Number of Minorities in US Internal Medicine Residencies Remains Low

Number of Minorities in US Internal Medicine Residencies Remains Low

28/01/2022

NEW YORK (Reuters Health) – Little has changed when it comes to minority representation among U.S. internal-medicine residencies, researchers report.

An analysis of data on internal medicine (IM) residency applicants and matriculants between 2010 and 2018 revealed that the number of minority applicants increased “minimally,” with a consistently greater proportion of white persons represented among matriculants compared with applicants.

The study, published in the Annals of Internal Medicine, shows “there is still significant work to be done for equitable racial/ethnic representation among resident physicians, and really, overall in the medical education pathway,” three study authors, Joanna Liao, Sangeetha Thevuthasan, and Thamanna Nishath, all medical students at the University of Washington School of Medicine in Seattle, told Reuters Health in a joint email.

“These disparities persist for several reasons, including deeply rooted system-based barriers; for instance, in how residency programs define a ‘qualified’ applicant,” they said. “Benchmarks like licensing exams (USMLE Step 1), honors society (AOA), and even clinical grades have research documenting the inherent biases against” students who are underrepresented in medicine.

“Another contributor is the disconnect between discussions and actions; we have often witnessed institutions intellectualize, with a lapse in emphasis on the work to make meaningful change,” the three add. “We also acknowledge that while we have contemplated several reasons why these disparities exist, we are limited to our perspectives and lived experiences, and that there are several other contributing causes.”

To take a closer look at minority representation trends in residency programs, the researchers turned to the Association of American Medical Colleges data on applicants and matriculants to Accreditation Council for Graduate Medical Education IM-residency programs.

They found that among the more than 214,000 unique persons who applied to IM residency programs between 2010 and 2018, 87,489 matriculated, with 28,222 of the applicants (13.2%) and 9,269 of the matriculants (10.6%) self-identifying as a minority underrepresented in medicine.

Overall, the researchers found that the proportion of minorities underrepresented in medicine grew “minimally,” but significantly.

On stratified analysis, the increase was seen for applicants who identified as Black or African American and those who identified as Hispanic, Latino, or of Spanish origin. While the proportion of aggregate underrepresented-minority matriculants also showed a small increase, when disaggregated data were examined, the only significant change was among those identifying as Hispanic, Latino or of Spanish origin.

For every year the researchers examined, the proportion of white matriculants was greater than the proportion of applicants. In 2018, for example, 31.8% of applicants had identified as white, while 40.0% of matriculants identified as white.

The researchers observed the opposite trend when it came to minorities: There was a greater proportion of minority applicants compared with matriculants. “Given the history of racism in medicine, particularly anti-Black racism, these findings are alarming,” the researchers conclude.

“The COVID-19 pandemic has highlighted the immense importance of representation within medicine,” the three coauthors told Reuters Health.

“Physicians of color have played a fundamental role in caring for communities of color hit hardest by SARS-CoV-2, including calling national attention to the disparities in morbidity and mortality and mobilizing successful community-based public health initiatives,” they added. “Minoritized patients need physicians (who are currently underrepresented in medicine). Given that completion of medical school and IM residency takes a minimum of seven years, inaction now bears significant consequences for communities of color in years to come. Therefore, immediacy is warranted.”

Given the under-representation of minorities in medical schools, the new findings are “disappointing but unsurprising,” said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.

“There is no simple fix,” Dr. Wu said Reuters Health by email. “Steps should begin to ‘widen the funnel,’ that is to increase the number of applicants at the college level that might apply to medical school. Additional steps across the entire process should be taken to understand and reduce biases that can work to discriminate against minority applicants.”

Minority under-representation in healthcare can lead to harms at both the individual and population level, said Dr. Wu, who was not involved in the study.

“For example, in the last two years, people have reported their primary-care physician as their most trusted source of information about the Covid-19 pandemic,” he said. “The lack of diversity among these healthcare providers may have contributed to disparities in the uptake of lifesaving preventive measures such as taking personal protective measures and vaccination.”

SOURCE: https://bit.ly/3tWM27O and https://bit.ly/32rI4si Annals of Internal Medicine, online January 24, 2022.

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