The Diversity Benefit: How Does Diversity Among Health Professionals Address Public Needs?

The Patient Protection and Affordable Care Act (PPACA) signed by President Obama on March 23, 2010, is a far-reaching law intended to improve access to and the quality of health care for Americans. Recognizing the importance of the health workforce to the nation's health, the Act addresses health workforce and health professions education and training issues through provisions to strengthen the primary care workforce, provide tax relief for health professionals with state loan repayments, establish a national Health Care Workforce Commission, and expand the primary healthcare workforce by increasing and improving low-interest student loans. It is estimated that PPACA would afford access to health care for 32 million more currently uninsured new healthcare consumers, many of which ethnic and racial minorities or members of other vulnerable groups.As the Act is enacted, the nation is experiencing unprecedented demographic change. When the 2010 Census counts are tallied, we may finally grasp the degree of demographic shifts that the nation has undergone in the past decade. Since the 2000 Census, data gleaned from the American Community Survey and demographic models such as the one carried out by the Pew Research Center (Passel and Cohn, U.S. population projections: 2005-2050. Washington, DC: Pew Research Center: Social and Demographic Trends, 2008) predict major population shifts. By 2042, one in two Americans will be an Asian American, Pacific Islander, African American, Hispanic, American Indian, and/or Alaska Native. Since 2000, Hispanics have accounted for over one-half of the population increase in the United States. The number of Asian Americans grew at a larger proportion (9.0%) than any other racial or ethnic group during this same time period. In at least four states (California, Hawaii, Texas, and New Mexico) and the District of Columbia, racial and ethnic "minorities" constitute a majority of the population (U.S. Census Bureau, An older and more diverse nation by midcentury, 2008. http://www.census.gov/Press-Release/ www/releases/archives/population/012496.html, Accessed 22 Oct 2008; U.S. Bureau of Census, Hispanic Americans by the number, 2008. http://www.infoplease.com/ spot/hhmcensusl.html, Accessed 9 Jan 2010). Moreover, because of reproductive and immigration patterns, minorities are disproportionally represented among the younger population. Today, minorities account for 43% of Americans under 20 years of age, and it is projected that over the next two decades minority students will account for almost 40% of the total college population (Roberts, Minorities often a majority of the population under 20, The New York Times, 2008).Despite the rapid growth of racial and ethnic minority groups in the United States, many are dramatically underrepresented among the nation's health professionals. The percentage of African American, Hispanic, American Indian, Alaska Native, or Pacific Islander(1) in the health professions has grown only modestly at best over the past 30 years. Yet relative to the growth of the minority population in the United States, this rate of increase still leaves the proportion of minority health professionals outstripped by several fold. Hispanics, for example, comprise over 15% of the U.S. population, but only 2% of the registered nurse population, 4.6% of psychologists, and 5.0% of physicians. Similarly, one in eight individuals in the United States is African American, yet less than 1 in 20 dentists or physicians are African American. Minorities are severely underrepresented in academia. During the 2007-2008 academic year, URMs (underrepresented minorities) made up only 7.4% of U.S. medical school faculty, fewer than 7% of undergraduate faculty, less than 10% of baccalaureate and graduate nursing school faculty, 12% of clinical psychology faculty, and 8.6% of dental school faculty (Moreno et al., Using multiple lenses: an examination of the economic and racial/ethnic diversity of college students. In: Univ AoACa, editor. California: The James Irvine Foundation, Claremont Graduate University, 2006; Institute of Medicine, In the nation's compelling interest: ensuring diversity in the health-care workforce. Washington, DC: Institute of Medicine, 2004; Hall, Clin Psychol Sci Pract 13:258-261, 2006).