Despite efforts by medical schools to increase diversity in their student bodies, the percentage of students that make up medicine’s most underrepresented groups — Black men and Native American and Alaskan Native men and women — has decreased over the last four decades, according to a recent study published in the New England Journal of Medicine by researchers from the Warren Alpert Medical School.
The percentage of Black male medical enrollees decreased from 3.1 percent in 1978 to 2.9 percent in 2019. The percentage of Native American and Alaskan Native medical students also decreased during this time period, accounting for less than one percent of the total student body.
The study additionally found that the percentage of other historically underrepresented groups in medicine — Hispanic men and women, Native Hawai’ian or Pacific Islander men and women and black women — have increased, though these increases have not kept pace with the overall increase of these racial and ethnic groups in the U.S. population.
Using data collected by the Association of American Medical Colleges, researchers analyzed trends in gender and racial makeup of medical schools over the past 40 years. In what the researchers referred to as “a persistent failure to substantially improve the racial and ethnic diversity of the national medical student body,” they found that the percentage of minority medical students remains well under their representation in the national population.
“We knew the situation would be bad. What we weren’t prepared for is just the utter lack of progress over the time frame we examined,” said co-author of the paper Phillip Grupposo, professor of medical science and former associate dean of medical education at Warren Alpert Medical School. “Medical schools have been saying now for 20 plus years that (diversity of the medical student body) is a priority … but we’re basically at the same starting point we were at in 1980,” he said.
Lead author of the study Devin Morris MD '21 said that she hopes the results of this study will propel issues of racial and ethnic representation “to the forefront of medical education” and push medical schools to increase efforts to diversify their applicants.
There is a large body of evidence that suggests that the lack of racial and ethnic diversity in medical schools — and by extension, the medical profession — needs to be addressed to “maximize the effectiveness of the healthcare system,” Grupposo said. According to this California-based study cited by the researchers, racial and ethnic minorities are more likely to consult a physician of the same race or ethnicity. The study also found that Black and Hispanic physicians are more likely to practice in underserved communities of color with a low physician to patient ratio.
“The healthcare workforce would do well and do better if it were more diverse,” said Eli Adashi, professor of medical science and former Dean of Medicine and Biological Sciences at Warren Alpert Medical School. Public health issues that disproportionately affect communities of color, such as vaccine hesitancy, might be more effectively handled by physicians that can better connect to these communities, he added.
“With the strong empirical evidence we have, it’s actually unethical not to diversify medicine when we know it’s going to improve the quality of care people receive and the quality of doctors (that graduate),” said Elle Lett, a PhD recipient and MD candidate at the University of Pennsylvania who has also conducted research on diversity and inclusion in medical schools.
“I think that there’s a dissonance between the metrics we use to evaluate people and what makes a good doctor,” Lett said. She added that medical schools should prioritize admitting “those underrepresented individuals that go into primary care settings and actually help improve the quality of care,” as opposed to those with the highest standardized test scores.
The study calls for medical schools to increase the diversity of applicants by implementing more “holistic review” admissions policies, which would ensure that “balanced consideration is given to experiences, attributes and academic qualifications” and less emphasis is put on an applicant’s Medical College Admission Test score. Additionally, medical schools should invest in local bridge and pipeline programs, which prepare underserved high school and undergraduate students with the educational opportunities to succeed in medical school.
The Warren Alpert Medical School has been focused on growing existing pipeline programs — like the Department of Pathology and Laboratory Sciences’ Summer Research Internship for underrepresented high school students — and actively developing new ones, according to Joseph Diaz, associate dean for diversity and multicultural affairs for Warren Alpert. Month of Medical School is a pilot program launching this summer, where low-income, first-generation and under-represented Providence undergraduates will have the opportunity to undergo three weeks of guided medical school curriculum, lectures and application workshops.
The Warren Alpert Medical School admissions team also currently works with a task force that has been “charged with looking at our admissions process with a focus on underrepresented students,” Diaz said.
Changes in medical school admissions will have far-reaching effects on the future of healthcare. “I think that this is not just an issue of equity in education, but health equity,” he said. “Having a more diverse workforce means we better care for our communities.”
The lack of representation of racial and ethnic minorities in medicine is just one symptom of systemic racial inequities “in need of redress at the national level,” Dr. Adashi said.
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