Native Hawaiian and Other Pacific Islander Representation Among US Allopathic Medical Schools, Residency Programs, and Faculty Physicians

This cross-sectional study analyzes the representation of Native Hawaiian and Other Pacific Islander allopathic medical students, residents, and physicians in the US physician workforce.


Introduction
Native Hawaiian and Other Pacific Islander individuals are 1 of 5 official US racial categories, as designated by the US Census Bureau and Office of Management and Budget, and remain underacknowledged in health care research. 1Native Hawaiian and Other Pacific Islander individuals (who are of Melanesian, Micronesian, and Polynesian descent) are not synonymous with Asian individuals. 2They experience disproportionate health disparities yet are the least represented racial group in the medical professions. 1,3,4Native Hawaiian individuals compose 20% of the population of Hawai'i but less than 4% of the physician workforce. 3National physician workforce diversity research inappropriately aggregates or excludes Native Hawaiian and Other Pacific Islander individuals. 1,5Here, we analyze the representative quotients (RQs) of allopathic medical students, residents, and physicians who identify as Native Hawaiian and Other Pacific Islander.

Methods
The Gundersen Health System institutional review board approved this cross-sectional study, which was conducted and reported according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Publicly available medical student matriculant, resident, and academic faculty data between January 1, 2000, and December 31, 2020, were obtained by the Association of American Medical Colleges (AAMC); informed consent was waived by Gundersen Health System because the data were deidentified and publicly available. 4,6Participants self-identified as Native Hawaiian and Other Pacific Islander via the AAMC National Graduate Medical Education Census 6 and US Census Bureau/Office of Management and Budget 2 criteria.
As reported previously, 5 an RQ is the proportion of a subgroup compared with the US population: an RQ of 1 denotes equal representation; greater than 1, overrepresentation; and less than

Results
All participants in the study self-identified as Native Hawaiian and Other Pacific Islander.Between 2000 and 2020, there was overall underrepresentation of Native Hawaiian and Other Pacific Islander individuals; the numbers (RQs) for medical students, residents, and faculty physicians were 41 individuals (0.39), 82 individuals (0.37), and 85 individuals (0.40), respectively (Table ;

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Figure, A).There were no significant changes in the number of medical student matriculants identifying as Native Hawaiian and Other Pacific Islander alone (individuals who reported Native Hawaiian and Other Pacific Islander as their only race) (RQ slope, −6.3; 95% CI, −12 to −0.44; Q = 0.15), in combination (individuals who reported Native Hawaiian and Other Pacific Islander alone or in + Invited Commentary Author affiliations and article information are listed at the end of this article.Open Access.This is an open access article distributed under the terms of the CC-BY License.JAMA Network Open.2021;4(9):e2125051.doi:10.1001/jamanetworkopen.2021.25051(Reprinted) September 20, 2021 1/From: https://jamanetwork.com/ on 09/30/2023 combination with Ն1 other race) (RQ slope, 10; 95% CI, 0.15-20; Q = 0.19), and alone or in combination (RQ slope, −7.4; 95% CI, −22 to 7.5; Q>0.99) between 2002 and 2020 (Figure, B).The median annual total medical student matriculants for Native Hawaiian and Other Pacific Islander individuals alone and alone or in combination were 53 (range, 23-115) and 184 (range, 104-232),

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Figure.Representative Quotient (RQ) of Native Hawaiian and Other Pacific Islander (NHPI) Individuals Across Medical Specialties

quotient denominators reflected 2000-2020 US census data. 2 Linear re- gression was used to assess time vs RQ of Native Hawaiian and Other Pacific Islander individuals. Medi- ans, ranges, RQ slope estimates, P values, and 95% CIs were calculated. All tests were 2 tailed with Bon- ferroni
correction for multiple testing (Q values in the Table).Significance was set at P = .05.All analyses were conducted with R version 4.0.3 in RStudio (R Project for Statistical Computing).