Acknowledgment
Where Are the Rest of Us? Improving Representation of Minority Faculty in Academic Medicine
Abstract
Objectives: Low numbers of underrepresented minority faculty members in academic medicine (black, Hispanic, Asian/Pacific Islander, Native American/Alaskan) continue to be a concern for medical schools because there is higher attrition and talent loss among this group. Although much has been written on this topic, there has not been a systematic review of the indexed literature published.Methods: We searched MEDLINE, Web of Knowledge, ProQuest, and Google Scholar for articles relating to minority faculty and identified relevant articles. We then graded the evidence using the Strength of Recommendation Taxonomy. The same criteria were applied to extract evidence-based observations of challenges faced by minority faculty and provide recommendations.
Results: Of the 548 studies identified and reviewed, 15 met inclusion criteria for this literature review. Of the 15, 9 were cross-sectional studies and 6 were analyses of existing Association of American Medical Colleges workforce data. The cross-sectional studies documented perceived bias in the recruitment of faculty, quantified the lack of minority mentors, and revealed that black and Hispanic faculty members are more prevalent in states with higher minority populations. Studies using the Association of American Medical College workforce data also documented evidence of promotion bias, the lack of diversity in academic plastic surgery, and the lack of minority researchers funded by the National Cancer Institute.
Conclusions: This systematic review provides evidence that racism, promotion disparities, funding disparities, lack of mentorship, and diversity pressures exist and affect minority faculty in academic medicine. Based on these observed challenges, this review also provides specific recommendations that could improve representation of minority faculty members in academic medicine. These recommendations include implementing proven pipeline programs to increase the number of minority medical students, a systemwide adoption of proven culture change initiatives, reexamination of assignments to ensure equitable time distribution, and a reduction of medical school debt.
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Price EG, Gozu A, Kern DE, et al. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med 2005;20:565-571.
2. Mahoney MR, Wilson E, Odom KL, et al. Minority faculty voices on diversity in academic medicine: perspectives from one school. Acad Med 2008;83:781-786.
3. Pololi L, Cooper LA, Carr P. Race, disadvantage and faculty experiences in academic medicine. J Gen Intern Med 2010;25:1363-1369.
4. Price EG, Powe NR, Kern DE, et al. Improving the diversity climate in academic medicine: faculty perceptions as a catalyst for institutional change. Acad Med 2009;84:95-105.
5. Rodriguez JE, Campbell KM, Fogarty JP, et al. Underrepresented minority faculty in academic medicine: a systematic review of URM faculty development. Fam Med 2014;46:100-104.
6. Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. J Am Board Fam Pract 2004;17:59-67.
7. Howick J,Chalmers I, Glasziou P, et al.TheOxford 2011levels of evidence. http://www.cebm.net/ocebm-levels-of-evidence. Accessed September 19, 2013.
8. Andriole DA, Jeffe DB, Hageman HL, et al. Variables associated with fulltime faculty appointment among contemporary U.S. medical school graduates: implications for academic medicine workforce diversity. Acad Med 2010;85:1250-1257.
9. Palepu A, Carr PL, Friedman RH, et al. Minority faculty and academic rank in medicine. JAMA 1998;280:767-771.
10. Peterson NB, Friedman RH, Ash AS, et al. Faculty self-reported experience with racial and ethnic discrimination in academic medicine. J Gen Intern Med 2004;19:259-265.
11. Cropsey KL, Masho SW, Shiang R, et al. Why do faculty leave? Reasons for attrition of women and minority faculty from a medical school: four year results. J Womens Health (Larchmt) 2008;17:1111-1118.
12. Marbella AM, Holloway RL, Sherwood R, et al. Academic ranks and medical schools of underrepresented minority faculty in family medicine departments. Acad Med 2002;77:173-176.
13. Lewis-Stevenson S, Hueston WJ, Mainous AG, et al. Female and underrepresented minority faculty in academic departments of family medicine: are women and minorities better off in family medicine? Fam Med 2001;33:459-465.
14. Page KR, Castillo-Page L, Wright SM. Faculty diversity programs in U.S. medical schools and characteristics associated with higher faculty diversity. Acad Med 2011;86:1221-1228.
15. Palepu A, Carr PL, Friedman RH, et al. Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med 2000;75:157-160.
16. Lypson ML, Gruppen L, Stern DT. Warning signs of declining faculty diversity. Acad Med 2002;77(10 Suppl): S10-S12.
17. Nunez-Smith M, Ciarleglio MM, Sandoval-Schaefer T, et al. Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools. Am J Public Health 2012;102:852-858.
18. Fang D, Moy E, Colburn L, et al. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA 2000;284:1085-1092.
19. Christian MC, Trimble EL. Increasing participation of physicians and patients from underrepresented racial and ethnic groups in National Cancer Institute-sponsored clinical trials. Cancer Epidemiol Biomarkers Prev 2003;12:277s-283s.
20. Hoover E. An analysis of the association of American medical colleges’ review of minorities in medical education. J Natl Med Assoc 2005;97:1240-1242, 1244-1256.
21. Butler PD, Britt LD, Longaker MT. Ethnic diversity remains scarce in academic plastic and reconstructive surgery. Plast Reconstr Surg 2009;123:1618-1627.
22. Campbell KM, Berne-Anderson T, Wang A, et al. USSTRIDE program is associated with competitive Black and Latino student applicants to medical school. Med Educ Online 2014;19:4.
23. Johnson JC, Jayadevappa R, Taylor L, et al. Extending the pipeline for minority physicians: a comprehensive program for minority faculty development. Acad Med 1998;73:237-244.
24. Daley S, Wingard DL, Reznik V. Improving the retention of underrepresented minority faculty in academic medicine. J Natl Med Assoc 2006;98:1435-1440.
25. Daley SP, Broyles SL, Rivera LM, et al. A conceptual model for faculty development in academic medicine: the underrepresented minority faculty experience. J Natl Med Assoc 2011;103:816-821.
26. Cropsey KL, Masho SW, Shiang R, et al. Why do faculty leave? Reasons for attrition of women and minority faculty from a medical school: four-year results. J Womens Health (Larchmt) 2008;17:1111-1118.
27. Pololi LH, Krupat E, Schnell ER, et al. Preparing culture change agents for academic medicine in a multi-institutional consortium: the C-change learning action network. J Contin Educ Health Prof 2013;33:244-257.
28. Rust G, Taylor V, Herbert-Carter J, et al. The Morehouse Faculty Development Program: evolving methods and 10-year outcomes. Fam Med 2006;38:43-49.
29. US Department of Health and Human Services Health Resources and Services Administration Faculty. Loan repayment program. http://www.hrsa.gov/loanscholarships/repayment/Faculty/index.html. Accessed May 20, 2014.
30. Richert A, Campbell K, Rodriguez J, et al. ACU workforce column: expanding and supporting the health care workforce. J Health Care Poor Underserved 2013;24:1423-1431.
31. Marrast LM, Zallman L, Woolhandler S, et al. Minority physicians’ role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities. JAMA Intern Med 2014;174:289-291.
32. Rodriguez JE, Campbell KM. Ways to guarantee minority faculty will quit academic medicine. Acad Med 2013;88:1591.
33. Krupat E, Pololi L, Schnell ER, et al. Changing the culture of academic medicine: the C-Change learning action network and its impact at participating medical schools. Acad Med 2013;88:1252-1258.
34. Campbell KM, Rodriguez JE, Beitsch LM, et al. Underrepresented minorities in academic medicine: is Florida better off ? South Med J 2014;107:173-176.
35. Norris KC, Baker RS, Taylor R, et al. Historically black medical schools: addressing the minority health professional pipeline and the public mission of care for vulnerable populations. J Natl Med Assoc 2009;101:864-872.
36. Pololi LH, Evans AT, Gibbs BK, et al. The experience of minority faculty who are underrepresented in medicine, at 26 representative U.S. medical schools. Acad Med 2013;88:1308-1314.
37. Beech BM, Calles-Escandon J, Hairston KG, et al. Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature. Acad Med 2013;88:541-549.
