Pediatric Leadership Stuck in Diversity Void

Marcia Frellick

March 09, 2015

As the US population of children becomes increasingly diverse, the diversity of pediatricians has not kept pace, especially at the top of the field.

Fernando Mendoza, MD, MPH, from the Department of Pediatrics, Stanford University School of Medicine, California, and colleagues sent surveys to 131 US pediatric department chairs to evaluate whether an institution had a diversity plan, which groups were targeted, whether there was cultural competency training, and how successful they perceived their program to be.

Their results were published online March 9 in Pediatrics.

The researchers found that women were progressively less represented at higher ranks. Although they made up 75% of the residents, they made up only 54% of faculty and 26% of chairs.

Racial and ethnic diversity also was limited across the board among trainees, faculty, and leaders. Only 10% of each group was black, Hispanic, or Native American.

Asian Americans were more common among trainees (15% - 33%) but were not often found in faculty and top leadership (0% - 14%). The authors note that these low numbers are not unique to pediatrics but are a challenge overall in medicine.

Half of US Infants Are Minorities

At the same time, the child population has changed. In 2010, 50.4% of infants in the United States were minorities, and 1 in 4 children currently lives in an immigrant family.

Of the 49.6% of the chairs who responded to the survey, three fourths reported having a plan for diversity, including race, sex, ethnicity, disability status, and sexual orientation. Overall, 69% reported that their diversity efforts were successful.

Diversity measures included the number of trainees and faculty, promotions, climate assessments, and exit interviews.

Regarding underrepresentation of women at the top, coauthor Leslie Walker, MD, from the Department of Pediatrics, University of Washington School of Medicine, Seattle, told Medscape Medical News that conventional thinking has been that it will just take time for women to rise in pediatric leadership. However, since the sex percentages evened out in 2003, she said, the trend is not there. "That should have already happened if it were going to happen in some natural way."

Far from being an issue of political correctness, she said, lack of diversity is stunting the growth of pediatrics. Without more points of view and cultural competence, the field cannot achieve the excellence the health system demands. Discrepancies in care are not disappearing, she said, and part of the reason is that the people looking for solutions may not have the same investment in the outcomes if they are not in the group directly affected by them.

"One of the interesting things about the paper is that most of the people who replied in general felt pretty good about what they have done thus far, so I think what we're hoping is that there will be a different bar.... We have to have a different understanding of what's missing," she said.

What is missing is particularly striking in California, Dr Mendoza told Medscape Medical News: "In California, "50% of all the children being born are Latinos, and we have 5% Latino pediatricians."

Problems Plague Pipeline

One problem is the pipeline, the authors say. Citing data from the Association of American Medical Colleges, they found that from 2002 to 2012, there was no change in the proportion of medical school graduates who were black or Native American (7% and 0.8%, respectively). The proportion of Latinos rose slightly, going from 6% to 7.8%.

However, other gaps need to be addressed, and to that end, the researchers offer nine points of action for departments, the Accreditation Council for Graduate Medical Education, and pediatric organizations.

Dr Mendoza said that because workforce diversity is not a change that can come quickly, the field also urgently needs to focus on cultural competency care. Among the needs are learning language and cultural histories and cultural beliefs, such as preference for shaking hands or whether a patient wants to be touched at all.

It is not just the quality of care, he said, but efficiency of care that is at stake. Without the training, it takes more time to establish trust and understand cultural issues.

"Effective medicine comes from having effective relationships between patients and their doctors," he said.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 9, 2015.

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