Diversity in Medical Faculty and Students

Simply put, diversity in academic medicine makes us better at delivering on our core missions of clinical care, research, and education. Diversity makes our institutions reflective of the communities we serve. Patients will trust us more.¹ A diverse research workforce also makes for more scientifically innovative teams and helps us attract students and faculty from diverse communities. We should value diversity and inclusion, which is why leading health care organizations recommend diversifying the health care profession as an important strategy to address inequalities in medical care. The disproportionate effect of the ongoing coronavirus disease 2019 pandemic on communities of color and socioeconomically disenfranchised communities and the past several weeks of unrest in response to tragic social injustices are also strong reminders of the need for diversity in academic medicine.^2-5

Within this context comes the report by Ogunwole et al⁶ in this issue of JAMA Network Open. The authors used data from the Association of American Medical Colleges on full-time faculty and medical school matriculant from 1980 to 2018 and data from the US Census Bureau to examine trends by sex and race/ethnicity and implications for the future. The authors focused their analysis on faculty in internal medicine (IM), in part because IM is the largest specialty in medicine and a significant source of teachers and role models for future generations of physicians.

The authors did a good job with a limited data set to show trends. The message is one of hope. The number of IM faculty increased overall in the 38 years studied. Sex diversity improved markedly and is now closer to sex representation in the population. This analysis also confirms the good news that women are now fully represented in medical schools. In fact, for the first time in the history of the nation, we now have more female medical students than male medical students, which is welcome progress.

As the authors mention, work remains to be done in increasing the proportion of underrepresented racial/ethnic groups in medical schools and on IM faculty rosters. However, the fact that medical school matriculation among underrepresented racial/ethnic groups was the highest in 2018 is cause for optimism. As the authors articulate, this increase does not reflect the increasing representation of these groups in the US population at large.

The authors note several limitations to consider in interpreting their results. First, variations exist in race/ethnicity reporting. In the US Census, race/ethnicity is self-reported (the gold standard), but that is not the case for faculty files. Second, the classification of race/ethnicity changed between 1990 and 2000. Although IM is the largest specialty in medicine, other specialties contribute to the observed disparity in health care. Therefore, diversity in other medical specialties is just as important in addressing health care inequalities outside IM. Third, the authors note the heterogeneous nature of the progress reported in this study, namely, trends in Black medical school representation and more specifically Black male matriculants.

Notwithstanding these limitations, this report is a step in the right direction during this time of national crisis in health care and social justice. A more granular approach to this issue will help the nation see the areas relevant to diversity that need additional attention and focus.⁷ The authors deftly articulate the possible reasons for the sustained lack of diversity in IM faculty, even though the data set is not detailed enough to help us answer the whys and what-to-dos.

Published: September 1, 2020. doi:10.1001/jamanetworkopen.2020.15326

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Ibrahim SA. JAMA Network Open.

Corresponding Author: Said A. Ibrahim, MD, MPH, MBA, Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th St, Floor 2, Room LA 215, New York, NY 10065 (sai2009@med.cornell.edu).

Conflict of Interest Disclosures: None reported.