Browse the corpus

The United States is a diverse country and a place for people of all backgrounds. However, discrimination against individuals and groups belonging to minority identities persists, leading to negative outcomes for patients and healthcare professionals. Clinicians are responsible for addressing inequity in the medical profession, a part of the American healthcare system. Several decades ago, diversity and discrimination were considered terms within social justice or social movements. However, in recent years, there has been a notable shift in focus within the healthcare field towards understanding and addressing social determinants of health. Remaining cognizant of these cultural shifts is relevant for healthcare community members at all levels to remain productive and contribute within the field. This activity reviews the concepts of diversity and discrimination and highlights the interprofessional team's role in improving care for patients from diverse backgrounds through medical education. Participating clinicians are equipped with historical milestones, past and present events, and recommendations to inform policy that aims to increase diversity and decrease discrimination within healthcare settings. Objectives: Identify different manifestations of diversity and discrimination, and analyze their impacts on health care. Interpret the different levels within the healthcare system on which bias and discrimination occur. Evaluate relationships between bias and negative patient outcomes in the healthcare system. Implement interprofessional guidance that healthcare systems can adopt to increase diversity and reduce disparities. Access free multiple choice questions on this topic.

Diversity is broadly defined as the inclusion of varied attributes or characteristics. In the medical community, diversity often includes healthcare professionals, trainees, educators, researchers, and patients from diverse backgrounds, including race, ethnicity, gender, disability, social class, socioeconomic status, sexual orientation, gender identity, primary spoken language, and geographic region. Discrimination in health care is defined as negative actions or lack of consideration directed towards an individual or group based on preconceived notions about their identity. Individuals do not have to belong to a marginalized group themselves to experience discrimination against that group. Discrimination can occur based on perceived membership. Furthermore, harm does not need to occur for discrimination to exist. A group may be discriminated against if it consistently receives lower-quality healthcare services compared to another group solely because of their race, ethnicity, gender, disability, social class, socioeconomic status, sexual orientation, gender identity, primary spoken language, or location of residence. Although discrimination can manifest for various reasons, this activity focuses mainly on gender, ethnicity, and race-based discrimination in the healthcare workforce. Discrimination occurs in all workforce segments, not limited solely to health care. However, health care presents a unique scenario because both care providers and recipients may face discrimination simultaneously, underscoring an inherent power dynamic.[1]

Based on existing literature and the results of several studies, the hypothesis positing an inverse relationship between discrimination and diversity is recognized. The prevailing belief within the medical community is that discrimination decreases and equity increases if the percentage of underrepresented minorities reaches a critical mass. Evidence suggests that although diversity is a goal, it alone does not create equity. Although more than half the pediatricians and gynecologists in the United States are now women, leadership positions within departments remain predominantly occupied by men.[5] Men are likelier to be selected for editorial board membership and achieve status as an associate or full professor, department chair, or medical school dean. Men also earn more at each academic rank.[49] Therefore, diversity does not necessarily impact the distribution of resources within the teaching system. These results are similar to those found in the nursing profession. The male advantage in nursing has been described as a glass escalator, in which men are put on a fast track and almost pushed to achieve positions that include greater responsibility, higher salaries, and more organizational benefits.[50] Thus, although diversity is necessary and important, equity is needed to decrease disparities and mitigate the impact of discrimination. Although increasing diversity may not eliminate all problems related to healthcare disparities and discrimination, we strongly encourage healthcare systems to promote diversity among clinicians. A larger talent pool, including clinicians with heterogeneous customs, experiences, and problem-solving tactics, can create more innovative approaches to systems-based problems. Individuals within a group may best solve healthcare issues that are more prevalent within that group. Diverse viewpoints enhance patient care and clinical research design, which may lead to improved inclusion.

Although increasing diversity may not eliminate all problems related to healthcare disparities and discrimination, we strongly encourage healthcare systems to promote diversity among clinicians. A larger talent pool, including clinicians with heterogeneous customs, experiences, and problem-solving tactics, can create more innovative approaches to systems-based problems. Individuals within a group may best solve healthcare issues that are more prevalent within that group. Diverse viewpoints enhance patient care and clinical research design, which may lead to improved inclusion. Numerous studies have shown that increased clinician diversity is associated with improved healthcare quality. Concordant care, defined as a patient and clinician sharing a common attribute such as race, ethnicity, or gender, has been associated with improved quality of care. Race-concordant patient-physician relationships are associated with improved communication, longer patient visits, greater medication adherence, and higher patient satisfaction scores.[51][52] Language and gender-concordant patient-physician relationships have similarly been associated with improved home medication compliance and outcomes.[53][54] Such results suggest that patient-physician concordance may facilitate communication and trust. Poor access to quality care continues to impact minority and low-income individuals in the United States disproportionately. A potential solution is to focus on recruiting and retaining underrepresented healthcare professionals. Underrepresented minority physicians are more likely to serve in areas with a physician shortage and serve underserved groups, including minorities, low-income individuals, and the uninsured.[55][56][57] The following measures are encouraged to be considered by healthcare groups and systems to improve the recruitment and retention of employees from underrepresented groups: Eliminate financial barriers to higher education for socioeconomically disadvantaged groups by developing scholarships, grants, and tuition assistance. Create mentorship and pipeline programs to increase the number of underrepresented minorities in healthcare careers. When possible, these mentorship pairings should align with the race and gender of participants. Provide opportunities for coaching and leadership training for healthcare professionals from underrepresented groups.

Create mentorship and pipeline programs to increase the number of underrepresented minorities in healthcare careers. When possible, these mentorship pairings should align with the race and gender of participants. Provide opportunities for coaching and leadership training for healthcare professionals from underrepresented groups. Use transparent processes to select committee members and leaders with diverse backgrounds and viewpoints. Provide pay transparency and objective measures for promotion and salary increase. The following actions are encouraged to be considered by healthcare groups and systems to quell discrimination and accelerate the remedy of healthcare disparities: Acknowledge that past discrimination and current implicit biases lead to inequities related to race, gender, ethnicity, sexual orientation, and disability, which still exist in healthcare settings. Progress is limited by denying the existence of discrimination and bias. Educate healthcare professionals on the impact of health disparities and structural racism on patient outcomes. Equip healthcare trainees and practicing clinicians with tools and resources to confront macroaggressions and microaggressions. Create a zero-tolerance policy for harassment and discrimination that includes a safe reporting mechanism for both the victim and the reporter. Increase support for research on healthcare disparities. Consider diversity as a subject integrated into medical education rather than an adjunct.