Diversity Imperatives

The future of the American workforce will increasingly depend on people of color – by 2050, one out of every two workers will be nonwhite. With increasing awareness, the medical community and health consumers understand that there exist glaring disparities in health care delivery based on race, ethnic and cultural considerations. Many programs and initiatives sponsored by the government, educational institutions, philanthropic groups and health organizations address this issue. The goal is to make the practice of medicine and other aspects of health care more accessible, affordable and “culturally competent.”

People of color are desperately underrepresented in today’s healthcare professions.(1) However, African Americans, Hispanics and American Indians make up about one quarter of the population, but only 10 percent of the nation’s health workforce.(2) And, in recent years the numbers of underrepresented minority students in medical school has been on the decline. Fifty percent of that decline has been due to anti-affirmative action measures in a few states.(3)

Despite some two decades of efforts to increase minority representation in medicine, many minorities remain critically underrepresented at every level of medicine. In 1997, black Americans, Hispanics, and American Indians/Alaska Natives represented approximately 23.6 percent of the population, while only 12.2 percent of all enrollees in allopathic medical schools were underrepresented minorities.* (4) In a 2003 follow-up report by the Council on Graduate Medical Education (COGME) that tracked disparities in medical school education, the picture had improved somewhat.  Among underrepresented minority (URM) medical school applicants for 2001, 46 percent were accepted into medical school compared to 50.6 percent of non-URMs.  African Americans had the lowest acceptance rate, 42.8 percent, compared to 53.4 percent for Mexican Americans, 60.4 percent for Mainland Puerto Ricans, 51.0 percent for Native Americans, 51.7 percent for whites, 51.1 percent for Asians.  However, the report recommended that a number of persistent obstacles must be addressed to raise the numbers of successful medical students, including quality early preparation, providing assistance with the increasing costs of schooling, and other steps.

The report also identified select examples where corporate and organizational assistance were effective efforts to improve the professional pipeline, such as the Fellowship Program in Academic Medicine, funded by Bristol-Meyers Squibb, and six Centers of Excellence in Women’s Health, offering support to help improve minority women faculty’s career advancement opportunities.

Healthcare as an industry has turned its attention to workforce diversity fairly recently, relative to some other major industries. However, a number of its leading organizations and employers have made considerable strides. However, nearly all authorities agree that increasing diversity in all aspects of the industry will be crucial to providing healthcare to our rapidly changing population in the future.

Diversity Snapshot

According to the Equal Employment Opportunity Commission (reporting on figures through 2003), the number of non-white workers in “Healthcare and Social Assistance” occupations is less than half of their white counterparts.  White workers constitute 69.6 percent of workers in this area, while non-white workers make up 30.4 percent.

As in other industries, disparities are particular apparent in professional and high level managerial positions.

However, industry-wide hiring and science education initiatives may be increasingly raising the numbers of underrepresented worker groups.

White workers hold 84.5 percent of “Official and Managerial” positions in the industry, compared to 8.5 percent Black workers, 3.8 percent Hispanic, 3.0 percent Asian American, and 0.3 percent American Indian.

Among workers represented in “Professional” positions (for example, physicians, dentists, etc.), White workers make up 79.7 percent, compared with 8.6 percent Black, 3.6 percent Hispanic, 7.7 percent Hispanic, and 0.4 percent American Indian.

At the same time, the gender profile of the industry — which here includes social services as well as healthcare — may be seen as unusual compared to other industries.  Women workers by far outnumber men in this area. Women constitute 79.1 percent of workers — with White women accounting for more than half of workers, at 55.9 percent. According to the EEOC analysis, women outnumber their male counterparts in all ethnic groups in both “Official and Managerial” and “Professional” type positions.

For more detailed data tables, please see the report, 2003 EEO-1 AGGREGATE REPORT – NAICS CODE 62 – HEALTH CARE AND SOCIAL ASSISTANCE,” at the EEOC web site.

These disparities by race and gender are more or less pronounced in analyses broken down by specific types of healthcare employment.  For example, in related occupations in the areas of “Ambulatory Health Care Services” and “Nursing & Residential Care Facilities,” men and nonwhite workers may hold slightly higher percentages of “Official and Managerial” and “Professional” positions.  Meanwhile, among workers at “Hospitals,” where job growth tends to be lower and salaries tend to be higher, women make up a greater percentage of the workforce, at 79.5 percent, and White workers are more highly represented in “Official and Managerial” and “Professional” positions, and overall.

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Diversity Initiatives

Almost every employer says it’s committed to diversity. But which ones actually are?

When this channel was first launched, we cited a 2002 Fortune survey that included Abbott Labs as the only organization in the healthcare field ranked as one of the 50 best companies for minorities. Their findings are based on the percentage of new hires who are minorities, the percentage of minorities in leadership roles, and the turnover rate of minorities when compared to non-minorities.

By 2006, the Fortune survey’s list of the 25 Best Companies to Work for  Minorities included 4 hospitals — Baptist Health South FloridaMethodist Hospital SystemMemorial Health, andChildren’s Healthcare of Atlanta — as well as the biotech giant Genentech, whose related work includes research into diseases such as cancer.  Further, eight hospitals were ranked among the top 25 companies for women in the 2006 Fortune survey. In the 2007 list, 16 healthcare or pharmaceutical research related companies were ranked among the best employers overall, andBaptist Health S. Florida and (Houston-based) Methodist Hospital System were ranked Number 1 and 2 on the 2007 Best Companies for Minorities list respectively.

Increased attention to workforce diversity among healthcare employers may be responses to a few factors.  On one hand, inclusiveness in recruiting is sound practice for healthcare providers who face labor shortages in such occupations as nursing care, where demand is growing due to the needs of the aging baby boomer population.  On another, healthcare providers are changing to meet the needs of the nation’s shifting ethnic demographics, including growing populations of recent immigrants whose healthcare may involve workers with specialized knowledge, research foci, language skills or cultural fluencies. (See U.S. Dept. of Health and Human Services report,Changing Demographics and the Implications for Physicians, Nurses, and Other Health Workers.) At the same time, many healthcare industry employers have availed themselves of the widening availability of specialized professional, consulting and networking organizations that assist in workplace diversity recruitment and development.

In any case, many leading healthcare organizations now routinely rank in diversity listings such as those by Fortune, THE BLACK COLLEGIAN, and other specialized media, and often publish details of their organizational diversity initiatives on their websites.

Advancement Opportunities and Disparities

According to a two-stage study by the American College of Healthcare Executives (ACHE), entitled “A Race/Ethnic Comparison of Career Attainment in Healthcare Management,” moving up the ladder is fraught with barriers, although one interesting fact emerged:

“The proportion of top level management positions (defined as CEOs, COOs and senior vice presidents) varies by gender. Among women, whites continue to hold a disproportionately large share of upper level positions (35 percent) when compared to minorities (23 percent of blacks, 26 percent of Hispanics and 15 percent of Asians). But where in 1992, white males exceeded black males in top positions, today (1997), there are no important differences in the proportion of top positions held by male managers in the various race/ethnic groups.”

The study goes on to report that people of color face unfair treatment and advancement opportunities due to “structural factors in the system embedded racism, lack of organizational commitment to affirmative action, a paucity of mentors and the influence of the ‘good old boys’ clique. Hispanics and Asians also attribute career inequities to language and cultural differences.” Additional disparities were conveyed by black and Hispanic men who felt their organizations were “not as fair relative to continuing education opportunities as whites and Asian men.”

Importantly, fewer blacks and whites agreed that race relations in their organization were “good” than they had five years earlier, and proportionately fewer women than men thought so.

The work environment, in sum, continues to represent a fertile place for possible explanations for the lower career attainments of minorities in healthcare management. The study found that minorities are recruited to the same level of jobs as whites, but that it was white women in particular who were more likely than others to rise to senior executive positions.

Disparities in the executive suite seem to have persisted since that time. In ACHE’s 2002 follow-up report, the situation had changed only slightly.

“The proportion of top-level management positions (defined as CEOs, COOs, and senior vice presidents) varies by gender. Among women, a disproportionately large share of whites continue to hold top-level positions (40 percent) when compared with minorities: blacks (26 percent), Hispanics (25 percent), Asians (24 percent), and Native Americans (28 percent). With one exception, a higher proportion of men than women held top-level positions no matter what their race/ethnicity. White men in top positions exceeded minority men by a wide margin. Thus, 62 percent of white men compared with 44 percent of black, 47 percent of Hispanic, 34 percent of Asian, and 46 percent of Native American men held top-level positions.” (Report PDF is here.)

The report further indicated a wide disparity between whites and nonwhites in terms of their careers’ “starting place”:

More white healthcare executives than minorities took high-level first positions in the organizations for which they currently work. Moreover, we saw that whites were promoted to higher-level positions to a greater extent than their minority counterparts. Importantly, all of the race/ethnic groups learned about the availability of their current positions in very similar ways—notably, through their professional networks and via promotions.

In its 2006 report of its own demographics, ACHE reported that among its 28,890 affiliates, members and fellows, the overwhelming majority reported White/Non-Hispanic (88.8%), followed by a distant 5.3% for Blacks, 2.8% for Hispanics, 2.6 % for Asian/Pacific Islander, and 0.5% for Native American.