Intersectional Analysis of U.S. Medical Faculty Diversity over Four Decades

Abstract

The 2020 U.S. Census data show a rapidly diversifying U.S. population. We sought to evaluate whether clinical faculty and leadership representation at academic medical schools reflects the diversifying population over time. Using data from the Association of American Medical Colleges for the period of 1977 through 2019, we found notable progress in female representation among clinical faculty, with smaller gains among department chairs and medical school deans. Racial and ethnic groups that are underrepre-sented in medicine are designated as such because their presence within the medical profession is disproportionate to the U.S. Census data. Even with accounting for this underrepresenta-tion, clinical faculty and leadership positions show even starker disparities. Thoughtful policy implementation could help address this persistent underrepresentation among medical school faculty and leadership positions. R ecent publications have underscored the pressing need to achieve workforce diversity at the highest levels of academic medicine. 1-5 National headlines, notably about the Covid-19 pandemic and its disproportionate effects on racial and ethnic minority communities, 6,7 have further magnified the deleterious effects of sys-temic racism and inequities in medicine, which are compounded by mistrust of a health care workforce that does not adequately reflect the communities it serves. Understanding racial identity as a social construct and how it relates to health behaviors is an imperative for clinical medicine. 8 Despite countless scientific advances, health disparities among racial and ethnic groups remain pervasive. The mitigation of health disparities ultimately requires a multipronged approach, including policy-driven initiatives to improve health status 9 and increase diversity in the physician workforce. 2-5,10,11 Academic physicians actively participate in the recruitment and retention of medical students and junior trainees from diverse backgrounds, serving as role models who can support diversity , equity, and inclusion priorities regardless of their own racial and ethnic identities. A diverse academic faculty can help address health disparities through their "seats at the table," 5 from formulating clinical guidelines and designing clinical trials to serving on critical committees (e.g., medical admissions and curricular development). Diversity among medical educators can foster an environment that helps alleviate factors in the current education system that are known to propagate bias. 1,12 Morris et al. recently summarized the persistent lack of diversity among medical students. 3 We assessed relative diversity over a four-decade period within the broader medical education system, specifically among clinical faculty, department chairs, and medical school deans, given their influence on the next generation of physicians and physician leaders. Me thods We evaluated data from the Association of Amer-ican Medical Colleges (AAMC) full-time faculty roster for 18 clinical academic departments for the period from 1977 through 2019 (see Supplementary Appendix 1, available with the full text of this article at NEJM.org), including data according to faculty rank, clinical department chair positions, 13 and medical school dean positions. 14 We combined departmental faculty data to evaluate trends among total clinical faculty The New England Journal of Medicine is produced by NEJM Group, a division of the Massachusetts Medical Society. Downloaded from nejm.org on June 24, 2025. For personal use only. No other uses without permission.