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Black, Hispanic, Native American individuals ‘left behind’ in health care workforce

In 2019, Black, Hispanic and Native American populations were underrepresented in the current workforce and education pipeline for 10 health professions, according to data in JAMA Network Open.

There is substantial evidence that shows a diverse health care workforce is “critical to increasing access to care and improving aspects of health care quality among underserved populations,” Edward Salsberg, MPA, co-director of the Health Workforce Diversity Tracker project at the GW Milken Institute School of Public Health in Washington, D.C., and colleagues wrote in JAMA Network Open.

In 2019, representation of Black individuals was lower in the education pipeline than the current workforce for the following health professions:  Physician assistant, occupational therapy, physical therapy, speech-language pathology and registered nurse

Reference: Salsberg E, et al. JAMA Network Open. 2021;doi:10.1001/jamanetworkopen.2021.3789.

“Although studies have informed policies to improve diversity, most focus on the medicalworkforce, with fewer studies examining the racial/ethnic diversity of other health care professions,” they continued. “Furthermore, few studies have systematically assessed the diversity of multiple professions or compared performance over time.”

To close the data gap, the researchers conducted a cross-sectional study using weighted data from the American Community Survey and Integrated Postsecondary Education Data System. The analysis included information on 148,358,252 people aged 20 to 65 years who were employed or looking for work, and 71,608,009 people aged 20 to 35 years in the education pipeline in 2019.

The researchers also created a health workforce diversity index that looked at how minorities were represented in each of 10 studied professions: advanced practice registered nurse, dentist, pharmacist, physician, physician assistant, occupational therapist, physical therapist, respiratory therapist, speech language pathologist and registered nurse.

This analysis showed that in 2019, Black individuals accounted for 12.1% of the total United States workforce, but among the studied health care occupations, their representation varied from 3.3% for physical therapists to 11.4% for respiratory therapists. The health workforce diversity index for Black individuals was 0.54, which meant they were “very underrepresented” among health professions, according to a press release.

Although Hispanic individuals accounted for 18.2% of the total U.S. workforce, their presence among the health care occupations was low, ranging from 3.4% for physical therapists to 10.8% for respiratory therapists, with a workforce diversity index of 0.34.

Native Americans only accounted for 0.6% of the total U.S. workforce, and among the health professions, their presence ranged from 0% to 0.9%, yielding a health workforce diversity index of .54.

When looking at the education pipeline, the researchers found that the mean diversity index for Black individuals was also low — 0.54. They reported that representation of Black individuals was lower in the education pipeline than the current workforce in five of the 10 health professions: physician assistant (0.23 vs. 0.37), occupational therapy (0.31 vs. 0.50), physical therapy (0.23 vs 0.28), speech-language pathology (0.28 vs. 0.39) and registered nurse (0.82 vs. 0.94).

Among Hispanic individuals, the diversity index of the education pipeline was lower than the index of the current workforce in one occupation — physician assistant (0.37 vs. 0.4).

For Native American individuals, the diversity index was lower in the education pipeline than the current workforce in four occupations: physician assistant (0.48 vs. 0.94), occupational therapy (0.24 vs. 0.30), respiratory therapy (1.05 vs. 1.64) and speech-language pathology (0.54 vs. 0.96).

The researchers reported “limited improvements” in the education pipeline, but “underrepresentation of these groups persists,” they wrote.

“Our findings suggest that Blacks, Latinos and other people of color have been left behind when it comes to the health professions,” Salsberg said in the press release.

Maria Portela, MD, study co-author and chief of family medicine in the department of emergency medicine at the GW School of Medicine and Health Sciences in Washington, D.C., said in the press release that raising awareness of the diversity gaps could help increase efforts to reverse the study findings.

Until more resources are devoted to diversifying the workforce, “this trend is unlikely to change,” she said.


George Washington University. Blacks, Latinos and Native Americans severely underrepresented in health workforce. Accessed March 30, 2021.


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