Promoting Progress or Propagating Problems: Strategic Plans and the Advancement of Academic Faculty Diversity in U.S. Medical Schools

United States Medical School Academic Faculty Workforce Diversity, Institutional Characteristics, and Geographical Distributions From 2014-2018

Purpose

Academic healthcare workforce diversity is important in addressing health disparities. Our goal was to evaluate trends and associations in faculty diversity of United States (US) medical schools over a five-year period.

Methods

We analyzed the Association of American Medical Colleges (AAMC) Faculty Roster data of 151 US medical schools from 2014-2018. Outcome faculty variables were female gender, underrepresented in medicine (UiM), age, and professorial representation. Predictor variables included geographical distributions, and institutional characteristics. Statistical analysis included Jonckheere-Terpstra test, ANOVA, and regression analysis.

Results

Female faculty increased from 37.6% to 40.4% (p<0.001), senior faculty (age >60 years) from 22.6% to 25.9% (p=0.001) while UiM faculty stayed relatively flat from 9.74% to 10.08% (p=0.773). UiM [adjusted odds ratio (aOR) = 0.39, p=0.015], and female faculty (aOR=0.3, p=0.001) had independently significantly decreased associations with professorial representation, while senior faculty had increased associations (aOR=3.82, p<0.001). Significant independent differences occurred in female, UiM, and professorial faculty distributions within US regions; Hispanic faculty were highest in Southwest (6.57%) and lowest in Midwest region (1.59%), while African-American faculty were highest in Southeast (8.15%) but lowest in the West (3.12%). UiM faculty had significantly independent decreased associations with MD/PhD degree (aOR=0.30, p=0.004) and higher US ranking institutions (aOR=0.45, p=0.009).

Conclusions

From 2014 to 2018, female faculty increased modestly while the UiM faculty trend remained flat. Female and UiM faculty were less represented at the professor level. UiM faculty were less represented in higher-ranking institutions. Geographic location is associated with faculty diversity.

Value, Support, and Advancement: An Organization's Role in Faculty Career Intentions in Academic Medicine

Purpose

Faculty engagement in academic medical centers is essential to advancing efficient healthcare delivery, research productivity, and organizational quality. The authors used turnover theory to empirically examine factors that influence faculty engagement, including both aspirational and attrition-related career intentions.

Methods

Using a convergent, mixed methods design, the authors surveyed 284 faculty at a large Midwestern public university's school of medicine in Fall 2015, Fall 2016, and Spring 2017. The study's questionnaire included a series of scales which informed three outcome variables (promotion aspirations, leadership aspirations, and intent to leave the organization) and four groups (role strain, work-family conflict, organizational commitment and support, and departmental commitment and support) of predictor variables, all of which have been previously validated with medical faculty populations. The scales were followed by open-ended questions which allowed respondents to further elaborate on their experiences in their organization related to each outcome variable. The authors used a hierarchical multiple regression model to assess the effect of each of the four groups of predictor variables on the outcome variables and then employed an iterative thematic analysis of open-ended responses to further elucidate faculty's reported experiences.

Results

Organizational commitment and support were significantly associated with faculty's promotion aspirations, leadership aspirations, and intentions to leave the organization. Thematic analysis of participant responses to open-ended questions further revealed the specific career development support faculty desired, mainly, streamlined and transparent promotion and leadership processes; clear guidance to maneuver these processes; holistic professional development opportunities; feeling valued; and supports for clinical and administrative tasks.

Conclusion

Advancing organizational policy that supports infrastructure for evidence-based interventions and programming for the intentional career development of faculty is an important aspect of a proactive talent development and retention model in academic medical centers.

Addressing the Need for Ethnic and Racial Diversity in the Pipeline for Pharmacy Faculty

Objective To analyze the ethnic and racial diversity of faculty in pharmacy, medicine, and dentistry in the United States and suggest how the pipeline for pharmacy academe can be diversified.Methods A retrospective analysis of the representativeness of faculty at schools and colleges of pharmacy was compared to that in schools and colleges of medicine and dentistry. The range of ethnic and racial diversity across top schools of pharmacy, historically black colleges and universities (HBCUs), and newer schools of pharmacy was evaluated for both faculty and students for the year 2019-2020. The ethnic and racial diversity in residency and fellowship programs along with graduation rates provided insight into the available pipeline for future pharmacy faculty.Results Faculty in pharmacy, medicine, and dentistry demonstrated similarly low representation of underrepresented minorities (URMs) compared to their composition within the US population. Dentistry had the largest percentage of URMs (13.9%), compared with 8.5% in pharmacy and 7.1% in medicine. Five HBCUs contributed 32.8% of all Black faculty, yet their graduates had comparatively low residency match rates. The ratio of URM students to non-URM students in post-PharmD and graduate training programs is lower than the ratio of URM students to non-URM students in pharmacy programs.Conclusion Lack of access to postgraduate residency or fellowship training programs is a major barrier to progression to pharmacy academe and impacts URMs more significantly. Barriers to advanced training must be removed or decreased to create the needed diverse faculty candidates for pharmacy academe. Without intervention, students in pharmacy programs will be primarily trained by non-URM faculty, which may impact how graduates provide care in an increasingly diverse patient population.

Assessment of Diversity Outcomes in American Medical School Admissions: Applying the Grutter Legitimacy Principles

In the last 30 years, except for female participation, the enrollment of Latinx, African Americans, Native Americans, Alaskan natives, and disadvantaged students in medical school has been constant; however, increasing enrollment of these minority populations is feasible, if admissions committees make two changes in approach. First, the traditional belief that matriculation merit is a linear function of past academic performance must be rejected. Second, once the threshold needed to complete medical school in four years and to pass licensing examinations at the first attempt has been met, all candidates are equally qualified, and matriculation decisions must be based, in part, on societal interests. In Grutter vs. Bollinger, the United States Supreme Court determined that graduate admission committees can and should consider societal interests. Each admission decision represents a substantial government investment in each student, as the Medicare Act directly subsidizes much of the cost of medical education. As Grutter explained, there is a societal interest in the public having confidence in, and access to, the medical school training that will prepare tomorrow’s medical, professional, and political leaders. Our analysis suggests that medical school admissions are biased towards academic achievement in matriculants, beyond acceptable thresholds for graduation and licensure. We believe medical schools must shift their admissions strategies and consider noncognitive factors in all candidates as determinative once minimum acceptable academic standards have been met.