Strategies for Addressing and Mitigating the Lack of Diversity in Emergency Medicine

By Reuben William Horace, II MPH Emergency medicine (EM) has experienced incredible growth over the past decade; unfortunately, growth in the number of EM physicians from underrepresented minority (URM) backgrounds remains stagnant. Increasing the number of underrepresented minorities in graduate medical education, particularly in emergency medicine, is a priority that continues to be actively supported and advocated by numerous medical professional societies such as the Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), Council of Emergency Residency Program Directors (CORD), and National Medical Association (NMA). With this understanding of the lack of underrepresented minorities in emergency medicine, graduate medical education institutions have incorporated diversity and inclusion committees as part of their effort to not only attract these minority groups, but to also bridge the gap in emergency medicine.

Embracing diversity and inclusion in the workplace and professional societies has the potential to improve patient care and outcomes. Some of our country’s emergency departments regularly serve these minority patients and the trend will continue to rise as our population becomes more and more diverse. As a result, a diverse workforce in EM is more representative of the larger population, and diverse providers can bring their unique experiences and understanding of patient backgrounds, leading to increased cultural sensitivity and improved care for the diverse emergency department (ED) patient population. Furthermore, studies have shown that patients gravitate more to physicians similar to themselves, and that when patients

"A DIVERSE WORKFORCE IN EM IS MORE REPRESENTATIVE OF THE LARGER POPULATION, AND DIVERSE PROVIDERS CAN BRING THEIR UNIQUE EXPERIENCES AND UNDERSTANDING OF PATIENT BACKGROUNDS, LEADING TO INCREASED CULTURAL SENSITIVITY AND IMPROVED CARE FOR THE DIVERSE EMERGENCY DEPARTMENT (ED) PATIENT POPULATION. FURTHERMORE, STUDIES HAVE SHOWN THAT PATIENTS GRAVITATE MORE TO PHYSICIANS SIMILAR TO THEMSELVES, AND THAT WHEN PATIENTS HAVE DEMOGRAPHIC CONCORDANCE THEY ARE MORE SATISFIED, HAVE MORE TRUST IN THE PHYSICIAN, AND GREATER COMPLIANCE TO TREATMENT."

have demographic concordance they are more satisfied, have more trust in the physician, and greater compliance to treatment. As a whole, EM has the opportunity to serve these diverse populations by attracting and increasing their minority applicant pool.

Recruitment Strategies

Based on identified barriers and the need for more underrepresented EM applicants in emergency medicine, recommendations encompass seven main areas: 1. Maximizing the URM applicant’s exposure to faculty that are themselves underrepresented in emergency medicine that share similar clinical or research interest 2. Improving the communication between highly ranked underrepresented in emergency medicine applicants and key program faculty 3. Improving outreach to underrepresented minorities interested in EM by recruiting and attending yearly Student

National Medical Association (SNMA) conferences 4. Improving the residency curriculum surrounding community emergency medicine and cultural competence. (Each residency serves a different population and having residents who look like the population they serve will only strengthen patient physician relationship which can lead to better patient outcomes.) 5. Utilizing social media platforms such as Twitter and Instagram to showcase program highlights and hold open forums where underrepresented minority applicants can speak with other minority residents and key faculty within the residency programs 6. Being open to mentor and encourage underrepresented minorities to pursue careers in EM. This can include formal mentoring at your current institution or engagement with national student originations such as Student National

Medical Association (SNMA) and National Hispanic Medical

Association (NHMA)

On a personal note, many highly qualified URM candidates may not be considered “high priority” due to arbitrary cutoffs based on COMLEX Level 1 or USMLE Step 1 scores. I argue that institutions will still get highly regarded candidates if selection criteria are broadened to not solely focus on just board scores, but instead more tangible and meaningful criteria such as research experience, standardized letter of evaluation, long term leadership roles, and other meaningful life experiences that will enrich the institution's environment.

It is crucial, now more than ever, that emergency medicine programs recruit URM applicants to their programs to help serve the needs of a diverse and ever-growing population. The importance of recruiting URM candidates cannot be underestimated in the emergency medicine setting and through these efforts, we can facilitate a richer emergency department environment. These recommendations should be used to help equip emergency medicine programs with the knowledge to achieve the ultimate goal of increasing diversity at their institutions, attracting high quality faculty, and increasing the work force of unrepresented physicians in emergency medicine.

ABOUT THE AUTHOR: Reuben Horace is a third-year medical student at New York Institute of Technology. Among his interests are topics surrounding research in cardiovascular emergencies and diversity and inclusion.