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End of Affirmative Action—Who Is Impacted Most? Analysis of Race and Sex Among US Internal Medicine Faculty

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Abstract

Background

For over 50 years, the United States (US) used affirmative action as one strategy to increase diversity in higher education including medical programs, citing benefits including training future public and private sector leaders. However, the recent US Supreme Court ending affirmative action in college admissions threatens advancements in the diversity of medical college faculty.

Objective

Our study evaluated the demographic trends in Internal Medicine (IM) faculty in the US by assessing sex and race/ethnicity diversity to investigate who is likely to be impacted most with the end of affirmative action.

Design

Longitudinal retrospective analysis

Subjects

IM faculty from the Association of American Medical Colleges faculty roster from 1966 to 2021 who self-reported sex and ethnicity

Main Outcomes

The primary study measurement was the annual proportion of women and racial/ethnic groups among IM faculty based on academic rank and department chairs.

Results

Although racial/ethnic diversity increased throughout the era of affirmative action, African American, Hispanic, and American Indian populations remain underrepresented. White physicians occupied > 50% of faculty positions across academic ranks and department chairs. Among the non-White professors, Asian faculty had the most significant increase in proportion from 1966 to 2021 (0.6 to 16.6%). The percentage of women increased in the ranks of professor, associate professor, assistant professor, and instructor by 19.5%, 27.8%, 25.6%, and 26.9%, respectively. However, the proportion of women and racial/ethnic minority faculty decreased as academic rank increased.

Conclusion

Despite an increase in the representation of women and racial/ethnic minority IM faculty, there continues to be a predominance of White and men physicians in higher academic ranks. With the end of affirmative action, this trend has the danger of being perpetuated, resulting in decreasing diversity among IM faculty, potentially impacting patient access and health outcomes.

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Data Availability:

The data which support the findings of this study are available from the corresponding only by reasonable request.

References

  1. Chung A, Kruzel J. US Supreme Court rejects affirmative action in university admissions. Reuters [Internet]. 2023 Jun 29 [cited 2023 Jun 30]; Available from: https://www.reuters.com/legal/us-supreme-court-strikes-down-university-race-conscious-admissions-policies-2023-06-29/

  2. Jones N, Marks R, Ramirez R, Rios-Vargas M. 2020 Census Illuminates Racial and Ethnic Composition of the Country [Internet]. United States Census Bureau. [cited 2023 Oct 23]. Available from: https://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-reveal-united-states-population-much-more-multiracial.html#:~:text=The%202020%20Census%20shows%20(Figures,in%20combination%20with%20another%20group.

  3. Li SNJ, Siddiqi J, Mahmood A, Khosa F. Equity, diversity, and inclusion in academic Internal Medicine at US medical schools. Eur J Intern Med. 2020 Jan;71:89–91.

    Article  PubMed  Google Scholar 

  4. Ogunwole SM, Dill M, Jones K, Golden SH. Trends in Internal Medicine faculty by sex and race/ethnicity, 1980-2018. JAMA Netw Open. 2020 Sep 1;3(9):e2015205.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Niu BT, Nicolaou S, Levine D, Sanelli PC, Abujudeh H, Siddiqi J, et al. Trends in gender and racial profiles of US academic radiology faculty. J Am Coll Radiol. 2020 Oct;17(10):1337–43.

    Article  PubMed  Google Scholar 

  6. Wooding DJ, Das P, Tiwana S, Siddiqi J, Khosa F. Race, ethnicity, and gender in academic obstetrics and gynecology: 12-year trends. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100178.

    Article  PubMed  Google Scholar 

  7. Zhang Y, Silver JK, Tiwana S, Verduzco‐Gutierrez M, Siddiqi J, Khosa F. Physical medicine and rehabilitation faculty diversity trends by sex, race, and ethnicity, 2007 to 2018 in the United States. PM&R. 2021 Sep;13(9):994–1004.

    Article  Google Scholar 

  8. Lu JD, Tiwana S, Das P, Siddiqi J, Khosa F. Gender and racial underrepresentation in academic dermatology positions in the United States: a retrospective, cross-sectional study from 2007 to 2018. J Am Acad Dermatol. 2020 Nov;83(5):1513–6.

    Article  PubMed  Google Scholar 

  9. Sinkford JC, Valachovic RW. Affirmative action: essential to achieving justice and good health care for all in America. J Dent Educ. 2003 Apr;67(4):468–72.

    Article  PubMed  Google Scholar 

  10. Thomas BR, Dockter N. Affirmative action and holistic review in medical school admissions: where we have been and where we are going. Acad Med J Assoc Am Med Coll. 2019 Apr;94(4):473–6.

    Article  Google Scholar 

  11. Smedley BD, Butler AS, Bristow LR, Institute of Medicine (U.S.), Institute of Medicine (U.S.), editors. In the nation’s compelling interest: ensuring diversity in the health-care workforce. Washington, DC: National Academies Press; 2004. 409 p.

  12. Thornton RLJ, Powe NR, Roter D, Cooper LA. Patient–physician social concordance, medical visit communication and patients’ perceptions of health care quality. Patient Educ Couns. 2011;85(3):e201–8.

    Article  PubMed  Google Scholar 

  13. Shen MJ, Peterson EB, Costas-Muñiz R, Hernandez MH, Jewell ST, Matsoukas K, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5(1):117–40.

    Article  PubMed  Google Scholar 

  14. Yong-Hing CJ, Khosa F. Provision of culturally competent healthcare to address healthcare disparities. Can Assoc Radiol J. 2023 Jan 30;084653712311542.

    Google Scholar 

  15. Young PJ, Kagetsu NJ, Tomblinson CM, Snyder EJ, Church AL, Mercado CL, et al. The intersection of diversity and well-being. Acad Radiol. 2023 ;S1076633223000430.

  16. Basco WT, Cull WL, O’Connor KG, Shipman SA. Assessing trends in practice demographics of underrepresented minority pediatricians, 1993–2007. Pediatrics. 2010 Mar 1;125(3):460–7.

    Article  PubMed  Google Scholar 

  17. Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority physicians’ role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities. JAMA Intern Med. 2014 Feb 1;174(2):289.

    Article  PubMed  Google Scholar 

  18. Tucker CM, Herman KC, Pedersen TR, Higley B, Montrichard M, Ivery P. Cultural sensitivity in physician-patient relationships perspectives of an ethnically diverse sample of low-income primary care patients: Med Care. 2003 Jul;41(7):859–70.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  20. Cooper-Patrick L. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999 Aug 11;282(6):583.

    Article  CAS  PubMed  Google Scholar 

  21. Seale E, Reaume M, Batista R, Eddeen AB, Roberts R, Rhodes E, et al. Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada. Can Med Assoc J. 2022 Jul 11;194(26):E899–908.

    Article  Google Scholar 

  22. del Pinal J. We the Americans: Hispanics. U.S. Department of Commerce; 1993 Sep p. 2. Report No.: WE-2R.

  23. Paisano EL, Carroll DL, Cowles JH, DeBarros KA, Robinson AJ, Miles KN, et al. We the Americans: Asians. U.S. Department of Commerce; 1993 p. 1. Report No.: WE-3.

  24. United States Census Bureau. Supplementary Tables on Race and Hispanic Origin: 2020 Census Redistricting Data (P.L. 94-171) [Internet]. 2021. [cited 2023 Oct 23]. Available from: https://www.census.gov/data/tables/2020/dec/2020-redistricting-supplementary-tables.html

  25. U.S. Department of Commerce. Race of the population of the United States, by states: 1970. U.S. Department of Commerce; 1972 p. 1–293. Report No.: S1-11.

  26. National Research Council. Changing Numbers, Changing Needs: American Indian Demography and Public Health [Internet]. Washington, D.C.: National Academies Press; 1996 [cited 2023 Oct 23]. Available from: http://www.nap.edu/catalog/5355

  27. Yip T, Cheah CSL, Kiang L, Hall GCN. Rendered invisible: are Asian Americans a model or a marginalized minority? Am Psychol. 2021 May;76(4):575–81.

    Article  PubMed  Google Scholar 

  28. Mickey-Pabello D, Garces LM. Addressing racial health inequities: understanding the impact of affirmative action bans on applications and admissions in medical schools. Am J Educ. 2018 Nov;125(1):79–108.

    Article  Google Scholar 

  29. Garces LM, Mickey-Pabello D. Racial diversity in the medical profession: the impact of affirmative action bans on underrepresented student of color matriculation in medical schools. J High Educ. 2015;86(2):264–94.

    Article  Google Scholar 

  30. Lakhan SE. Diversification of U.S. medical schools via affirmative action implementation. BMC Med Educ. 2003;3(1):6.

  31. Sharma S, Patlas M, Khosa F, Yong-Hing CJ. Equity, diversity and inclusion in radiology: prioritizing trainee involvement. Can Assoc Radiol J. 2023 Nov;74(4):610–1.

    Article  PubMed  Google Scholar 

  32. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019 Aug;111(4):383–92.

    CAS  PubMed  Google Scholar 

  33. Capers Q, Johnson A, Berlacher K, Douglas PS. The urgent and ongoing need for diversity, inclusion, and equity in the cardiology workforce in the United States. J Am Heart Assoc. 2021 Mar 16;10(6):e018893.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement — results of a national study of pediatricians. N Engl J Med. 1996 Oct 24;335(17):1282–90.

    Article  CAS  PubMed  Google Scholar 

  35. Hricak H. Women, careers, and academic radiology. Acad Radiol. 2000 Jul;7(7):485–6.

    Article  CAS  PubMed  Google Scholar 

  36. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA. 2003 Sep 3;290(9):1173.

    Article  CAS  PubMed  Google Scholar 

  37. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014 Mar 4;160(5):344–53.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Williams D, Cooper L. Reducing racial inequities in health: using what we already know to take action. Int J Environ Res Public Health. 2019 Feb 19;16(4):606.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Rios E. The Guardian. 2023 [cited 2023 Jul 2]. ‘A cautionary tale’: colleges in states with affirmative action bans report racial disparities. Available from: https://amp.theguardian.com/law/2023/jun/30/affirmative-action-ban-state-colleges-racial-disparities-supreme-court

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Funding

This project was partially supported by grants from Disparities Research Institute LTD and Arrowhead Neuroscience Foundation. The funding sources had no role in the collection, analysis, and interpretation of data or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Rui Yang Xu HSD, Jeffrey Ding HSD & Nadia Khan MD

  2. Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada

    Nilita Sood MD

  3. Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada

    Sabeen Tiwana DMD

  4. Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, CA, USA

    Javed Siddiqi MD

  5. Marshfield Clinic Health System, Marshfield, WI, USA

    Ateeq Rehman MD

  6. UT Southwestern Medical Center, Dallas, TX, USA

    Namirah Jamshed MD

  7. Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

    Faisal Khosa MD, MBA, FFRRCSI, FRCPC

Authors
  1. Rui Yang Xu HSD
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  2. Nilita Sood MD
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  3. Jeffrey Ding HSD
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  4. Nadia Khan MD
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  5. Sabeen Tiwana DMD
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  6. Javed Siddiqi MD
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  7. Ateeq Rehman MD
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  8. Namirah Jamshed MD
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  9. Faisal Khosa MD, MBA, FFRRCSI, FRCPC
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Contributions

FK, RX, and JD conceptualized and designed the study. JS and JD worked on the data curation. RX, NS, and NK performed the formal analysis and interpretation of the results. RX, NS, and JD wrote the original draft. All authors reviewed the results and approve of the final version of the manuscript.

Corresponding author

Correspondence to Faisal Khosa MD, MBA, FFRRCSI, FRCPC.

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Conflict of Interest:

Dr. Faisal Khosa received the Don Rix Physician Leadership Lifetime Achievement Award (2022); B.C. Achievement Foundation – Mitchell Award of Distinction (2022); University of British Columbia – Distinguished Achievement Award for Equity, Diversity & Inclusion (2022); and Vancouver Medical Dental & Allied Staff Association – Equity, Diversity & Inclusion Award (2022). In addition, Dr. Khosa is the recipient of the Health Professional-Investigator Award of the Michael Smith Foundation for Health Research (HPI-2022-2876).

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Xu, R., Sood, N., Ding, J. et al. End of Affirmative Action—Who Is Impacted Most? Analysis of Race and Sex Among US Internal Medicine Faculty. J GEN INTERN MED (2023). https://doi.org/10.1007/s11606-023-08554-0

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