America is growing more diverse. People who identify as black, Hispanic, or Native American make up nearly one-third of the population. That figure will grow to over 40 percent within the next 40 years.
The nation's doctor corps is bucking this trend. Only about 13 percent of primary care doctors today are black, Hispanic, or Native American. That share is unlikely to budge in the near future, as the current pool of medical students is disproportionately white and well-off.
The lack of diversity among doctors is a problem — and not just one of optics. There's evidence that a diverse physician workforce can yield better outcomes or patients — and even save lives.
Medical schools don't reflect American society. The U.S. Census Bureau projects that the United States will become a "majority-minority" nation by 2045. In 2017, less than 6 percent of U.S. medical graduates were black — even though African-Americans account for 12 percent of the U.S. population. Amazingly, fewer African-American men applied to medical school in 2014 than in 1978.
Linguistic diversity is lacking, too. Nearly 40 million Americans speak Spanish at home. Twenty-five million Americans have "limited English proficiency." But in 2017, less than 5 percent of U.S. medical graduates were Hispanic. The ratio of Latino doctors to Latino patients has actually fallen by more than 20 percent since 1980.
America's doctors-in-training also lack socioeconomic diversity. Between 2007 and 2017, more than 75 percent of medical school graduates came from households with annual incomes in the top two quintiles, or more than $75,000 a year. Only 5 percent came from the bottom quintile, or up to $24,000 a year.
The intersection of race and socioeconomic status is revealing, too. In 2015, black and Hispanic or Latino medical school matriculants were three times more likely than white matriculants to come from households with an income of less than $50,000.
This disconnect between the composition of American society and that of the doctor workforce threatens public health. Here's why.
First, patients report greater levels of satisfaction with their care when treated by physicians with similar racial backgrounds, according to a study in the Journal of Health and Social Behavior.
The number of minority patients is growing. If they're unable to find a doctor they identify with and trust, they may opt not to seek care. And that has serious implications for not just their health but that of the public.
Consider a recent study from Stanford. Researchers randomly assigned black and non-black male doctors to a group of over 1,300 black men in Oakland, California. They found that patients treated by black doctors were more likely to seek preventive services than those treated by non-black doctors. Patients were also more likely to discuss other health issues with doctors of the same race.
The study concluded that increasing the number of black doctors "could help reduce cardiovascular mortality by 16 deaths per 100,000 per year" among black men.
Second, language barriers can increase the risk of health complications. In a 2007 study of six hospitals, patients with limited English proficiency were 66 percent more likely than English speakers to experience physical harm from "adverse events."
Third, doctors tend to practice in communities similar to the ones they've come from. Upper middle-class med students from the suburbs tend not to set up shop in poor urban or rural areas.
As a study published in the Journal of Health Care for the Poor and Underserved put it, minority physicians "are more likely to practice in areas federally designated as medically underserved or experiencing health professional shortages than white physicians."
The story is the same in rural areas. One of the top "predictors of choice of rural primary care" is rural background, according to The Journal of the American Medical Association.
Some medical schools are trying to diversify their ranks. The Yale Department of Psychiatry just announced plans to establish a new program dedicated to training minorities who provide treatment to patients in high-need, underserved areas.4 comments on this story
The CityDoctors scholarship program at St. George's University in Grenada — the school I lead — covers tuition for certain students from the New York metropolitan area who commit to working in the city's public hospital system after graduation. The program helps make medical school affordable for students committed to addressing inequity in our health care system — including some who have been the first in their families to go to college.
The organization "Black Men in White Coats" has partnered with select medical schools to create short documentaries to raise awareness about the dearth of African-American doctors — and encourage young black students to pursue careers in medicine.
Diversity saves lives. It's time we make diversifying our doctor workforce a bigger priority.