusion efforts in recruitment and retention at most medical schools during the years we studied, we expected to see an increase in representation. But some schools have actually had negative change." 

The study didn't address the reasons for the continuing imbalance, but Yiadom, second author on the study, offers her insight. "Students of color are often not able to find mentors who can guide and support them," she said. "There is more to learning and being successful than what one can find in a textbook or on a board exam."

There's a hidden curriculum for navigating the system, and if you don't have guidance along the journey at key times, completing medical school successfully and transitioning to residencies can be a difficult feat, Yiadom said.

Finding the gap

Emergency medicine is one of the medical residency specialties that decreased in Black representation during the 11 years that were analyzed, declining from 4.8% in 2007-2008 to 4.4% in 2017-2018.

"I see more emergency physicians of color now than I did when I was a medical student, but emergency medicine has also grown in size," Yiadom said. "The specialty is more popular and attracting more people in general. But the growth of the specialty appears to have outpaced the growth of Black and Latino representation."

At the end of the study period, OB-GYN had the highest representation of both Black and Latino residents; otolaryngology (a field that focuses on ear, nose and throat health) had the widest gap in the representation of Black medical residents; and dermatology had the highest gap of representation among Latino medical residents.

The gaps are not on pace to close any time soon, the study showed. To figure out just how long it might take to narrow those disparities, the authors looked at the small number of specialties with growth in representation and used that rate of growth to project the number of years it might take a specialty to catch up to representation akin to national demographics.

If nothing changes, the researchers predicted it could take 77 years for Black radiology candidates to catch up. Latino orthopaedic surgical residents face the biggest challenge, with an estimate of 93 years before their numbers are equal to their representation in the U.S. population. For Latino emergency medicine residents, it could take 54 years.

Speeding up change

With the right approaches, though, it's possible to close the gaps a lot sooner, the authors said. "Having the right talent and resources in the right place is a start," Yiadom said. "However, success may be elusive if candidates are unable to access the mentorship and collegial support for the journey toward becoming an academic."

Efforts to address the disparities have been in place for several years in most medical schools, with improvements progressing at various paces.

The Stanford University School of Medicine has seen a significant increase in the past few years in representation of Latino and Black medical students, said Iris Gibbs, MD, associate dean of MD admissions and professor of radiation oncology. In Stanford's entering medical school class in 2020, for instance, students who are underrepresented in medicine made up more than 35% of the class.

However, said Gibbs, who wasn't among the study's researchers, "A single medical school cannot solve this issue alone." Two important factors in closing the gap must be considered, she said: Stanford's medical school class size has increased only marginally in the past 30-40 years; and the nation is projected to become a majority-minority nation with a significant expected continued rise in the Latino population.

"It is highly unlikely that, at the current pace, that there will be parity unless truly transformational changes are made that account not only for the current, but also future trends," Gibbs said.

Initiatives across the board that include diversity training, mentorship programs, and revised recruitment practices are a step in the right direction, but the researchers said more needs to be done.

"We need more students with increased access to pre-med curriculum and students need support in applying to medical schools," Bennett said. "Medical schools need to revisit the interview process and recognize and eliminate conscious and unconscious biases. And people need to see the problem -- efforts won't be successful if people won't take ownership in changing the system. We hope our study will shed light on that."

Image by Nuthawut

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