The Diversity Benefit: How Does Diversity Among Health Professionals Address Public Needs?

Abstract

The Patient Protection and Affordable Care Act (PPACA) signed byPresident Obama on March 23, 2010, is a far-reaching law intended toimprove access to and the quality of health care for Americans.Recognizing the importance of the health workforce to the nation'shealth, the Act addresses health workforce and health professionseducation and training issues through provisions to strengthen theprimary care workforce, provide tax relief for health professionals withstate loan repayments, establish a national Health Care WorkforceCommission, and expand the primary healthcare workforce by increasingand improving low-interest student loans. It is estimated that PPACAwould afford access to health care for 32 million more currentlyuninsured new healthcare consumers, many of which ethnic and racialminorities or members of other vulnerable groups.As the Act is enacted, the nation is experiencing unprecedenteddemographic change. When the 2010 Census counts are tallied, we mayfinally grasp the degree of demographic shifts that the nation hasundergone in the past decade. Since the 2000 Census, data gleaned fromthe American Community Survey and demographic models such as the onecarried out by the Pew Research Center (Passel and Cohn, U.S. populationprojections: 2005-2050. Washington, DC: Pew Research Center: Social andDemographic Trends, 2008) predict major population shifts. By 2042, onein two Americans will be an Asian American, Pacific Islander, AfricanAmerican, Hispanic, American Indian, and/or Alaska Native. Since 2000,Hispanics have accounted for over one-half of the population increase inthe United States. The number of Asian Americans grew at a largerproportion (9.0%) than any other racial or ethnic group during thissame time period. In at least four states (California, Hawaii, Texas,and New Mexico) and the District of Columbia, racial and ethnic``minorities{''} constitute a majority of the population (U.S. CensusBureau, An older and more diverse nation by midcentury, 2008.http://www.census.gov/Press-Release/www/releases/archives/population/012496.html, Accessed 22 Oct 2008; U.S.Bureau of Census, Hispanic Americans by the number, 2008.http://www.infoplease.com/ spot/hhmcensusl.html, Accessed 9 Jan 2010).Moreover, because of reproductive and immigration patterns, minoritiesare disproportionally represented among the younger population. Today,minorities account for 43% of Americans under 20 years of age, and itis projected that over the next two decades minority students willaccount for almost 40% of the total college population (Roberts,Minorities often a majority of the population under 20, The New YorkTimes, 2008).Despite the rapid growth of racial and ethnic minority groups in theUnited States, many are dramatically underrepresented among the nation'shealth professionals. The percentage of African American, Hispanic,American Indian, Alaska Native, or Pacific Islander(1) in the healthprofessions has grown only modestly at best over the past 30 years. Yetrelative to the growth of the minority population in the United States,this rate of increase still leaves the proportion of minority healthprofessionals outstripped by several fold. Hispanics, for example,comprise over 15% of the U.S. population, but only 2% of theregistered nurse population, 4.6% of psychologists, and 5.0% ofphysicians. Similarly, one in eight individuals in the United States isAfrican American, yet less than 1 in 20 dentists or physicians areAfrican American. Minorities are severely underrepresented in academia.During the 2007-2008 academic year, URMs (underrepresented minorities)made up only 7.4% of U.S. medical school faculty, fewer than 7% ofundergraduate faculty, less than 10% of baccalaureate and graduatenursing school faculty, 12% of clinical psychology faculty, and 8.6%of dental school faculty (Moreno et al., Using multiple lenses: anexamination of the economic and racial/ethnic diversity of collegestudents. In: Univ AoACa, editor. California: The James IrvineFoundation, Claremont Graduate University, 2006; Institute of Medicine,In the nation's compelling interest: ensuring diversity in thehealth-care workforce. Washington, DC: Institute of Medicine, 2004;Hall, Clin Psychol Sci Pract 13:258-261, 2006).