The Urgent and Ongoing Need for Diversity, Inclusion, and Equity in the Cardiology Workforce in the United States
July 23, 2021
UPMC Division of Cardiology physician Kathryn Berlacher, MD, MS, FACC collaborated with colleagues at the University of Texas-Southwestern and Duke University to publish an editorial in the Journal of the American Heart Association entitled, “The Urgent and Ongoing Need for Diversity, Inclusion, and Equity in the Cardiology Workforce in the United States.”
The authors present evidence that establishing a more diverse workforce improves outcomes in clinical care and research. For example, data suggest that patients from racial minority groups may benefit for care when treated by race‐concordant physicians. Hispanic, Black, and American Indian physicians play a significant role in providing quality care to the nation’s most vulnerable patient populations. Selection processes that equally consider personal attributes and standardized test scores result in the selection of successful, humanistic physicians.
Racial Diversity Enhances Quality of Care and Research
According to past research, enhanced diversity improves overall quality of care through “higher levels of patient satisfaction and trust, enhanced cultural competency in patient‐provider relationships, expanding patients' access to and utilization of health services, increasing access to care for geographically underserved communities, and enhancing the breadth and scope of research with a broader range of racial/ethnic perspectives1.”
The current data indicate that more racially diverse physicians could lead to more patients from racial minority backgrounds to receive preventive care like “vaccines and health screenings, and guideline-indicated treatments like open heart surgery, care for severe heart failure, and compassionate end‐of‐life care1.”
With more diverse physicians devoting their careers to medicine and cardiology, new approaches to framing questions and other beneficial research practices can emerge. More diversity among physicians will also support community engagement efforts and involvement of underserved populations in research planning.
These findings argue that a diverse workforce in the field of cardiovascular medicine is “highly desirable and urgently needed1.”
Underrepresented Physicians Are More Likely to Serve Underserved Communities
More than four decades of data indicate that Black, Hispanic, and other physicians from underrepresented groups play a disproportionate role in serving underserved communities — often entering medical school with that goal in mind or coming to that decision by graduation.
The legacy of Black and Hispanic physicians choosing to serve underserved populations is so consistent that after analyzing practice trends among close to 5,000 generalist physicians, researchers suggested that "underrepresented minority" status should be “included in a model to accurately predict which medical school applicants would be more likely to serve underserved populations1.”
Based on that research, it is clear that many physicians from underserved and underrepresented backgrounds are unique in their passion and commitment to care for underserved and underrepresented patients. Recruiting underrepresented students into medicine and specifically cardiology should be a priority for academic health centers.
Standardized Test Scores, Holistic Review, and Quality of Applicants
Medical school selection committees have criticized the overreliance on grade point average and Medical College Admissions Test (MCAT) scores as the primary criteria for acceptance into medical school, noting the importance of other applicant characteristics such as diversity in background and philosophy, community service, and leadership roles. Because of that, many medical schools have moved to a "holistic review" of applicants, balancing emphasis on the candidate’s standardized test scores, personal attributes, and life experiences.
While standardized tests are important in the assessment of physicians, there is a wide range of MCAT scores associated with success in medical school. There is currently no evidence to support the idea that enhancing diversity in medicine or cardiology results in poor-quality trainees. In fact, available evidence suggests that medical school and graduate medical education selection committees should “embrace holistic review strategies to enhance the quality and diversity of training programs1.”
Conclusions
According to the editorial, authors have reviewed data indicating that “increasing the number of underrepresented groups in medicine and cardiology will enhance the cultural competence of majority race physicians, improve the care received by minority patients attributable in part to enhanced communication and trust, ensure that underserved and disadvantaged communities have a steady supply of physicians dedicated to their care, and enhance the inclusivity and impact of medical research resulting in improved care for all patients1.“
Reference
1. Capers IV Q, Johnson A, Berlacher K, Douglas PS. The Urgent and Ongoing Need for Diversity, Inclusion, and Equity in the Cardiology Workforce in the United States. J Am Heart Assoc. 2021 March 16; 10(6): 10:e018893. Epub ahead of print. Editorial.
