Month: July 2023

I am a fan of the Commonwealth Fund’s issue briefs, and the recent one on The Case for Diversity in Health Professions Remains Powerful was especially significant. The messaging was in direct response to the latest SCOTUS decision on Students for Fair Admissions, Inc. v. President and Fellows of Harvard College. For those who missed it, this decision removed “race-conscious affirmative action” in undergraduate admissions. This decision is poised to drop Black and Hispanic admissions by at least 10%, and strike a blow to diversity, equity, and inclusion (DEI) in education. The ripple-effect of this decision across all historically vulnerable populations was made clear in GLAAD’s post-decision statement: 

 “This decision inaccurately and unfairly limits access to the American dream, and drags our entire country backward, upending decades of precedent and progress. Equity for Black Americans and all people of color, including LGBTQ people, is essential to our democracy, economy, and future. This decision could also open the door for challenges to DEI practices in business settings and it is critical that companies and educational institutions respond with loud commitments to continue best practices for inclusion.”

Gaping wholistic health disparities already limit access to necessary physical, behavioral, and psychosocial health. The face of the current health and behavioral health workforce fails to mirror the workforce it cares for. The recent SCOTUS decision will only further negate cross-sector efforts to attract, admit, train and, sustain the inclusive workforce patients need. This action has great potential to inflict greater harm to a population already dealing with historical, experiential, developmental and other traumas. What must happen to mitigate this massive gap in care?

The Current Discordant Reality

I was educated and trained at a time when practitioners were often taught that anyone could work with anyone; I fought the opposing views for years. However, the research to support concordant care is equally compelling. I feel strongly that we must teach and emphasize the importance of cultural humility and work to eliminate implicit and explicit biases in practice. But, we also have an ethical obligation to be sensitive to the cultural nuances that come with caring for others. Every patient deserves to feel safe and a sense of belonging in the context of their care and treatment.

Academic programs across every discipline are working overtime to fill the massive void of practitioners available to treat underserved communities and their populations. Conclusive data validates how patient-provider concordance makes a difference in the quality of patient engagement, trust, and satisfaction. Patients do better in treatment when they feel that their providers and practitioners understand them and look like, and this reality transcends the cultural schema. However, current workforce demographics fails to ensure any level of concordant care.

A recent report  of medical residents yielded: 

• Black men make up less than 3 %of all physicians
• <1 percent identify as American Indian, Alaska Native, Native Hawaiian, or other, Pacific Islander

For active physicians:

• Persons who identify as men comprise a majority of the physician workforce: 63% vs. 37% (women) 
• Persons who identify as women comprise >50% of the medical specialties focused on children, women, and families (e.g., reproductive health, pediatrics, neonatal and perinatal medicine, and child and adolescent psychiatry). 
• 64 %: White
• 20.6 %: Asian 
• 6.9%: Hispanic, and 5.7 %: Black or African American. 
• Barely 1 %: multiple races and non-Hispanic
• < .3%: American Indian or Alaska Native or
• .1% Native Hawaiian or Other Pacific Islander

Data for mental health practitioners yield equally concerning results, particularly in light of the high demand for care. A survey >37,000 mental health professionals yielded abysmal numbers that fail to reflect the diversity of populations requiring intervention and treatment:

• 74.2%: White  
• 7.9%: Black or African American 
• 7.9%: Hispanic or Latino.
• 3.1 %: Asian
• .7%: American Indian or Alaska Native

There are insufficient health and behavioral health professionals trained to work with the LGBTQIA++ community, and ensure patient safety, trust, and satisfaction with their care. 

• 16% of LGBTQ adults face blatant discrimination in health care settings
• 40% of Transgender survey respondents (N=1,520 adults 18 or over) postponed or avoided preventative screenings due to discrimination
• Barely 5% of the provider workforce identify as LGBTQIA++

Persons with Disabilities have limited representation in the healthcare workforce. A report from 2022 revealed:

• 7.9% employed within healthcare with 4% as practitioners and 4% in healthcare support roles

The industry has miles to go toward ensuring a concordant health and behavioral health system and workforce that matches the face of the population it is entrusted to care for. How else can patients feel seen, heard, and assured of the care they deserve?

Advancing Action

I rarely post dramatic data without offering ways to mitigate the gaps in care presented. Considerable action across industry sectors is being dedicated to attaining a more diverse health and behavioral health workforce. The efforts in play comprise an exhaustive list, but a few novel ones are listed below. Add others that you may be aware of in the comments section at the end of this post.

• The ACLU champions members of the population who have traditionally been denied their rights, particularly equality for people of color, women, LGBTQIA++, prisoners, immigrants, and people with disabilities.
• The CDC has stepped up to advance proactive efforts to engage and recruit students early in their education (e.g., middle school, high school) for careers in public health. 
• AmeriCorps and the CDC have merged to support recruitment, training, and development of the next generation of public health leaders.
• HRC engages in fierce advocacy to diversify the workforce. Along with maps that track the over 500 anti-LGBTQIA++ legislative actions in 2023 and other actions, the organization holds an annual Diversity and Inclusion Leadership Summit with HBCU leaders from across the country.
• OutCare provides assorted state to state listings encompassing affirming healthcare providers to mentorship, health equity training, community building, support groups, and other resource provision. 
• The Education Trust advances policies and practices that dismantle the systemic racism within the American education system. Their goal is to ensure equity in education from preschool through college, and engage diverse communities dedicated to education equity and justice.
• The Institute for Equity in Health Policy Practice is part of the National Minority Quality Forum and focused on assuring equity is integral to the American health services research, delivery, and financing system.
• The National Academy for State Health Policy is a nonpartisan organization committed to developing and advancing state health policy innovations and solutions.A robust report on state strategies to increase diversity in the behavioral health workforce lives on their website.
• A number of states have developed cross-sector partnerships to advance workforce development actions reflecting a more diverse practitioner presence. Colorado has a strategic action plan through the state’s Behavioral Health Administration. The goal is to attract and retain a high-quality, diverse, and culturally responsive workforce and identify fresh ways to accelerate training and entry into behavioral health careers. 
• The National Association of Certified Professional Midwives is on the front lines to improve outcomes for all childbearing people and their infants, investing in a strong racially, ethnically, and socially representative workforce, and driving urgently needed changes in the systems that care for birthing people in the U.S. today.
• The National Rural Health Association provided leadership on issues impacting their providers and patient populations, including that of workforce sustainability. 
• The Urban Institute engages in efforts across the industry to mitigate health disparities and inequities. Recent efforts also include those to support diversifying the health care workforce, with their nursing report available on their website.
• Professional associations have stepped with resource frameworks, scholarship programs, and other efforts to support diversifying the workforce, and include:
  • The American Association of Medical Colleges
  • The American Hospital Association
  • The American Medical Women’s Association
  • The Association of Black Psychologists, Inc.
  • The Association of LGBTQ+ Psychiatrists
  • The Indian Health Service
  • The National Association of Black Social Workers
  • The National Association of Hispanic Nurses