Diverse Medical Workforce Improves Outcomes, But Diversity Is Still Rare

Having more Black primary care physicians in a given area is linked with better survival-related outcomes for the Black people who live there, according to new JAMA Network Open data. These findings indicate that medical workforce diversity can improve health equity, but the researchers noted that places with high workforce diversity are still hard to come by.

These findings follow similar articles indicating that medical workforce diversity is better for health equity. Some experts have indicated that racial concordance can improve patient experience, while others have identified a link between racial concordance and patient-centered care.

This latest study, spearheaded by the Health Resources and Services Administration (HRSA), takes that notion a step further. By simply having more Black doctors serving a given community, the Black people who lived there saw greater life expectancy—even if they weren’t treated by one of those Black doctors.

The retrospective study took place between 2009 and 2019. The HRSA researchers looked at the proportion of Black primary care physicians in one of around 1,600 communities as well as the survival-related outcomes, including life expectancy and all-cause mortality, for the Black people who lived there. Additionally, the team looked at changes in mortality-related racial health disparities between Black and White people in studied communities.

Having more Black doctors in a community was linked to better survival-related outcomes for Black people. In fact, with every 10 percent increase in Black PCP representation, the researchers reported a nearly 31-day increase in life expectancy for Black residents.

Moreover, having more Black primary care providers was linked with lower all-cause mortality rates and fewer mortality rate disparities between Black and White people.

But there are some caveats, the researchers said. Although there was a reported link between better mortality rates and more Black PCPs in a community, the researchers did not investigate the forces behind that link.

Additionally, they pointed out that it is still rare for communities to have a high proportion of Black PCPs. Just because having more Black PCPs improves health equity doesn’t mean it happens very often, the team said.

In fact, the study’s sample size was small for that very reason. The researchers were limited to 1,618 US counties because that is how many counties had at least 1 Black PCP working there during the 10-year study period. That’s less than half of the 3,142 Census-defined US counties as of 2014.

Said otherwise, more than one-half of all US counties have no Black primary care physician working in them.

What’s more, the number of Black physicians was not proportionate to the number of Black people who lived in a county, generally speaking. During the study period, Black people accounted for between 13 and 13.4 percent of the total US county-level population. By comparison, Black primary care physicians accounted for 5.7 percent of all PCPs in 2009, 6.3 percent in 2014, and 6.7 percent in 2019.

In order for the potential benefits of having more Black physicians to reach a wider population, the healthcare industry must do more to cultivate a more diverse medical workforce.

“Potential interventions to address this include implementing changes in the processes for admissions, hiring, and promotions at universities, such as holistic review, and efforts to better nurture an educational and training environment that is structured for inclusion,” the HRSA researchers said.

Complementary action items include improving cultural competency training; infusing all of medical education with diversity, equity, and inclusion; and providing medical students and trainees with more diverse learning opportunities.