Is Diversity a Disqualification to Practicing Medicine?
By: Dane Flanigan
Tags: Diversity In Medicine, Barriers To Entry, Discrimination

By Kate Lopez

Dec. 1, 2020

Despite improvements, medical school students and healthcare professionals still do not reflect the diversity of their patients.

A breakdown of the first twenty-one Google image search results for “doctor” yields roughly equal images of men and women, nine pictures with people of color, and three show an animated or ambiguous partial image. Looking further, both pediatricians are female, the only surgeon is a white male, and all appear not to have a disability. While difficult and even impossible to gauge identifiers like race and ethnicity, disability, and sexuality from images, this rudimentary analysis reveals some key truths about these categories of diversity in medicine while also misrepresenting others.

Starting with what Google got wrong, women do not make up half the physician population. They’re actually closer to 36%. Additionally, about 2% of physicians identify as having a disability. While not a large portion, it is completely excluded from the results even when scrolling far past the sample. Google did get some things right, although that is not entirely positive. The racial breakdown is surprisingly accurate. 43.8% of physicians identify as a racial or ethnic minority. The majority are Asian, while Hispanic, Black or African American, and Native Americans make up a combined 11%. Almost three-quarters of surgeons are white, and two-thirds are male. And the proportion of women in family medicine, as opposed to general surgery, is higher than males.

The percentages of acceptees to and graduates from medical school for men and women are almost equal. But research shows almost 40% of women physicians go part-time or leave medicine completely within six years of completing their residencies. The majority of women reduce hours or leave to achieve a better work-family balance. Women in medicine “take on an average of 8.5 hours more work at home each week than men. Married men with children worked 7 hours longer and spent 12 hours less per week on parenting or domestic tasks than women.” Women lessen their hours at significantly higher rates than men, pointing to larger issues in gender dynamics.

Another factor, lack of support for women with families that stay. Women have an average of 8.6 weeks paid family leave as opposed to the recommended 12. Having to decide between family and career is one of the main reasons why women are steered away from surgical specialties and encouraged to choose disciplines with less demanding residencies and professional schedules like family medicine. This also plays on the stereotype that women are more nurturing and emotional, thus more suited to working with children.

For physicians with disabilities, stereotypes also affect perceptions of them and their abilities. One doctor that uses a wheelchair recalled how a fellow physician mistook her for a patient in the cafeteria even though she was wearing her uniform and had “doctor” written on her badge. She described how this moment underscored that she, and others with disabilities, are often seen as a person with a disability before anything else. While disability is often underreported, those that do identify themselves only make up 2.7% of physicians when including learning or psychological disabilities. Those that don’t report may fear they will be perceived as weak or not capable of fulfilling their duties.

A lack of self-identifying, rather than actual absence from medical professions, also accounts for the underrepresentation of LGBTQ+ doctors. While not much research has been conducted on sexual minorities in medicine, one study from Stanford University found “about one-third…chose not to disclose that information while in medical school, with 40 percent admitting they feared discrimination.” However, one poll conducted from 2017 to 2019 found the rates of students identifying as bisexual, gay, lesbian, and transgender had increased. While not huge numbers, as more research is done and more workers feel comfortable identifying themselves, perhaps these numbers will improve even more.

Diversity, or lack thereof, in healthcare professions also has roots in education, particularly for racial and ethnic minority groups and those with disabilities. Black men cited a lack of educational opportunities and economic barriers as key reasons for not pursuing medicine. Black women gave similar reasons adding that 40% recalled a “high school or college counselor trying to dissuade them” from a career in medicine.

Barriers persist throughout education. The economic hurdles that hold some Black men from applying also contribute to why they and other minorities do not stay in medical school. The majority of medical students come from affluent backgrounds. Students coming from “low socioeconomic status families are underrepresented” and “more likely to leave medical school within the first two years.” Researchers theorize racial stereotypes leading to feelings of exclusion also explain why “Black and Latinx students in STEM programs are more likely to drop out or switch majors than their White peers.” Finding community significantly contributes to why these students stay or leave. Minority-serving institutions like Howard University and The University of Puerto Rico graduate the largest amount of Black and Latinx physicians. A study showed that while students at historically Black colleges saw their STEM programs as diverse and felt supported, students at predominantly white institutions felt excluded.

Application barriers may also discourage students with disabilities. Schools’ websites vary in advertising their accommodation policies. Researchers found only a third clearly stated they would accommodate students with disabilities that are otherwise qualified, while “another half had vague information about who they would accept.” Even when the researchers posed as students and inquired, multiple schools did not respond. In many cases, the technical standards (TSs), what a school will or will not accommodate, are not clear or readily available. Each school determines its TSs. Rather than helping students receive necessary accommodations, they may help institutions unwilling to make them disqualify students with disabilities.

From Google images to prestigious universities and world-class hospitals, the need for greater diversity exists at all levels. But diversity isn’t necessary just for diversity’s sake. Those that identify as members of underserved or underrepresented groups are not only more likely to serve those communities, understand their specific needs, and teach other students and physicians how to address them, making for better health care.