Diversity in the Doctor Workforce Saves Lives
By Dr G. Richard Olds
President of St George's University
and Founding Dean of UC-Riverside Medical School
Diversity in the doctor workforce saves lives. That's the finding of a recent study from Harvard. Researchers at the T.H. Chan School of Public Health examined outcomes for over 1.2 million Medicare patients treated by 44,000 internists at American hospitals. Patients treated by foreign medical graduates had better 30-day survival rates than patients treated by US-educated physicians.
The study is the latest to show that racial, socioeconomic, and international diversity aren't just nice things to have within America's physician workforce. They're matters of life and death.
More than 31 percent of the US population is Hispanic, Native American, or African-American. Yet people from these ethnic groups account for just 6 percent of practicing physicians.
This racial disparity isn't likely to change. Fewer than 14 percent of students admitted to medical school for the 2017-18 school year were black, Hispanic, or Native American.
Schools also lack economic diversity. Three in four medical students come from the richest 40 percent of families. Only one in twenty come from the poorest 20 percent of families.
It's tempting to argue that an applicant's race or socioeconomic background should be irrelevant in the medical school admissions process.
In reality, a doctor's background can have more impact on patient health than even the best academic credentials.
When people of color do seek medical care, they turn to nonwhite physicians. Sometimes, for language reasons. Two in five Hispanic patients consider whether a doctor can speak Spanish before choosing to visit.
Sometimes they do so because they're more comfortable with doctors who look like them and may have similar experiences. Black patients report higher satisfaction ratings when treated by black doctors.
As a result, nonwhite doctors care for over 53 percent of minority patients and over 70 percent of non-English-speaking patients, according to a study in JAMA Internal Medicine. The study concludes "racial and ethnic diversity of the physician workforce may be key to meeting national goals to eliminate health disparities."
Socioeconomic diversity is equally important. Doctors with parents who make less than $100,000 per year are more likely to enter family medicine, according to a meta-analysis of 57 different studies.
Diversity of national origin is also crucial, especially as America's immigrant population continues to swell. Since 1990, the number of foreign-born US residents has more than doubled, to roughly 42 million.
The growth in the diversity of our nation's population coincides with doctor shortages across the United States. The Association of American Medical Colleges predicts a shortage of about 105,000 doctors by 2030. More than 40 percent of that gap could be in primary care.
Doctors trained abroad will play an outsized role in closing that shortfall. That's in part because American medical school graduates refuse to do so. Only 15 percent of US medical school graduates go into internal medicine. Nearly half of international graduates choose the specialty.
Diversity is a top priority at the medical school I lead, St. George's University in Grenada. Our students currently hail from 104 different countries. Eighty percent receive financial aid. Roughly three-quarters of our graduates go into primary care.
If the Harvard study is right that international medical graduates offer better care than their domestically trained counterparts, then the United States should hold its doors wide open to doctors from abroad.
Policies that block these doctors from practicing in the United States put Americans at risk by undermining their ability to access quality health care.
(G. Richard Olds, MD, is President of St. George's University (www.sgu.edu). He was founding Dean of the University of California, Riverside, School of Medicine)
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