Section I: Cultivating a Health Care Workforce that Increases Access to and Quality of Care

Recent research suggests that the overall health of Americans has improved; however, disparities continue to persist among many populations within the United States.1 For example, racial and ethnic minority populations have poorer access to care and worse outcomes than their white counterparts. Approximately 20 percent of the nation living in rural areas are less likely than those living in urban areas to receive preventive care and more likely to experience language barriers.1-2 Individuals identifying as lesbian, gay, bisexual, or transgender are likely to experience discrimination in health care settings and, in some cases, verbal or physical abuse.3 Furthermore, these individuals often face insurance-based barriers and are less likely to have a usual source of care than patients who identify as straight.4

“Research indicates that diversity in the physician workforce impacts the quality of care received by patients.”

It is now fairly accepted that a diverse workforce is a key component in the delivery of quality, competent care throughout the nation.5 The data presented in this report echo research in the field suggesting that physicians from racial and ethnic backgrounds typically underrepresented in medicine (American Indian or Alaskan Native; black or African-American; or Hispanic or Latino) are significantly more likely to practice primary care than white physicians.6 These physicians also are more likely to practice in impoverished areas as well as those areas federally designated as medically underserved.7 Furthermore, research indicates that diversity in the physician workforce impacts the quality of care received by patients. For example, race concordance between patient and physician results in longer visits and increased patient satisfaction,8 and language concordance has been positively associated with adherence to treatment among certain racial or ethnic groups.9

aamc-figure7Recognizing the need for a diverse physician workforce, many medical schools have instituted programs designed to increase the number of applicants from underrepresented backgrounds in medical schools. One such program, the Robert Wood Johnson Foundation Summer Medical and Dental Education Program (SMDEP), has supported aspiring medical students throughout the United States for 25 years. Initiated as the Minority Medical Education Program, the program expanded its focus to include students from economically disadvantaged communities—the Summer Medical Education Program—and in 2006, changed to the Summer Medical and Dental Education Program to reflect the program’s inclusion of dentistry. Funded by the Robert Wood Johnson Foundation, more than 6,000 program alumni have graduated from M.D.-granting institutions and dental schools. Investments in such programs remain critical to engage a diverse talent pool.

“Now more than ever, there is an urgent need for health professionals to work together.”

However, diversifying the physician workforce alone will not sufficiently address projected shortages or the influx of newly insured patients with the implementation of the Affordable Care Act. Now more than ever, there is an urgent need for health professionals to work together10. The use of nurse practitioners and physician assistants, for example, may help provide primary care to patients unable or reluctant to access traditional health care.11-12 Research is also beginning to show that many patients feel comfortable receiving care from a physician assistant or nurse practitioner, especially if they can receive that care faster.13 Moreover, it is important to note that these professions also have a need for greater diversity. In 2006, for example, 86 percent of physician assistants identified as white.14

“By weaving together a diverse and culturally responsive pool of physicians working collaboratively with other health care professionals, access and quality of care can continue to improve throughout the nation.”

Improving the patient experience or quality of care received also requires attention to education and training on cultural competence.15 By weaving together a diverse and culturally responsive pool of physicians working collaboratively with other health care professionals, access and quality of care can continue to improve throughout the nation.

SMDEP Columbia 2011 White Coat Ceremony6

Credit: SMDEP at Columbia University College of Physicians and Surgeons and College of Dental Medicine

References

  1. 2013 National Healthcare Disparities Report. May 2014. Agency for Healthcare Research and Quality, Rockville, MD. ahrq.gov/research/findings/nhqrdr/nhdr13/2013nhdr.pdf. Accessed September 18, 2014.
  2. U.S. Census Bureau. (2010). Urban and Rural Classification and Urban Area Criteria. https://www.census.gov/geo/reference/ua/urban-rural-2010.html. Accessed September 17, 2014.
  3. When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV. 2010. Lambda Legal website. lambdalegal.org/health-care-report. Accessed September 18, 2014.
  4. Dill M. Sexual orientation, access to care, and patient-provider communications. 10th Annual Health Workforce Research Conference. May 1–2, 2014, Alexandria, VA.
  5. Nivet MA. Diversity 3.0: A necessary systems upgrade. Academic Med. 2011;86:1487–1489.
  6. Association of American Medical Colleges. Analysis in Brief: Analyzing Physician Workforce Racial and Ethnic Composition Associations: Physician Specialties. August 2014;14(8). Available at https://aamc.org/download/401798/data/aug2014aibpart1.pdf.
  7. Association of American Medical Colleges. Analysis in Brief: Analyzing Physician Workforce Racial and Ethnic Composition Associations: Geographic Distribution. August 2014;14(9). Available at https://aamc.org/download/401814/data/aug2014aibpart2.pdf.
  8. Cooper L, Roter D, Johnson R, et al. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. December 2003;139(11):907–15.
  9. Traylor A, Schmittdiel J, Uratsu C, Mangione C, Subramanian U. Adherence to cardiovascular disease medications: Does patient-provider race/ethnicity and language concordance matter?” J Gen Intern Med. November 2010;25(11):1173–7.
  10. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. May 2011. Interprofessional Education Collaborative, Washington, DC. https://members.aamc.org/eweb/upload/Core%20Competencies%20for%20Interprofessional%20Collaborative%20Practice_Revised.pdf. Accessed October 22, 2014.
  11. The projected physician shortage and implications for PAs. Physician Assistant Education Association. Accessed September 18, 2014. Available at: http://www.paeaonline.org/Networker/1106Networker/1106Keynote.htm.
  12. Naylor MD, Kurtzman ET. The role of nurse practitioners in reinventing primary care. Health Aff. 2010;29(5):893–9.
  13. Dill M, Pankow S, Erikson C, Shipman S. Survey shows consumers open to a greater role for physician assistants and nurse practitioners. Health Aff. June 2013;32(6):1135–1142.
  14. Grumbach K, Mendoza R. Disparities in human resources: Addressing the lack of diversity in the health professions. Health Aff. March 2008;27(2):413–422.
  15. Betancourt JR. Cultural competence and medical education: many names, many perspectives, one goal. Acad Med. 2006; 81(6):499-501.