Almost every night while in elementary school my mother treated me to a bedtime story. She would pull up a children’s book and, with her unique facial expressions, begin narrating away. In one particular instance, I remember a story of a young boy who explored the melting pot of the world. “Every skin tone, every culture, and every religion lives in America,” she read. I would close my eyes, and I would imagine people from all walks of life strolling through downtown New York City.
Not too long after that story was told, I got to see it for myself. Setting foot in New England amid the cold winter breeze, after immigrating from the tropical weather of the Peruvian jungle, I witnessed a biracial couple with their kid grabbing ice cream, a tall African American man with an impeccable suit on his way to a coffee shop, a Latino man picking up groceries at his local market, and an Asian soccer mom cheering for her son.
Growing up, I loved seeing the diversity all around me; every group seemed to be well represented. But as I continued on my educational path, I noticed a gap that only grew larger. It became even more apparent when I started medical training. I could barely find anyone with the same ethnicity in my class cohort.
“Where did they go?” I questioned. “Is this also true in residency and beyond?”
To my relief, I found hope and comfort during a residency interview. “Of the six of you here, three come from a Hispanic heritage,” the program director said. Their online platform seconded this: “We strive for diversity in medicine.”
It is estimated that, by 2050, more than half of the U.S. population will consist of people from racial minority groups. States like California, New Mexico, Texas, and Hawaii are already considered “majority-minority” states and show no signs of slowing down. And with this uptick, it is only a matter of time until we feel the impact within our health care community.
How will we address health inequities that have existed for decades? How can we consciously and properly respond to the health needs of various growing minority populations? How will we provide quality service not only to an individual patient's life but also to community health and wellness? How will the social determinants and unique, complex challenges in our area impact our patients?
The answer begins with us. We cannot adequately address the needs of our diversifying patient communities when diversity is not visible among us. Only 6% of physicians identify as Hispanic, for example, even though this group makes up 19% of the population. An initiative toward drawing a more representative proportion of ethnicities and races must be at the center of our mission. The lack thereof may only invite unwelcome adversities.
A study conducted by McKinsey & Co. showed that ethnically diverse companies are 35% more likely to outperform their nondiverse counterparts. A diverse health care workforce is also more likely to be culturally competent and equipped to deliver medical information to distinct groups of patients. Furthermore, residents may best learn to provide care for those suffering from health disparities in a place rich in cultural opportunity that allows for interaction and training with colleagues from various backgrounds.
For example, a federally qualified health center in San Bernardino has felt the impact of diversity in its organization. A training site for primary care residencies, it doubled its minority representation and went from having only a single bilingual attending physician to more than seven bilingual attendings. One of the primary drivers has been being intentional about embracing and promoting diversity.
We can all benefit from diversity in the room. Patients who are racial or ethnic minorities are often more likely to choose a health care professional who shares their background. In turn, clinicians who understand the values of the communities they work in may engage more effectively with their patients. As a result, the gap between health care workers and those they serve can shorten, helping reduce health disparities.
With a call to address our evolving communal needs, we are finally noticing a change in our educational front. We have a historical increase among underrepresented minorities per the AAMC. The number of Black or African American medical students who started school in the fall of 2021 rose by 21.0%, compared with prior years. There was also a 7.1% growth in students who identified as having Hispanic, Latin American, or Spanish origin.
This is just the start, though. We still have a long way to go. Whether that means providing more opportunities for minorities to apply for roles in medicine or widening the diversity pool of health care workers, we have some work left to do. “Health care is and should be a defined social benefit,” Dr. Theresa Nevarez, director of the Harbor-UCLA family medicine residency program, told me.
I believe my mom’s bedtime story can still hold true in medicine. The great poet and civil rights activist, Maya Angelou, said it nicely: “In diversity there is beauty and there is strength.”
What are the potential benefits of greater diversity in medicine? Share your thoughts in the comment section.
Ricardo Chujutalli graduated from Loma Linda School of Medicine, received his masters degree in Business Administration in Healthcare Management from La Sierra University, and is pursuing a masters degree in Bioethics.
Jason Lohr, MD, served as CEO at SAC Health and is passionate about service, locally and globally. He graduated from Loma Linda School of Medicine in 2001 and completed his Family Medicine and Tropical and Travel Medicine training.
Illustration by April Brust