Improving Diversity in the Hospitalist Workforce

The Society of Hospital Medicine (SHM) is committed to a diverse and inclusive membership that works to provide high quality, equitable care to diverse populations. At the SHM National Conference in Orlando, FL, physicians, advanced practice providers, and hospital medicine administrators from around the country gathered at the, first-of-its-kind, diversity special interest forum to discuss ways in which hospital medicine groups and divisions around the country can help lead diversity and equity efforts. While we defined diversity, equity, and inclusion, and strategized on ways to successfully attain these within hospital medicine, this forum ultimately served a larger purpose — it was a call to action! Attendees identified several key areas that needed attention including: (i) matching healthcare workforce to patient populations; (ii) providing training to healthcare providers in the provision of culturally competent care; and (iii) improving diversity within hospital medicine.

Individuals who attended the forum agreed that the diversity of our healthcare workforce should match the diversity of our patient populations. This includes but is not limited to race, ethnicity, gender, LGBTQ, religion, socioeconomic status, and individuals with disabilities. However, this goes beyond matching numbers or checking boxes. We had a vibrant discussion on microaggressions and macroaggressions, bias and racism, and the impact each of these plays in retaining and supporting diverse students, residents, faculty and staff. We need to be aware of our own biases and behaviors and utilize tools to mitigate the impact these have on others. A number of participants felt that unconscious bias training and workshops would be helpful in starting these discussions and identifying ways to address bias. We discussed the importance of “calling out” racism and bias when we see it and acting as allies to those who are experiencing these acts. In addition to being allies, we must be problem solvers and system navigators for our diverse patients and colleagues.

A diverse healthcare workforce is essential to providing culturally competent care and contributes to an enhanced learning environment. Cultural competence is defined as the ability to understand, communicate with and effectively interact with people across cultures. It is not always feasible to recruit and retain a diverse workgroup. Majority groups can be used to engender diversity with appropriate training. There was a consensus that workshops and sessions on racism, bias, cultural competency, diversity and equity should be part of yearly national hospital medicine meetings and hospitalist publications. These topics could be addressed through panel discussions where there could be sharing of stories as well as discussions on barriers and facilitators of each of the issues raised. Further, solutions could be developed from multiple perspectives (i.e. provider, learner and patient). Statements and/or guidelines from national hospitalist organizations on how to address racism and other diversity/equity issues would be very impactful.

In addition to diversifying our workforce, attendees commented on other areas for improvement within hospital medicine including: gender equity (speakership, leadership, compensation, access to resources such as childcare or lactation rooms at meetings, etc.), age discrimination, recruitment of diverse learners, as well as retention, mentorship, sponsorship and promotion of diverse students, residents, advanced practice providers, faculty and staff. In general, we should continue to advocate for an environment where individuals will be judged for their abilities and given equal opportunities to thrive in this field.

It was clear during our discussion that in order to make progress, there are a number of things that we need to do. First, we must have a better understanding of what our hospital medicine workforce as well as our national society looks like (demographics, representation on committees, board, etc.). Visibility and transparency bring accountability. Knowing and understanding our demographics will allow us to see how we compare to other specialties and will give us insight on how to uniquely recruit for hospital medicine. Second, it is extremely important to have committees and leadership committed to diversity and equity within each of our groups, divisions and national organization. Diversity and equity should be integrated into all that we do and ideally there should be a diversity champion or expert that sits on each committee. Third, we need to improve our outreach to diverse students. This may include reaching out to other societies and organizations (e.g. Student National Medical Association) that are geared towards underrepresented students in medicine. This would help provide that pipeline for a diverse workforce. Fourth, SHM could develop standardized processes and recommendations for best practices in recruitment and hiring and partner with other national organizations to help ignite these efforts. Specifically, there is an interest in creating checklists and toolkits that will help reduce bias in the hiring processes and allow for representation of diverse individuals on search committees and within applicant pools. Finally, an SHM diversity committee should be the next step to take on the task of fleshing out the key issues outlined, identify solutions to the problems, and implement strategies to ameliorate the problems.

Diversity, inclusion and equity are integral to the practice of medicine and must be infused into everything we do. It improves the quality of care we provide for our patients and strengthens relationships between healthcare providers. It is essential that SHM and its members continue these discussions on diversity, equity and inclusion and these discussions must be followed by action!

Dr. Amira Del Pino-Jones and Dr. Marisha Burden are at the Division of Hospital Medicine, University of Colorado, Denver, CO. Dr. Flora Kisuule is at the Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD

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