In the United States, racial and ethnic identity is often very complicated. And for the continuum from medical student to practicing physician, how race and ethnicity are captured varies widely. It also fails to grasp the complexity of the situation for many physicians.
But without this consistent data collection and reporting, it is difficult to determine where medical students, residents and fellows, or practicing physicians from historically excluded racial and ethnic groups are struggling professionally.
During an educational session at the 2022 AMA Annual Meeting, five AMA members discussed how racial and ethnic identity data collection in medicine can be improved.
“I don’t focus too much on what it means for an institution to be diverse because it’s often used as a point of pride,” said Alec Calac, a member of the Pauma Band of Luiseño Indians in North County. , San Diego. . Instead, it focuses on “how we serve each student and make them feel that their identity is not just tolerated or welcomed, but is respected and valued because they are two different distinctions.”
Calac is an MD-PhD student at the University of California, San Diego (UCSD) School of Medicine and Herbert Wertheim School of Public Health and Human Longevity Science. He also chairs the AMA Medical Student Section Committee on Native American Affairs and is an AMA Ambassador.
“As an intern, it can be incredibly isolating to be a Native American in medicine where you feel like your representation is difficult,” he said. “But you feel compelled to do so, because it will make it easier for the person following you.”
“My mother is Filipino, but her grandmother came from Spain and my father is a South Asian Indian,” said Tripti Kataria, MD, an anesthesiologist in Chicago and a member of the AMA’s Council on Legislation. “What’s important and not reflected in the data is that many of us want to return to our communities.”
“As we identify ourselves and look at the data, the only thing missing is who do we also want to serve, because that’s part of us,” Dr Kataria said.
“If you ask a first-year medical student how likely they are to practice in an underserved community, it varies by race,” said William McDade, MD, PhD, director of diversity and inclusion in the Accreditation Council for Higher Medical Education. in Chicago. “It’s about 65% for African Americans, about 55% for Native Americans, about 50% for Latinx, and about 20% for Whites and Asians.”
And “if you ask for four years, the numbers don’t change. People who enter medical education know that they are the ones they are going to serve. That’s what they want to do,” said Dr. McDade. “That’s why it’s very important for us to make sure we have the right people in medical school who are going to serve those communities. And that’s why getting the right data is so important.
“It really depends on the pipeline. This is the only way for us to really see an improvement in disparities,” said Erick Eiting, MD, emergency physician and member of the AMA Council on Medical Service. “And the only way to really reverse some of the inequities that we’re seeing is to make sure we fix the pipeline issues.
“We need to make sure that we give people the opportunity they need to provide the care that some of the most disadvantaged communities need,” Dr Eiting said. “We have to get it right.”
“If you’re not counted for who you are, you’re not counted and there’s tension,” said Siobhan Westcott, MD, MPH, associate professor in the Department of Health Promotion at the University of Nebraska Medical Center College of Public Health in Omaha and the Association of American Indian Physicians representative for the AMA Minority Affairs Section Board of Directors.
“Racial identity is very complicated and ethnicity is a whole new layer,” Dr Westcott said.
“We are just starting to tackle this, but we have to keep pushing to try to find solutions to this very difficult problem.”
Inconsistent policies for collecting and reporting data on race and ethnicity across the continuum of medicine can hamper efforts to improve diversity among medical students and physicians, according to a resolution proposed by the Minority Affairs Section of the AMA and the National Medical Association at the annual meeting.
To resolve the issue, the House of Delegates asked WADA to:
- Adopt racial and ethnic demographic data collection practices that allow self-identification of the designation of one or more racial categories.
- Report physician workforce demographics in the race and ethnicity categories in which Latinos, Hispanics, and other identified ethnicities are categories, regardless of race.
- Adopt racial and ethnic demographics reporting practices on the physician workforce that allow for the disaggregation of individuals who have chosen multiple racial categories to distinguish each category of individual demographics as either alone or in combination with any other racial and ethnic categories .
- Collaborate with Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, American Association of Colleges of Osteopathic Medicine, American Osteopathic Association, National Board of Medical Examiners, National Board of Osteopathic Medical Examiners, National Resident Matching Program, Federation of State Medical Boards , Council Medical Specialty Societies, American Board of Medical Specialties, Health Resources and Services Administration, Offices of Management and Budget, National Institutes of Health, Educational Commission for Foreign Medical Graduates, and all other appropriate stakeholders, including minority physician organizations and relevant federal agencies—develop standardized processes and identify strategies to improve the accurate collection, disclosure, and reporting of racial and ethnic data across the continuum of medical education and the medical workforce .