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Community Racial and Ethnic Representation Among Physicians in US Internal Medicine Residency Programs.

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Underrepresented in medicine (URIM) physicians remain significantly underrepresented in internal medicine residency programs compared to their communities. This disparity impacts healthcare access for underserved populations, highlighting the need for diversity policies in graduate medical education.

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Area of Science:

  • Medical Education
  • Health Disparities
  • Physician Workforce Diversity

Background:

  • Increasing the number of underrepresented in medicine (URIM) physicians from historically underserved communities is crucial for reducing health disparities.
  • Physician-community concordance enhances healthcare access, particularly for American Indian/Alaska Native, Black, and Hispanic/Latinx populations.

Purpose of the Study:

  • To analyze the county-level racial and ethnic representation of US internal medicine (IM) residents.
  • To examine the concordance between IM residents and their communities.
  • To assess how representation varies with the presence of academic institutions or underserved settings.

Main Methods:

  • A retrospective, cross-sectional study utilizing data from the Association of American Medical Colleges, ACGME, Area Health Resources Files, and US Department of Education.
  • Analysis of self-reported racial and ethnic data from 4,848 IM residents in 393 programs across 205 US counties in 2018.
  • Representation quotients (RQs) were calculated and quantile linear regression models were used to assess associations with county-level characteristics.

Main Results:

  • Underrepresented in medicine (URIM) residents, including American Indian/Alaska Native, Black, and Hispanic/Latinx individuals, were significantly underrepresented compared to their county populations (RQs < 1).
  • 24.8% of counties with IM programs had no URIM residents.
  • Black and Hispanic/Latinx residents showed higher representation in counties with more minority-serving institutions (MSIs), while Hispanic/Latinx residents were less represented in counties with more academic health centers (AHCs). Asian residents had lower RQs in counties with more MSIs, and White residents had higher representation in counties with more AHCs.

Conclusions:

  • Underrepresented in medicine (URIM) internal medicine residents continue to be underrepresented in relation to their program's county populations.
  • These findings underscore the need for targeted racial and ethnic diversity policies in graduate medical education.
  • Addressing physician underrepresentation is vital for improving care in historically underserved communities.