Abstract
Despite being nearly ubiquitous in major companies just five years ago, today diversity, equity, and inclusion (DEI) programs are facing an existential threat. Companies like Google, Meta, Target, and more are moving to shutter diversity offices, funding programs, and other initiatives that they touted with much fanfare back in 2020. They are making these changes in conjunction with the federal government, which has made its contempt for and distrust of diversity ideology plain. Charging that DEI compromises quality and standards, subverts meritocracy, and in extreme cases even costs lives, critics assert that these policies have minimal value and serve to discriminate against white men.
While opponents deride DEI, the research on health professions shows a different picture. The health care industry, particularly the professions of medicine and nursing, has spent decades emphasizing the importance of and need for more racial and gender diversity within these career fields. As of 2022, however, Black Americans were 13% of the US population but only 5% of physicians. Black men constituted a mere 2% of Black doctors, a number that, according to physician Dan P. Ly writing for the Journal of General Internal Medicine, has remained virtually unchanged since the early 1900s. The American Association of Colleges of Nursing also reported in 2022 that only 6% of registered nurses identified as Black, with Black men making up less than 2% of Black workers in this profession as well. For decades, numbers like these contributed to a push from industry leaders to attract more women of all races to medicine, and more men to the nursing profession.
There is an unquestionable, concrete benefit to more diversity in health care.
Indeed, in health care, there is a measurable value to a more diverse work force. For instance, in a 2023 JAMA Surgery article, Christopher Wallis and his colleagues found that despite their underrepresentation in surgery, women doctors in this specialty area have lower complication and death rates than their men counterparts. Management professor Brad Greenwood and his colleagues also published a 2018 Proceedings of the National Academy of Sciences paper documenting that women suffering from heart attacks show better outcomes when treated by women physicians. Furthermore, these effects are present even when women are treated by men doctors in departments with high numbers of women colleagues. Similar studies, such as Marcella Arsan’s 2018 NBER report “Does Diversity Matter for Health? Experimental Evidence from Oakland” and John Snyder and colleagues’ 2023 JAMA Open Network article, show that increasing the numbers of Black men in the physician profession could reduce cardiovascular deaths among Black men; and that Black residents in communities with higher numbers of Black doctors have better health outcomes, respectively. These studies show that there is an unquestionable, concrete benefit to more diversity in health care. It doesn’t just improve outcomes; it literally saves lives.
So, we know that diversity benefits healthcare and, accordingly, that health professions have tried to create more racial and gender diversity within their ranks. Why have they struggled? In my 2019 book Flatlining, a study of Black doctors, nurses, physician assistants, and technicians, I found that doctors were mostly exposed to diversity initiatives in the form of cultural competence trainings. These sought to help physicians understand how social and cultural differences could impact patient care. Nurses felt that the facilities where they worked paid lip service to diversity, but rarely addressed structural or interpersonal inequalities they faced—scheduling disparities, mistreatment from colleagues, or blocked access to credentialing. And technicians were largely left out of diversity discourse entirely, with few providers taking steps to attract underrepresented workers to the field or address the challenges faced by the ones who were there. It seemed that professional associations, industry leaders, and health care facilities openly touted the benefits and virtues of more diversity. But they rarely put initiatives or programs into place that would increase the numbers of Black workers in these professions or acknowledge the issues they confronted once inside.
In the absence of such efforts, Black practitioners did an enormous amount of work on their own to make health care more accessible and available to communities of color—both patient populations and potential care providers. Black doctors sought to address the structural dynamics that artificially depreciated their numbers in the profession. They engaged in intensive mentoring, lobbied for outreach programs, and started nonprofits to promote better health access. Black nurses cast themselves as “change agents” who lobbied for Black patients to receive more respectful, compassionate care. Black technicians attempted to advocate for Black patients, helping them to be taken seriously in health care systems that often overlooked or ignored them. In short, with health care facilities unable or unwilling to do this work, Black workers took up the responsibility for creating more diversity in the profession.
These patterns spur a serious question: what will happen to health care—and the health of our population in general—as diversity initiatives become increasingly stigmatized and eventually shuttered? The research shows that more diversity among health professionals helps improve outcomes, even saves lives. But for a variety of reasons, Black workers remain underrep-resented, especially in medicine and nursing. These disparities leave Black doctors and nurses doing the additional labor of both tending to underserved Black patients’ particular needs and trying to expand potential Black care providers’ access to their fields. As diversity programs continue to fall by the wayside, this strain is likely to leave Black practitioners with ever more work and responsibility.
It is also key to ask whether shuttering diversity programs will reverse the progress women of all races have made in the medical profession. Sociologists Ann Boulis and Jerry Jacobs found that the numbers of women attending medical school have been steadily increasing for decades, and, at present, women are in the majority among students enrolled in U.S. medical schools. But women doctors still face barriers that effective diversity programming could address. As sociologist Kate Kellogg shows, among these are the punishing schedules that are incompatible with cultural expectations for caregiving, sexual harassment in male-dominated specialty areas like surgery and anesthesiology, and underrepresentation in leadership roles. Sociologists Wasudha Bhatt and Glenda Flores find that women of color in the physician profession face barriers that reflect their race and gender, with Latinas asked to provide translation services, Indian women stereotyped as foreigners who face bias if they speak with an accent, and Black women presumed to be less competent. Eliminating diversity initiatives makes it less likely that issues like these will be resolved in ways that allow women to reach their full potential in the medical field.
In health care, there is a measurable value to a more diverse work force. For instance, women surgeons have lower patient complication and death rates than their male colleagues.
iStockPhoto // AaronAmat
Abandoning efforts to achieve more diversity among health care providers means accepting the fact that more patients may suffer. Black men doctors and women physicians of all races help enhance health outcomes, reducing patient complications and extending life expectancy. Gutting diversity programming won’t advance our nation’s health. Instead, it might literally kill us.