Enhancing diversity in healthcare: Only 34% of residency program directors are people of color—can we improve?

By Stephanie Srakocic | Fact-checked by Davi Sherman
Published September 26, 2023

Key Takeaways

  • A recently published study found a lack of diversity among current medical residency program directors and assistant program directors. 

  • There was more diversity among associate program directors than program directors.

  • The results did not suggest any direct correlation between factors such as race or gender and hiring.

  • The study’s authors suggest that implicit bias and institutions’ structural hiring practices could contribute to the lack of diversity.

Diversity in medical workforce hiring practices has been an important topic in recent years. Multiple papers and studies have focused on the influence of diverse leadership on the overall workforce. A study published in the American Journal of Medicine in September 2023 looked at the hiring practices of residency program directors and associate program directors. As educational leaders, those who hold these roles have a large influence on future physicians and the future of the medical field.[] 

Previous studies have looked into gender diversity among these professionals; in a 2022 survey, 46.7% of internal resident program directors were women. Similar data on other forms of diversity among residency program directors have not been collected, but multiple publications have discussed the overall lack of diversity in academic medical leadership roles. For instance, a 2022 report published in the Journal of the American Board of Family Medicine reported that only 11% of medical school deans were from underrepresented minority groups. This newly published study aimed to see whether factors within academic hiring processes could contribute to a lack of diversity in leadership.[][]

The study authors surveyed residency program directors from the 439 medical programs in the United States that held “initial” or “continued” accreditation status from the Council for Graduate Medical Education prior to July 1, 2020. They received responses from 267 program directors. Among these respondents, 46.8% self-reported as women, and 34.8% self-identified as non-White. Of those who identified as non-White, 6.6% self-identified as underrepresented in medicine (URiM).[]

Respondents were asked about the hiring process for their role as program directors. Data points of note from survey respondents include:[]

  • Nearly 80% of program directors held a previous residency leadership position.

  • 64.5% of program directors did not train in the program they currently lead.

  • 55.4% of program directors were mentored for their program director role.

  • 62.5% of program directors who received mentorship were mentored for over a year before taking their position.

  • 80.9% of program directors said they would ideally use an open search to find their replacement. 

  • The percentage of respondents hired through a search was higher for women in program director positions than for men.

  • Large university programs are more likely to select their program directors internally.

Respondents were also asked about associate program directors. Through respondents’ answers, data were gathered on 832 associate program directors. Of this group, 51.5% were women, and 15% were identified as URiM. Program directors were responsible for hiring 68.1% of the associate program directors. Among respondents, 38.9% were hired through a search process. Program directors with longer tenure were likelier to select associate program directors rather than using a search process. The data did not suggest any hiring association between demographics, such as program director gender and associate program director gender.[] 

The authors found no direct association between gender or race and the hiring process. However, they suggest that factors such as implicit gender biases that favor men over women for leadership roles could impact decision-making and the hiring of women. Additionally, they suggest that when large universities select program directors from within their own leadership, this reduces their potential to expand the diversity of their programs. The authors suggest an open search to find the best candidates for program director and associate program directors as a way to increase diversity within academic medical leadership, writing:

“Selecting individuals for a position risks alienation of current employees seeking growth and professional development and can increase risk of legal issues as promotions are covered by federal and state employment and non-discrimination laws. Search processes provide younger faculty, URiM, and women faculty with more visible pathways for career advancement.”[] 

They conclude that there is room for improvement, and possibly standardization, within residency hiring programs and that, although additional studies are needed, the hiring process is a key facet of increasing diversity in medical academic leadership.[]

Increasing diversity in the healthcare leadership

Previous papers have suggested ways to increase diversity across medical leadership roles. One common suggestion is establishing a pipeline and recruiting candidates from diverse backgrounds at every step, from medical school entry all the way through leadership positions. Research has found that medical student diversity was the strongest predictor of faculty diversity. A diverse admissions committee and relationships with Hispanic-serving institutions (HSIs), historically Black colleges and universities (HBCUs), and tribal colleges and universities (TCUs) can help build a diverse student body.[][] 

Continued mentorship and career development are also suggested as vital steps, emphasizing mentorship from women and URiM in leadership roles. Additional suggestions include conducting implicit bias training for interviewers and recruiters, posting job openings on professional organizations’ websites that are likely to reach diverse candidates, emphasizing a commitment to diversity and non-discrimination in recruitment materials, and working to establish a culture of inclusivity. As more institutions strive to promote diversity, there might be models of success to follow and additional suggestions for taking actionable steps toward achieving diversity at every level of healthcare leadership.[][][] 

“Diversity is very encompassing,” says Efrain Talamantes, MD, MBA, MSc, physician, and academic researcher with the University of California Davis’s Center for a Diverse Healthcare Workforce. “It’s very inclusive. It ensures that people who need to be at the table are included in important discussions,” he adds.

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