Furthering the American Medical Association's (AMA) commitment to racial justice and equity within the medical profession and society as a whole, and building on the recent release of its strategic plan to embed racial justice and advance health equity, the AMA adopted policy during the Special Meeting of its House of Delegates this week aimed at improving the diversity of the physician workforce. The report outlines practices and interventions that can increase racial, ethnic, gender, and socioeconomic diversity among the physician workforce, including targeted recruitment and revised medical school admissions policies, curriculum changes, summer enrichment programs, and comprehensive programs that integrate multiple interventions, such as financial, academic, and social support.
The report also identifies institutional and structural factors that interfere with or create attrition on the path to becoming a physician and discusses recommendations to minimize these interferences. Additionally, the report examines the harmful past actions that the medical profession as a whole and organized medicine have perpetrated on communities of color, particularly the role that the Flexner Report of 1910 played in the closure of the majority of Black medical schools at the time and in severely limiting the number of Black physicians.
"Studies show that racial, ethnic and gender diversity among health professionals promotes better access to health care, improves health care quality for underserved populations, and better meets the health care needs of our increasingly diverse population. Yet, our physician workforce does not adequately reflect the actual racial, ethnic or gender makeup of the patients in the communities we serve," said AMA Board of Trustee Member Jesse M. Ehrenfeld, M.D., M.P.H. "A critical step in moving forward, we must call out the lasting negative impact that the Flexner Report, and other harmful past actions by the medical profession, has had on today's physician workforce. We must address and reconcile these lasting harms to ensure that future physicians are aware of structural factors that are impeding their patient's health outcomes, and continue efforts to ensure a diverse physician workforce that meets the needs of our patients."
The new policy calls on the AMA to:
- Recognize some people have been historically underrepresented, excluded from, and marginalized in medical education and medicine because of their race, ethnicity, disability status, sexual orientation, gender identity, socioeconomic origin, and rurality, due to racism and other systems of exclusion and discrimination;
- Commit to promoting truth and reconciliation in medical education as it relates to improving equity;
- Recognize the harm caused by the Flexner Report to historically Black medical schools, the diversity of the physician workforce, and the outcomes of minoritized and marginalized patient populations;
- Work with appropriate stakeholders to commission and enact the recommendations of a forward-looking, cross-continuum, external study of 21st century medical education focused on reimagining the future of health equity and racial justice in medical education, improving the diversity of the health workforce, and ameliorating inequitable outcomes among minoritized and marginalized patient populations;
- Encourage the development of evidence-informed programs to build role models among academic leadership and faculty for the mentorship of students, residents, and fellows underrepresented in medicine and in specific specialties;
- Encourage physicians to engage in their communities to guide, support, and mentor high school and undergraduate students with a calling to medicine;
- Encourage medical schools, health care institutions, managed care and other appropriate groups to adopt and utilize activities that bolster efforts to include and support individuals who are underrepresented in medicine by developing policies that articulate the value and importance of diversity as a goal that benefits all participants, cultivating and funding programs that nurture a culture of diversity on campus, and recruiting faculty and staff who share this that goal;
- Continue to study and provide recommendations to improve the future of health equity and racial justice in medical education, the diversity of the health workforce, and the outcomes of marginalized patient populations;
- Encourage the U.S. Department of Education and Department of Labor to develop policies and initiatives in support of students from marginalized backgrounds that 1) decrease the educational opportunity gap; 2) increase participation in high school Advanced Placement courses; and 3) increase the high school graduation rate;
- Advocate for funding to support the creation and sustainability of Historically Black College and University (HBCU), Hispanic-Serving Institution (HSI), and Tribal College and University (TCU) affiliated medical schools and residency programs, with the goal of achieving a physician workforce that is proportional to the racial, ethnic, and gender composition of the United States population;
- Work with appropriate stakeholders to study reforms to mitigate demographic and socioeconomic inequities in the residency and fellowship selection process, including but not limited to the selection and reporting of honor society membership and the use of standardized tools to rank applicants, with report back to the House of Delegates;
- Establish a task force to guide organizational transformation within and beyond the AMA toward restorative justice to promote truth, reconciliation, and healing in medicine and medical education.
The new policy builds on AMA's efforts to increase diversity among the physician workforce, including the AMA's Doctors Back to School program. Launched in 2002, the program encourages Black, Indigenous, and Hispanic/Latinx students to enter health care career pathways. The AMA developed a Doctors Back to School™ Kit to support physicians and medical students who act as role models by visiting elementary and high schools to talk with students about careers in medicine. The program demonstrates to students from groups that have been marginalized that a medical career is well within their reach. The AMA will continue to support policies and programs that will lead to a more diverse physician workforce and improve patient outcomes.