Diversity in Dermatology: A Call for Action

Association of Professors of Dermatology

Norcross, GA

Corresponding author:

Richard D. Granstein, M.D.

Department of Dermatology

Weill Cornell Medicine

1305 York Avenue, 9th Floor

New York, NY 10021

E-mail:

Tel: 646-962-7546

Manuscript word count: 1082

As discussed in the recent paper by Chen and Shinkai1, there is a striking lack of racial and ethnic diversity in American dermatology. Approximately 3% of American dermatologists are black and 4.2% are Hispanic compared to 12.8% and 16.3%, respectively, of all Americans1,2, defining them as underrepresented minorities (URM) in medicine within our specialty. In 2014, dermatology residents in the United States were 68.8% white, 3.9% black, 6.7% Hispanic, 20.3% Asian, 0.2% Native American/Alaskan Native, 0.2% Native Hawaiian/Pacific Islander, 1.9% multiracial and4.8% other/unknown3 (Numbers add-up to more than 100% as individuals may report more than one category). While strikingly different from the proportions of URM in the general population, with the exception of the multiracial category, these numbers are closer to the proportions of URM in recent medical school graduates4, highlighting the issue of lack of diversity in medical schools.The Association of Professors of Dermatology (APD) is the organization representing leaders of dermatology training in the US. The APD believes that increasing URM representation in dermatology iscrucial to the future of quality health care. To increase the diversity of the dermatology workforce, dermatology training programs must attract and accept more individuals from populations that are underrepresented in medicine. To meet the long-term goal of creating a specialty made up of professionals with diversity that mirrors that of the American population, the APD proposes that all academic dermatology training programs make a concerted effort towards more inclusive resident recruitment.

In addition to race and ethnicity, diversity includes gender, age, economic status, sexual orientation, religion and physical ability5. Great strides have been made in recruiting women to dermatology. Today women are appropriately equally represented within our specialty; however,there is still marked gender disparity insenior academic leadership positions6. While the APD is concerned with diversity in all of these areas, this paper will focus only on questions of race and ethnicity.

Why is diversity important? Having a diverse workforce has important benefits for our profession, our society andour patients. First and foremost, having a more diverse workforce will improve care to all patients that we serve2. Patients report more satisfaction with race-concordant physician visits, minority physicians are more likely to care for patients of their own race or ethnic group and are also more likely to care for underserved populations2. Increased representation of URM individuals in dermatology may positively impact health care disparities, increase access to care, and address issues in geographic distribution of dermatology providers2.

The APD recognizes that there are many factorsthat have contributed to the lack of diversity within dermatology. The APD recommends the followingactions:

  1. Increase diversity in dermatology residency programs.To solve the diversity problem for dermatology as a whole, the first step must be to increase the diversity of dermatology residents. The APD recommends careful evaluation by each program of the methods by which dermatology programs select residents. The paper by Chen and Shinkai suggests methods for more inclusive recruitment of dermatology residents. While the APD does not endorse any specific methods, these suggestions may represent a valuable starting point for residency selection committees. Diversity should be an explicit aim of the recruitment process. Dermatology departments and divisions are encouraged to initiate outreach activities to minority medical students to increase the numbers of those who make their career choice in dermatology. One opportunity is involvement in the American Academy of Dermatology (AAD) Diversity Mentorship Program and participation in institutional programs aimed at providing financial support for research and visiting clerkships for underrepresented or economically distressed medical students to explore dermatology as a career. Dermatology departments are strongly encouraged to establish funding mechanisms to provide similar scholarships if these programs do not exist at their institution. Indeed, evidence suggests that health professionals who train within a diverse class have enhanced preparedness to serve diverse communities7.
  2. Increase diversity in health sciences.The lack of diversity in medical schools results from low application rates from diverse populations, not from low acceptance rates of qualified applicants from populations that are underrepresented in medicine. Most medical schools have programs within their communities and institutions that encourage high school and college students to consider the healthcare sciences as career choices. The APD urges dermatology academic faculty to enthusiastically support, and participate in, their school’s diversity initiatives and admissions committees. The APD also recommends that dermatology faculty participate in educational activities within their institutions that stress the importance of healthcare delivery to minority populations.Participation in mentorship programs for underrepresented minority students is an additional way to support students already matriculated at the institution.
  3. Develop more programsfocused on problems of skin of color. The APD supports research, clinical, and educational program development focused on skin issues of underrepresented populations. These could include: curriculum development for skin issuesof minority populations andinitiatives towards improved understanding of health disparities within dermatology.
  4. Make diversity part of the mission for every dermatology department.The APD urges dermatology departments tomake diversity part of their mission statement. Departments should identify and address local barriers to inclusive recruitment and retention of academic faculty from underrepresented minority groupsas well as to raise awareness of the value of an inclusive dermatology workforce. Departments should prioritize achieving parity for underrepresented faculty regarding pay and promotion at their institutions.
  5. Enhance awareness of implicit bias. The APD invites all faculty members who teach dermatology residents to actively explore how implicit bias impacts recruitment, education, and career development of our trainees. The APD urges every faculty in every academic department to examine their own implicit bias(es). This can be done by taking the Harvard implicit association test found here (

The APD will also take other steps to promote diversity in dermatology. The APD proposes to have a presence at the Student National Medical Association (SNMA) annual meetings to promote interest and awareness of our specialty amongst members.The APD will host a full-daydiversity retreatfor Program Directorsto systematically examine best practices in residency selection processes within their programs aimed at diversity. The APD will partner with the American Academy of Dermatology and other organizations to support initiatives aimed at increasing diversity in dermatology.

All of us have a role to play in solving the diversity problem in dermatology. We hope that the steps outlined above will invite all dermatologists and other health professionals who care for patients with skin disease to engage in this important discussion and to take action at local and national levels to solve this long-term problem.

References

1. Chen CV, Shinkai K. Turning the Tide: Re-thinking How We Select Dermatology Applicants. JAMA. Dermatology, 2016, in press.

2.Pandya AG, Alexis AF, Berger TG, Wintroub BU. Increasing racial and ethnic diversity in dermatology: A call to action. J Am Acad Dermatol. 2016;74(3):584-587.

3. Brotherton SE, Etzel SI. Graduate medical education. JAMA. 2015;314(22):2436-2454.

4. Association of American Medical Colleges.Enrollment, Graduates, and M.D.-Ph.D. Data. aamc.org. Published December 6, 2016. Accessed December 17, 2016.

5. Kimball AB, Resneck JS Jr. The US dermatology workforce: a specialty remains in shortage.

J Am Acad Dermatol. 2008;59(5):741-745.

6. Lester J Wintroub W, Linos E. Disparities in Academic Dermatology JAMA Dermatol. 2016;152(8):878-879.

7. Saha S, Guiton G, Wimmers PF, Wilkerson L. Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA. 2008;300(10):1135-1145.

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