Improving the Diversity Climate in Academic Medicine: Faculty Perceptions as a Catalyst for Institutional Change

Increasing the diversity of the physician workforce has gained national attention as one of many potential solutions to problems of racial and social class disparities in access to health care. Ethnic minority physicians are more likely to practice in underserved areas and to care for patients of their own race/ethnic group, as well as low-income patients, Medicaid-insured and uninsured patients, and patients with poorer health status.1–3 Ethnic minority patients have been shown to experience higher levels of participation and satisfaction with ethnic minority physicians.4–5 Thus, a more diverse health care workforce could enhance the health care experiences of ethnic minority patients. Diversity in the health care workforce could also improve the experiences of health care professionals. Moreover, ethnic diversity in medical school and other higher education settings is associated with better educational experiences for all students.6 Ethnic minority faculty serve as important role models and mentors to trainees. However, compared with whites, they are less likely to be satisfied with their jobs and more likely to leave academic medicine.7 Ethnic minority and foreign-born physicians have reported harassment, bias, and discrimination by their colleagues in academic settings.8–10 Moreover, ethnic minority faculty experience of bias is related to their decreased career satisfaction compared with white faculty.9 Ethnic disparities in promotion in academic medicine have been documented nationwide.11 The Institute of Medicine recommends that health professions educational institutions improve their diversity climate12; however, strategies for enhancing organizational change in academic medicine have not been clearly defined. The Johns Hopkins University School of Medicine (JHUSOM) and its affiliated medical institutions (Johns Hopkins Medicine [JHM]) recognize the importance of institutional diversity climate and are taking necessary steps to improve it. The JHM vision of diversity is that “by 2020, JHM will be recognized by peer institutions, patients and the community as a leader for diversity and inclusion in medicine” (personal communication, Drs. Janice Clements and George Dover, co-chairs, JHU Committee for Faculty Recruitment and Diversity, February 1, 2008). The Committee for Faculty Recruitment and Diversity was chartered in 2004 to lead this change throughout the institution. Similarly, in 2002, the Department of Medicine (DOM) chartered its Diversity Council to strategically address recruitment and retention of individuals from underrepresented racial and ethnic groups into the department.13 The charter includes reviewing policies and procedures and informal practices across the department that affect recruitment and retention and establishes a data-based approach to analyzing the department’s diversity profile and informing improvement of the institution’s diversity climate. Most published studies addressing diversity in academic medicine focus on gender-related issues or diversity in undergraduate and graduate medical education. Gender disparities in faculty promotion, compensation, and perceptions of harassment and discrimination are well documented.14–16 Ethnic minority medical students have reported experiencing bias, discrimination, and stereotyping, which results in feelings of isolation, depression, and burnout.17–18 Moreover, an institutional climate of diversity influences ethnic minority students’ choices of residency programs.19 To our knowledge, relatively few studies have addressed racial/ethnic differences in faculty experiences in academic medicine,7–10 and despite the demonstrated importance of collegial networks to professional success and well-being in physicians,20–22 few studies have examined the experiences of diverse faculty with regard to networking opportunities. The DOM Diversity Council, therefore, sponsored a qualitative study of the diversity climate at JHUSOM in which academic physicians reported that visible dimensions of cultural diversity (race/ethnicity, gender, foreign-born status) provoked cumulative advantages or disadvantages in the workplace, including disparities in recruitment, subtle manifestations of bias in the promotion process, and differential access to career networking opportunities.23 Ethnic minority faculty anecdotally described structural barriers (e.g., poor retention efforts by persons in leadership positions) that hindered their success and professional satisfaction after recruitment. In light of this background, this study’s objectives are to (1) quantify perceptions of bias or career obstacles, satisfaction with diversity and support for professional development, and inclusiveness of career networks among physician faculty in the JHUSOM, (2) compare the perceptions of ethnic minority and majority physicians, and (3) identify areas in which targeted strategies might improve the diversity climate in the DOM and JHUSOM.