Education
Minorities struggle to advance in academic medicine: A 12-y review of diversity at the highest levels of America's teaching institutions

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Abstract

Background

Blacks, Hispanics, and women are underrepresented in academic medicine. This study sought to identify recent trends in the academic appointments of underrepresented groups at all levels of academic medicine.

Methods

This was a retrospective cross-sectional analysis of the Association of American Medical Colleges' data on faculty at U.S. medical schools from 1997 to 2008. The distribution across race and gender at different academic ranks (instructor, assistant professor, associate professor, and full professor) and the leadership positions of chairperson and dean were calculated for each year of the study.

Results

Averaged over the 12-y study period, whites accounted for 84.76% of professors, 88.26% of chairpersons, and 91.28% of deans. Asians represented 6.66% of professors, 3.52% of chairpersons, and 0% of deans. Blacks represented 1.25% of professors, 2.69% of chairpersons, and 4.94% of deans. Hispanics represented 2.76% of professors, 3.37% of chairpersons, and 2.91% of deans. Women represented 14.7% of professors, 9.2% of chairpersons, and 9.3% of deans. Overall, there was a net positive increase in the percentage of minority academic physicians in this study period, but at the current rate, it would take nearly 1000 y for the proportion of black physicians to catch up to the percentage of African Americans in the general population. Additionally, year-by-year analysis demonstrates that there was a reduction in the percentage of each minority group for the last 2 y of this study, in 2007 and 2008.

Conclusions

Minorities, including Asian Americans, and women remain grossly underrepresented in academic medicine. Blacks have shown the least progress during this 12-y period. The disparity is greatest at the highest levels (professor, chairperson, and dean) of our field. We must redouble our efforts to recruit, retain, and advance minorities in academic medicine.

Introduction

In 1847, Dr David Jones Peck became the first African American to receive a Doctor of Medicine degree from an American medical school [1]. Soon thereafter, Dr Elizabeth Blackwell became the first woman to graduate from a U.S. medical school, receiving her degree in 1849 [2]. These historic breakthroughs marked the birth of racial or ethnic minority and female representation in medicine in this country. Since then, these groups have continued to push for equal status in the field.

By 2010, there were 79,070 students enrolled in U.S. medical schools; 22% of these students were Asian, 7% were black, and 8.2% were Hispanic [3]. Whites accounted for 60.1% of all medical students. Based on these numbers, certainly some progress has been made in the diversification of our field. However, for the purpose of comparison, in that same year, there were 308,745,538 people in the United States: whites made up 72.4% of the population, Asians 4.8%, blacks 12.6%, and Hispanics 16.3% [4]. Given these statistics, blacks and Hispanics continue to be grossly underrepresented in medicine, earning the designation of underrepresented minority (URM) as defined by the U.S. Department of Health and Human Services and the Association of American Medical Colleges [5], [6].

Although the overrepresentation of Asians in medical school is significant, the observation raises interesting questions about their advancement into high-ranking positions later in their career. Social determinants of health that benefit Asians at the community level, such as higher income status, higher education, and access to health care, also benefit their advancement into the medical field. However, one might ask, what are the factors that hinder advancement? Perhaps, a factor is cultural. Discovering the in-group characteristics of whites may be helpful in identifying inclusion criteria that may help females and Asians, who are better represented in medical school, advance into high-ranking positions in academia.

Females likewise remain underrepresented in medicine, although in a different manner. In the past decades, women had difficulty entering the proverbial pipeline. For example, in 1982–1983, only 26.8% of MD degrees were awarded to women [7]. Since then, women have made great strides forward in medical school matriculation and graduation. As a result, in 2009–2010, women received 48.3% of the medical degrees awarded. This represented the largest number of women earning an MD of any national graduating class to date [7]. But despite these significant advances at the entry level, compared with their male counterparts, women have had poor success advancing their careers and are overrepresented in the junior faculty ranks [8], [9].

In obstetrics and gynecology, the overrepresentation of women is significant. Women serving the health care needs of other women has been a growing trend and has been supported by their willingness to pursue specialties with longer work hours and heavier workloads [10]. Effective planning and greater institutional support have made their success in these areas possible [10].

Minorities have also had difficulty climbing the academic ladder. In 2000, Fang et al. [11] investigated the promotion rates of minority and white medical school faculty in the United States. Their analysis of data from the Association of American Medical Colleges' Faculty Roster System from 1980 through 1997 demonstrated a significantly lower rate of promotion for Asian or Pacific Islanders and URMs, including blacks and Hispanics.

Recently, Merchant and Omary [12] confirmed just how great the gap continues to be between URMs and women and the status quo in academic medicine. They showed that blacks and Hispanics, respectively, accounted for only 3% and 4.2% of all academic faculties in 2008. Furthermore, although the percentage of white faculty had decreased over the past 5 y, the low percentage of black and Hispanic faculty did not change proportionally. Although there was relative gender parity at the level of instructor, they validated findings that females were grossly underrepresented at higher rungs of the academic ladder (i.e., full professor). They additionally demonstrated that female URMs were doubly underrepresented, also with worsening disproportion as the academic rank advanced from the level of instructor to professor.

These data are extremely troubling, foremost because of the extensive literature published in the past one to two decades documenting the disparity in medical care provided to minority and female patients. It is well known, for instance, that relative to whites, blacks and women are less likely to be referred for cardiac catheterization [13]. Black and female stroke patients are less likely than their respective male and white counterparts to receive adequate preventive care for subsequent strokes [14]. Overall, minorities are more likely to receive lower quality basic clinical services, even when multivariate analyses control for insurance status, income, age, comorbid conditions, and symptom expression [15]. Discouragingly, differences in care are associated with greater mortality among minority patients [16].

Although it is difficult to prove, it is certainly logical—if not probable—that there is a link between the disparate care of female and minority patients and the underrepresentation of women and minorities among physician ranks, specifically in academic medicine. There is evidence that stereotyping, biases, and uncertainty on the part of health care providers can contribute to unequal treatment of these groups [17]. Minorities encounter a range of barriers to accessing care, even when ensured at the same level as whites, including those of language, geography, and cultural familiarity [17]. Closing the racial and gender gap in academic medicine may overcome these barriers.

This study sought to expand on the previous work of Fang et al. [11] and Merchant and Omary [12]. We hypothesize that the problem of disparity has improved but at a slow pace and that the disparity continues to be greater at progressively higher levels in academic medicine.

Section snippets

Materials and methods

This was a retrospective cross-sectional analysis of American Association of Medical Colleges' data. The database encompassed all full-time faculties at the United States' medical schools from 1997 to 2008.

The distribution across race and gender at different academic ranks (instructor, assistant professor, associate professor, and full professor) and the leadership positions of chairperson and dean were calculated for each year of the study. Data for medical school deans were available only for

Results

The absolute number of academic physicians steadily increased over the 12-y study period. This was true at all levels (instructor, assistant professor, associate professor, and full professor), across all races (white, Asian, black, and Hispanic), and inclusive of both genders (Table 1).

Analysis of the distribution across race and gender at different academic ranks over the 12-y study period (see Table 2) demonstrates numerous findings. White physicians comprised most academic physicians in

Discussion

Several results found in this study merit close attention. First, this study validates the recent results of Merchant and Omary [12] and indicates that the problem of disparate minority promotion first noted by Fang et al. [11] more than a decade ago continues to this day. Clearly, whites comprise most academic physicians, such that in 2008, they accounted for nearly 83% of full professors, 86% of chairpersons, and almost 90% of deans. Although the field has become more diverse in this 12-y

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