Diversity in Medicine: New Report Examines Minimal Growth in Native Representation

While there have been significant efforts to increase the diversity of the physician workforce, the number of individuals who identify as American Indian and Alaska Native applying to and enrolling in medical school has seen slow and uneven growth, according to a new report released this week by the Association of American Medical Colleges and the Association of American Indian Physicians (AAIP). (Related: Coming in 2020: The First-Ever Tribally Affiliated Medical School in America)

The report, Reshaping the Journey: American Indians and Alaska Natives in Medicine, is the first of its kind in which two national organizations worked together to delve into the current state of Native representation in medicine. The report also makes the case for increasing Native representation in the health professions and attending to institutional culture and climate.

Cover of the 78-page report (aamc.org)

Designed to serve as a blueprint for medical schools and teaching hospitals, the report summarizes effective and promising practices and programs at many of the nation’s medical schools that have contributed to the development of Native physicians and allies who are prepared to address the health care needs of American Indian and Alaska Native communities.

“This is not a challenge solely for our institutions in regions with American Indian and Alaska Native communities. It is a national issue that needs the attention of all medical schools and teaching hospitals as they prepare the next generation of physicians to provide high-quality and culturally responsive care,” said AAMC President and CEO Darrell G. Kirch, MD. “We are at a crossroads, and real and sustainable change can only be achieved if we work together as a community.”

“AAIP enthusiastically supports this report as it formulates successful strategies to recruit, retain, and graduate American Indian/Alaska Natives into medicine and thereby increase the Indian health workforce which is needed to improve American Indian health status,” said Walter Hollow, MD (Sioux/Assiniboine), president of the AAIP board of directors.

American Indians and Alaska Natives have experienced minimal gains in representation across the medical education continuum. Despite the growth and expansion of medical schools over the past 30 years, the number of applicants and matriculants identifying as American Indian and Alaska Native alone decreased from academic year 2006-07 to 2017-18, while those identifying as American Indian and Alaska Native in combination with at least one other race or ethnicity increased slightly over the same period.

Small numbers of American Indian and Alaska Native individuals are also found in clinical and medical school classroom settings. In 2016, individuals reported as American Indian and Alaska Native (alone and in combination with another race) represented 0.56% of the 727,398 active physicians, and 0.48% of the 174,570 total full-time faculty members at U.S. medical schools and teaching hospitals.

“While the presence of American Indian and Alaska Native students in medicine remains marginalized, a similar storyline can be extended for the presence of American Indians and Alaska Natives faculty, researchers, educators, providers and more,” said AAIP Executive Director Tom Anderson. “Imperative to shifting this paradigm is garnering a workforce of Native American role models for facilitating students along their journey as a first step, followed closely by adequate educational funding.”

According to the report, culturally responsive academic enrichment programs, access to information, connection with mentors, and availability of financial support, including federal programs, have been shown to influence the number of AI-AN students preparing to apply and enroll in medical school.

“The AAMC is honored to create this report with the AAIP, and it is our hope that we can all assist in addressing the challenges facing our Native communities across America,” said AAMC Chief Diversity and Inclusion Officer David A. Acosta, MD. “There has never been a better time to work together as a community to bridge the cultural divide and remind ourselves of the social accountability that we, as academic medical institutions, have to society. We have a responsibility to train physicians who are prepared to tackle today’s and tomorrow’s greatest health care challenges.”

To view Reshaping the Journey: American Indians and Alaska Natives in Medicine, visit aamc.org/reshapingthejourney.