By Toyese Oyeyemi and Dr. Maria Portela. Illustrated by Fernando Miguez
The United States is becoming much more diverse, but those changes aren’t always evenly reflected across industries and professions. A case in point is that the health care workforce in many states has failed to keep pace with representation, sometimes drastically, leading to unaddressed disparities in access to care and opportunities.
But it doesn’t need to be this way. Health equity is a worthwhile goal for businesses, schools and institutions—not just because it's a reflection of good values but also because it makes good economic sense.
Removing health disparities across the United States would result in an economic gain of $132 billion per year. That number could see a $98 billion increase annually if disparities are eliminated by 2050. Yet, a recent study from the George Washington University Milken Institute of Public Health, has found a severe lack of parity in the health care workforce and the health care education pipeline.
The latest Census (in 2020) shows that people of color represent 43% of the total U.S. population, up nearly 10% from 2010. With projections reflecting growing diversity, adverse health outcomes will not only hit marginalized and underrepresented communities, but our pocketbooks too.
According to the GWU Fitzhugh Mullan Institute’s Health Workforce Diversity Tracker, Black/African American, Hispanic/Latino, and Native American communities were severely underrepresented in the health care workforce across ten critical health professions: advanced practice registered nurses, dentists, occupational therapists, pharmacists, physical therapists, physicians, physician assistants, respiratory therapists, registered nurses, and speech pathologists.
Nationally, about 6% of physicians identify as Hispanic or Latino, but represent 18% of the population. Similarly, only 5% of physicians identify as Black or African American, despite comprising 13% of the population.
It should come as no surprise that states with more diverse populations see higher profits—just like our workforce. The most diverse states in the U.S. are also the two largest state economies by GDP: California and Texas. A healthy workforce is unquestionably the lifeblood of a functional economy and given that people of color are five times more likely to see a physician of their own race, a racially reflective workforce is a protective benefit to our valued state and national economies.
In California, the largest racial ethnic group is the Hispanic/Latino population, representing 39.4% of Californians. Although 31% of the Hispanic/Latino population is considered workforce age, they represent only 6% of physicians in the state. This is especially concerning when looking at population growth. Between 2010 and 2018, the workforce age for the Hispanic/Latino population grew by 17%. Yet, the percentage of physicians grew a dismal .5%.
Further compounding this issue is the workforce pipeline. Medical schools across the U.S. do not have graduating classes that reflect national or state racial and ethnic demographics. In Texas, for example, statistics closely mirror national data. Black students make up 12% of the student-age population, but amount to only 5% of physician graduates.
So, what does this mean, exactly? The lack of diversity across the country’s health care workforce has significant ramifications for our society: underrepresented communities experience inequities in health care. Implicit racial and ethnic bias by health care providers exacerbates these inequities. Simply, not having parity in the health care sector translates to worse health outcomes. Worse health outcomes mean more doctor or emergency room visits. And that costs money.
Barriers to education and access to opportunities are at the heart of the issue. At the graduate medical education level, fewer than 14% of students are underrepresented minorities (URM). At the bachelor’s level, fewer than 7% of URM students earn bachelor’s degrees in STEM related disciplines.
Health care needs to diversify its educational pathway. Policies and pedagogy should include: meaningful increases in STEM education at the primary school level and an encouragement of students to pursue these types of majors in college; commitment to recruiting and mentoring young talent in underserved communities; addressing implicit and ethnic bias within medical profession classrooms; and investing in support programs that actively support the retention of URM students and educators.
We need to go beyond the education system too. Both the private and public sectors should focus on advancing diverse talent into executive and management roles in health care, and on creating a more inclusive workplace environment that values diversity. Currently, fewer than 6% of the medical school faculty are Hispanic/Latino and fewer than 4% are Black/African American.
If we don’t invest in a health care workforce and pipeline which reflects the patients and communities it serves, we are defaulting morally and economically.
Toyese Oyeyemi is director of the Beyond Flexner Alliance at George Washington University and Lecturer of Family and Community Medicine and Population Health at University of New Mexico. He is a Senior Fellow with Atlantic Fellows for Health Equity. The opinions expressed are his own.
Dr. Maria Portela is chief of the Family Medicine Section and co-chief of the Health Equity section within the Department of Emergency Medicine at the Medical Faculty Associates at George Washington University. She is also the medical director of the Bridge to Care clinic and co-director of the Health Workforce Diversity Initiative. She is a Senior Fellow with Atlantic Fellows for Health Equity. The opinions expressed are her own.