Increasing Family Medicine Faculty Diversity Still Lags Population Trends

Discussion

Faculty diversity has grown but still neither reflects the diversity of the U.S. population nor that of medical students. The fact that lower-rank professoriates had higher proportions of female and URM faculty than higher rank professoriates highlights the mobility barriers these groups face from a promotion perspective.^6,7 Though the specific barriers would need to be elucidated in future studies, we hypothesize that they may include overt prejudice, subtle discrimination, undervaluing the unique contributions of women and URMs, family responsibilities, and opting out of promotion paths. Early studies have found that female and nonwhite faculty members had lower promotion rates and leave full-time faculty appointments at a higher rate than male and white faculty members.^5,8,9 The tendency for URM and female physicians to practice primary care could partially explain higher FM department faculty diversity compared with other departments.^10,11 The fact that FM departments are becoming more diverse is encouraging, given that primary care faculty are charged with training the source of first contact, continuous, coordinated, and comprehensive care for underserved minority patients.¹²

There are several limitations in this study. First, Faculty Roster data were reported by medical schools. We could not confirm whether faculty gender, race, and ethnicity were completely self reported. Second, our unit of analysis is medical school department based on a December 31 snapshot for each calendar year. There were 128 departments across 121 medical schools classified as FM department as of December 31, 2015. We reported diversity by departments, not by physician's specialties. For instance, there could be a faculty with a MD degree in FM serving in another department. Moreover, not all faculty are necessarily physicians. In 2015, 80.4% of full-time faculty at FM departments held a MD degree. Non-physician faculty diversity may reflect more of the current diversity challenges in the overall biomedical research workforce in the nation.¹³ We were unable to differentiate International Medical Graduate (IMG) status of faculty in this study. Understanding how IMG faculty self identify regarding race and ethnicity is an important research question to be examined. Furthermore, we combined all other department faculty as a single group for reference. This masks the substantial interdepartmental variations in diversity by gender, race, and ethnicity. For instance, female and URM proportions for FM departments in 2015 were ranked 10th and seventh out of all 36 academic departments (based on medical school department classification). Finally, our analysis does not establish a causal relationship between faculty diversity and student diversity, although strong associations have been demonstrated.¹⁴ Earlier findings suggest that diversity would be slower for faculty as their turnover is much longer than medical students. This seems to suggest that student diversity improvement would eventually lead to faculty diversity improvement in the long run.

Better approaches are needed to improve faculty diversity and opportunities for promotion of diverse faculty in academic medicine overall and in FM faculty. Pipeline programs for academic FM departments should be strengthened and initiated at an early stage of training.¹⁵ Mentoring minority and female junior faculty members in academic FM is also important. Finally, medical schools and academic FM departments may need to review their current practices and policies with an eye toward enabling more faculty diversity through institutional transformation⁷ and moving diversity from the periphery to the core of institutional excellence.¹⁶