| Dear Colleagues,
This letter will focus on ANA’s efforts to promote diversity and inclusivity in the academic neurology workforce. Definition: individuals designated “underrepresented in medicine” (URM), defined by the Association of American Medical Colleges (AAMC) as those racial/ethnic populations that are “underrepresented in the medical profession relative to their numbers in the general population.” “Diversity” can of course mean many different things — it can relate to age, race, gender, sexual orientation, religion, nationality, disability, and more. For the purposes of this message I will focus on race and ethnicity, but in subsequent messages I plan to also focus on these other elements. A commonly asked question whenever this topic is brought up in faculty meetings is “why the focus on diversity?” My first response is rooted in social justice: it is just the right thing to do, to attempt to create a more inclusive workforce. There are, however, other important, albeit secondary reasons. Better performance and greater innovation: Solid evidence has been generated that shows the value of exposing individuals and teams to experiences with multiple perspectives and worldviews. A broader blend of social diversity should bring a broader spread of experience, adding to the collective knowledge of a team, and making it perform more effectively. In business settings, productivity is higher among more diverse teams than homogenous teams.1 Representativeness: The production of a cohort of physician-scientists that more closely represents the US population that will be majority/minority by 2050. This is important because it appears that patients who are race concordant reported greater satisfaction with their physician.2 Academic neurology talent pool: Academic neurology is not a particularly competitive pathway for medical students, especially those with high medical school debt, or a desire/need for higher salaries. Neurophobia remains common at most medical schools.3 Opening the door to URM candidates allows us to expand the talent pool considerably. So what results has neurology seen over that past few years? There have been many efforts to diversify the physician-scientist workforce. In 2009, the Liaison Committee on Medical Education (LCME) instituted formal accreditation guidelines that required medical schools to develop programs or partnerships designed to “make admission to medical education more accessible to potential applicants of diverse backgrounds.”4 Lett et al found little evidence of increasing diversity in US medical schools during this period. In fact, they found that Hispanic individuals are under-represented among medical school applicants and matriculants by nearly 70% relative to the age-adjusted US population; black male applicants and matriculants, nearly 60%; black female applicants, nearly 30%; and black female matriculants, nearly 40%. These data suggest that “there are large, untapped pools of potential URM applicants and matriculants in diverse states”.5 2017 data for neurologists suggest that 63.4% are white (US census 76.5%), 13.8% Asian Indian (US Census 5.9%), 5.3% Hispanic/Latino (US Census 18.9%), and 1.3% Black/African-American (US Census 13.4%).6 Another survey of neurologists demonstrated minimal change in demographic composition from 2000 -2010: Hispanic/Latino (from 4.8% to 4.9%), Asian Indian (from 14.9% to 17.0%), and Black/African American (from 1.5% to 1.7%).7 For academic neurology the data are similarly flat, despite many well-intentioned efforts by NIH, our institutions, and our professional organizations. My own department reflects this relative lack of diversity despite personal and collective efforts to encourage diversity. So what role should the ANA have in this process? Given the small size of our organization and our limited resources we will have to choose wisely amongst a range of strategies and tactics. I am open to ideas from you as to how we should engage with the process, but I do think that we must engage actively. Please join with me in this effort. Justin C. McArthur, MBBS, MPH |