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Healthcare Disparities at the Crossroads with Healthcare Reform pp 167–193Cite as

The Diversity Benefit: How Does Diversity Among Health Professionals Address Public Needs?

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Abstract

The Patient Protection and Affordable Care Act (PPACA) signed by President Obama on March 23, 2010, is a far-reaching law intended to improve access to and the quality of health care for Americans. Recognizing the importance of the health workforce to the nation’s health, the Act addresses health workforce and health professions education and training issues through provisions to strengthen the primary care workforce, provide tax relief for health professionals with state loan repayments, establish a national Health Care Workforce Commission, and expand the primary healthcare workforce by increasing and improving low-interest student loans. It is estimated that PPACA would afford access to health care for 32 million more currently uninsured new healthcare consumers, many of which ethnic and racial minorities or members of other vulnerable groups. As the Act is enacted, the nation is experiencing unprecedented demographic change. When the 2010 Census counts are tallied, we may finally grasp the degree of demographic shifts that the nation has undergone in the past decade. Since the 2000 Census, data gleaned from the American Community Survey and demographic models such as the one carried out by the Pew Research Center (Passel and Cohn, U.S. population projections: 2005–2050. Washington, DC: Pew Research Center: Social and Demographic Trends, 2008) predict major population shifts. By 2042, one in two Americans will be an Asian American, Pacific Islander, African American, Hispanic, American Indian, and/or Alaska Native. Since 2000, Hispanics have accounted for over one-half of the population increase in the United States. The number of Asian Americans grew at a larger proportion (9.0%) than any other racial or ethnic group during this same time period. In at least four states (California, Hawaii, Texas, and New Mexico) and the District of Columbia, racial and ethnic “minorities” constitute a majority of the population (U.S. Census Bureau, An older and more diverse nation by midcentury, 2008. http://www.census.gov/Press-Release/www/releases/archives/population/012496.html, Accessed 22 Oct 2008; U.S. Bureau of Census, Hispanic Americans by the number, 2008. http://www.infoplease.com/spot/hhmcensus1.html, Accessed 9 Jan 2010). Moreover, because of reproductive and immigration patterns, minorities are disproportionally represented among the younger population. Today, minorities account for 43% of Americans under 20 years of age, and it is projected that over the next two decades minority students will account for almost 40% of the total college population (Roberts, Minorities often a majority of the population under 20, The New York Times, 2008). Despite the rapid growth of racial and ethnic minority groups in the United States, many are dramatically underrepresented among the nation’s health professionals. The percentage of African American, Hispanic, American Indian, Alaska Native, or Pacific Islander1 in the health professions has grown only modestly at best over the past 30 years. Yet relative to the growth of the minority population in the United States, this rate of increase still leaves the proportion of minority health professionals outstripped by several fold. Hispanics, for example, comprise over 15% of the U.S. population, but only 2% of the registered nurse population, 4.6% of psychologists, and 5.0% of physicians. Similarly, one in eight individuals in the United States is African American, yet less than 1 in 20 dentists or physicians are African American. Minorities are severely underrepresented in academia. During the 2007–2008 academic year, URMs (underrepresented minorities) made up only 7.4% of U.S. medical school faculty, fewer than 7% of undergraduate faculty, less than 10% of baccalaureate and graduate nursing school faculty, 12% of clinical psychology faculty, and 8.6% of dental school faculty (Moreno et al., Using multiple lenses: an examination of the economic and racial/ethnic diversity of college students. In: Univ AoACa, editor. California: The James Irvine Foundation, Claremont Graduate University, 2006; Institute of Medicine, In the nation’s compelling interest: ensuring diversity in the health-care workforce. Washington, DC: Institute of Medicine, 2004; Hall, Clin Psychol Sci Pract 13:258–261, 2006).

Groups that are considered among those underrepresented in medicine (URM).

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References

  1. Institute of Medicine. In the nation’s compelling interest: ensuring diversity in the health-care workforce. Washington, DC: Institute of Medicine; 2004.

    Google Scholar 

  2. Sullivan Commission on Diversity in the Health Workforce. Missing persons: minorities in the health professions. Washington, DC; Sept 2004.

    Google Scholar 

  3. Association of Academic Health Centers. Out of order out of time: the state of the nation’s health workforce. Washington, DC: Association of Academic Health Centers; 2008.

    Google Scholar 

  4. Macy Jr J. Revisiting the medical educational mission at a time of expansion. New York: The Josiah Macy Foundation; 2009.

    Google Scholar 

  5. Mullan F, Chen C, Petterson S, Kolsky G, Spagnola M. The social mission of medical education: ranking the schools. Ann Intern Med. 2010;152(12):804–11.

    PubMed  Google Scholar 

  6. Brown TT, Scheffler RM, Tom SE, Schulman KA. Does the market value racial and ethnic concordance in physician-patient relationships? Health Serv Res. 2007;42(2):706–26.

    Article  PubMed  Google Scholar 

  7. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15.

    PubMed  Google Scholar 

  8. LaVeist TA, Carroll T. Race of physician and satisfaction with care among African-American patients. J Natl Med Assoc. 2002;94(11):937–43.

    PubMed  Google Scholar 

  9. LaVeist TA, Morgan A, Arthur M, Plantholt S, Rubinstein M. Physician referral patterns and race differences in receipt of coronary angiography. Health Serv Res. 2002;37(4):949–62.

    Article  PubMed  Google Scholar 

  10. Laveist TA, Nuru-Jeter A. Is doctor–patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43(3):296–306.

    Article  PubMed  Google Scholar 

  11. LaVeist TA, Nuru-Jeter A, Jones KE. The association of doctor–patient race concordance with health services utilization. J Public Health Policy. 2003;24(3–4):312–23.

    Article  PubMed  Google Scholar 

  12. Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA. Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes? Ethn Health. 2009;14(1):107–30.

    Article  PubMed  Google Scholar 

  13. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient–physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004.

    Article  PubMed  CAS  Google Scholar 

  14. Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff (Millwood). 2000;19(4):76–83.

    Article  CAS  Google Scholar 

  15. Street Jr RL, O’Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient–physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008;6(3):198–205.

    Article  PubMed  Google Scholar 

  16. Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U. The predictors of patient–physician race and ethnic concordance: a medical facility fixed-effects approach. Health Serv Res. 2010;45(3):792–805.

    Article  PubMed  Google Scholar 

  17. Traylor AH, Subramanian U, Uratsu CS, Mangione CM, Selby JV, Schmittdiel JA. Patient race/ethnicity and patient–physician race/ethnicity concordance in the management of cardiovascular disease risk factors for patients with diabetes. Diab Care. 2010;33(3):520–5.

    Article  Google Scholar 

  18. Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff (Millwood). 2002;21(5):90–102.

    Article  Google Scholar 

  19. Shaw SJ. The logic of identity and resemblance in culturally appropriate health care. Health. 2010;14(5):523–44.

    PubMed  Google Scholar 

  20. Cooper-Patrick L, Gallo JJ, Gonzales JJ. Race, gender, and partnership in the patient–­physician relationship. JAMA. 1999;282(6):583–9.

    Article  PubMed  CAS  Google Scholar 

  21. Perez-Stable EJ, Napoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care. 1997;35(12):1212–19.

    Article  PubMed  CAS  Google Scholar 

  22. Clark T, Sleath B, Rubin RH. Influence of ethnicity and language concordance on physician–patient agreement about recommended changes in patient health behavior. Patient Educ Couns. 2004;53(1):87–93.

    Article  PubMed  Google Scholar 

  23. Green AR, Ngo-Metzger Q, Legedza AT, Massagli MP, Phillips RS, Iezzoni LI. Interpreter services, language concordance, and health care quality. Experiences of Asian Americans with limited English proficiency. J Gen Intern Med. 2005;20(11):1050–6.

    Article  PubMed  Google Scholar 

  24. Heins A, Homel P, Safdar B, Todd K. Physician race/ethnicity predicts successful emergency department analgesia. J Pain. 2010;11(7):692–7.

    Article  PubMed  Google Scholar 

  25. Betancourt J, Green A, Carrillo J. Cultural competence in health care: emerging frameworks and practical approaches. New York: The Commonwealth Fund; 2002.

    Google Scholar 

  26. Brown T, Liu JX, Scheffler RM. Does the under- or overrepresentation of minority physicians across geographical areas affect the location decisions of minority physicians? Health Serv Res. 2009;44(4):1290–308.

    Article  PubMed  Google Scholar 

  27. Chen J, Rathore SS, Radford MJ, Wang Y, Krumholz HM. Racial differences in the use of cardiac catheterization after acute myocardial infarction. N Engl J Med. 2001;344(19):1443–9.

    Article  PubMed  CAS  Google Scholar 

  28. Institute of Medicine. Unequal treatment: confronting ethnic and racial disparities in health care. Washington, D.C.: The National Academic Press; 2003.

    Google Scholar 

  29. Konrad TR, Howard DL, Edwards LJ, Ivanova A, Carey TS. Physician–patient racial concordance, continuity of care, and patterns of care for hypertension. Am J Public Health. 2005;95(12):2186–90.

    Article  PubMed  Google Scholar 

  30. Burgess DJ, Crowley-Matoka M, Phelan S, et al. Patient race and physicians’ decisions to prescribe opioids for chronic low back pain. Soc Sci Med. 2008;67(11):1852–60.

    Article  PubMed  Google Scholar 

  31. Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478–86.

    Article  PubMed  Google Scholar 

  32. Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.

    Article  PubMed  Google Scholar 

  33. Hernandez AF, Fonarow GC, Liang L. Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA. 2007;298(13):1525–32.

    Article  PubMed  CAS  Google Scholar 

  34. Schulman KA, Berlin JA, Harless W. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340(8):618–26.

    Article  PubMed  CAS  Google Scholar 

  35. Burgess DJ, van Ryn M, Crowley-Matoka M, Malat J. Understanding the provider contribution to race/ethnicity disparities in pain treatment: insights from dual process models of stereotyping. Pain Med. 2006;7(2):119–34.

    Article  PubMed  Google Scholar 

  36. van Ryn M, Burgess D, Malat J, Griffin J. Physicians’ perceptions of patients’ social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease. Am J Public Health. 2006;96(2):351–7.

    Article  PubMed  Google Scholar 

  37. Malat JR, van Ryn M, Purcell D. Race, socioeconomic status, and the perceived importance of positive self-presentation in health care. Soc Sci Med. 2006;62(10):2479–88.

    Article  PubMed  Google Scholar 

  38. Avenanti A, Sirigu A, Aglioti SM. Racial bias reduces empathic sensorimotor resonance with other-race pain. Curr Biol. 2010;20(11):1018–22.

    Article  PubMed  CAS  Google Scholar 

  39. Ferguson WJ, Candib LM. Culture, language, and the doctor–patient relationship. Fam Med. 2002;34(5):353–61.

    PubMed  Google Scholar 

  40. Rosenheck R, Fontana A, Cottrol C. Effect of clinician-veteran racial pairing in the treatment of posttraumatic stress disorder. Am J Psychiatry. 1995;152(4):555–63.

    PubMed  CAS  Google Scholar 

  41. Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA. 1995;273(19):1515–20.

    Article  PubMed  CAS  Google Scholar 

  42. Cantor JC, Miles EL, Baker LC, Barker DC. Physician service to the underserved: ­implications for affirmative action in medical education. Inquiry. 1996;33(2):167–80.

    PubMed  CAS  Google Scholar 

  43. Komaromy M, Grumbach K, Drake M. The role of black and Hispanic physicians in ­providing health care for underserved populations. N Engl J Med. 1996;334(20):1305–10.

    Article  PubMed  CAS  Google Scholar 

  44. Solomon E, Williams CR, Sinkford JC. Practice location characteristics of Black dentists in Texas. J Dent Educ. 2001;65:571–4.

    Google Scholar 

  45. Mertz EA, Grumbach K. Identifying communities with low dentist supply in California. J Public Health Dent. 2001;61(3):172–7.

    Article  PubMed  CAS  Google Scholar 

  46. Wayne S, Timm C, Serna L, Solan B, Kalishman S. Medical students’ attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency. J Health Care Poor Underserved. 2010;21(2):438–47.

    Article  PubMed  Google Scholar 

  47. Rosenblatt RA, Andrilla CH. The impact of U.S. medical students’ debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire. Acad Med. 2005;80(9):815–19.

    Article  PubMed  Google Scholar 

  48. Jeffe DB, Whelan AJ, Andriole DA. Primary care specialty choices of United States medical graduates, 1997–2006. Acad Med. 2010;85(6):947–58.

    Article  PubMed  Google Scholar 

  49. Saha S, Guiton G, Wimmers PF, Wilkerson L. Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA. 2008;300(10):1135–45.

    Article  PubMed  CAS  Google Scholar 

  50. Adashi EY, Gruppuso PA. Commentary: the unsustainable cost of undergraduate medical education: an overlooked element of U.S. health care reform. Acad Med. 2010;85(5):763–5.

    Article  PubMed  Google Scholar 

  51. Association of American Medical Colleges. Diversity in medical education: facts and ­figures 2008. Washington, DC: AAMC; 2008.

    Google Scholar 

  52. American Medical Association. Total physicians by race/ethnicity. 2006. http://www.­ama-assn.org/ama/pub/category/12930.html.

  53. U.S. Census Bureau. An older and more diverse nation by midcentury. 2008. http://www.census.gov/Press-Release/www/releases/archives/population/012496.html. Accessed 22 Oct 2008.

  54. Roberts S. Minorities often a majority of the population under 20. The New York Times. 2008.

    Google Scholar 

  55. Association of American Medical Colleges. The complexities of physician supply and demand: projections through 2025. Center for Workforce Studies. 2008. https://services.aamc.org/Publications/showfile.cfm?file=version122.pdf&prd_id=244&prv_id=299&pdf_id=122. Accessed 11 Nov 2008.

  56. PricewaterhouseCoopers Health Research Institute. What works: healing the healthcare staffing shortage. 2007.

    Google Scholar 

  57. Association of American Medical Colleges. AAMC statement on the physician workforce. 2006. http://www.aamc.org/workforce/workforceposition.pdf. Accessed 11 Nov 2008.

  58. Association of Schools of Public Health. Confronting the public health workforce crisis. 2008. http://www.asph.org/document.cfm?page=1038. Accessed 21 May 2008.

  59. American Association of Colleges of Pharmacy. Dramatic rise in need for pharmacists projected. 2002. http://www.aacp.org/site/tertiary.asp?TRACKID=&VID=2&CID=577&DID=4638. Accessed 11 Nov 2008.

  60. Pal S. Pharmacist shortage to worsen in 2020. US Pharm. 2002;27:12.

    Google Scholar 

  61. Page SE. The difference: how the power of diversity creates better groups, firms, schools, and societies. Princeton: Princeton University Press; 2007.

    Google Scholar 

  62. Institute of Medicine. The unequal burden of cancer: an assessment of NIH programs and research on minorities and the medically underserved. Washington, DC: National Academy Press; 1997.

    Google Scholar 

  63. Whitla DK, Orfield G, Silen W, Teperow C, Howard C, Reede J. Educational benefits of diversity in medical school: a survey of students. Acad Med. 2003;78(5):460–6.

    Article  PubMed  Google Scholar 

  64. Antonio AL, Chang MJ, Hakuta K, Kenny DA, Levin S, Milem JF. Effects of racial diversity on complex thinking in college students. Psychol Sci. 2004;15(8):507–10.

    Article  PubMed  Google Scholar 

  65. Gurin P, Dey El E, Hurtado S, Gurin G. Diversity and higher education: theory and impact on educational outcomes. Harv Educ Rev. 2002;72:330–66.

    Google Scholar 

  66. Flexner A. Medical education in the United States and Canada. New York: Carnegie Foundation for the Advancement of Teaching; 1910.

    Google Scholar 

  67. Sullivan LW, Suez Mittman I. The state of diversity in the health professions a century after Flexner. Acad Med. 2010;85(2):246–53.

    Article  PubMed  Google Scholar 

  68. Moreno J, Smith D, Parker S, Clayton-Pedersen A, Teraguchi D. Using multiple lenses: an examination of the economic and racial/ethnic diversity of college students. In: Univ AoACa, editor. California: The James Irvine Foundation, Claremont Graduate University; 2006.

    Google Scholar 

  69. Grumbach K, Coffman J, Rosenoff E, Munoz C, Gandara P, Sepulveda E. Strategies for improving the diversity of the health professionals. Woodland Hills: The California Endowment; 2003.

    Google Scholar 

  70. Institute of Medicine. The right thing to do the smart thing to do. Washington, D.C.: Institute of Medicine, National Academy Press; 2001.

    Google Scholar 

  71. Lee PR, Frank PE. Diversity in U.S. medical schools revitalizing efforts to increase diversity in a changing context, 1960–2000s. San Francisco: Institute for Health Policy Studies, School of Medicine University of California; 2009.

    Google Scholar 

  72. Darling-Hammond L. Inequality in teaching and schooling: how opportunity is rationed to students of color in America. In: Smedley B, Stith A, Colburn L, Evans C, editors. The right thing to do: the smart thing to do: enhancing diversity in health professions. Washington, DC: The National Academy Press; 2001.

    Google Scholar 

  73. Nettles M, Millett C. Towards diverse student representation and higher achievement in heigher levels of the American educational meritocracy. In: Smedley B, Stith A, Colburn L, Evans C, editors. The right thing to do, the smart thing to do: enhancing diversity in health professions. Washington, DC: The National Academy Press; 2001.

    Google Scholar 

  74. Rainey M. How do we retain minority health profession students? In: Smedley B, Stith A, Colburn L, Evans C, editors. The right thing to do, the smart thing to do: enhancing diversity in health professions. Washington, DC: The National Academy Press; 2001.

    Google Scholar 

  75. Cantor JC, Bergeisen L, Baker LC. Effect of an intensive educational program for minority college students and recent graduates on the probability of acceptance to medical school. JAMA. 1998;280(9):772–6.

    Article  PubMed  CAS  Google Scholar 

  76. Edwards JC, Elam CL, Wagoner NE. An admission model for medical schools. Acad Med. 2001;76(12):1207–12.

    Article  PubMed  CAS  Google Scholar 

  77. Passel JS, Cohn DV. U.S. population projections: 2005–2050. Washington, DC: Pew Research Center: Social and Demographic Trends; 2008.

    Google Scholar 

  78. U.S. Bureau of Census. Hispanic Americans by the number. 2008. http://www.infoplease.com/spot/hhmcensus1.html. Accessed 9 Jan 2010.

  79. Hall GCN. Diversity in clinical psychology. Clin Psychol Sci Pract. 2006;13(3):258–61.

    Article  Google Scholar 

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  1. Health Policy Institute, Joint Center for Political and Economic Studies, Washington, DC, USA

    Brian D. Smedley (Vice President and Director)

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Correspondence to Brian D. Smedley .

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  1. Medicine at UCLA, and, The Minority Health Institute, Inc., The David Geffen School of, Clairton Place 3425, Los Angeles, 91436, California, USA

    Richard Allen Williams

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Smedley, B.D., Mittman, I.S. (2011). The Diversity Benefit: How Does Diversity Among Health Professionals Address Public Needs?. In: Williams, R. (eds) Healthcare Disparities at the Crossroads with Healthcare Reform. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-7136-4_11

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