Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and a Robert Wood Johnson (RWJF) Nurse Faculty Scholar. Her research focuses on traumatic experiences, especially violence, mental health responses to trauma, and aspects of forensic nursing. This is part of a series of posts looking at diversity in the health care workforce.

As a new nurse, I had just entered a patient’s room when he called out from the bathroom to ask his wife who was there. She replied, “it’s a lil’ colored girl to see you.” Luckily, I have a pretty good poker face and was able to not show outwardly how flustered I was inwardly. I was able to introduce myself and conduct my assessment in a professional manner. Over the next three days, I took care of this patient and as we built a relationship, he marveled and told his visitors what a great and smart nurse I was.

While I’d like to think that I am great and smart, I happen to know that I worked on a floor full of great and smart nurses, all of whom were Caucasian. The patient commented on attributes in me that he felt were remarkable and exceptional. He didn’t conceive that ‘a lil’ colored girl’ could be great or smart until we interacted.

"We often see the benefits of diversity as being for minorities. We seldom see that the majority benefits as well."

Fast forwarding to my role as a faculty member, I’ve worked in majority serving institutions where I’m often one of two or three African American faculty members and the numbers of African American students is also small. Frequent comments on my student evaluations are: “She’s so smart. She’s really intelligent.”

Regina Stokes Offodile, MD, CHSE, is an assistant professor in the Department of Medical Education, Division of Clinical Skills and Competencies at Meharry Medical College.  She currently instructs first- and second-year medical students on clinical skills, physician patient interaction, and clinical correlations of breast disease.  Her research interests include cultural competency.  She is pursuing a Masters in Health Professions Education at Vanderbilt University. This is part of a series of posts looking at diversity in the health care workforce.

Cultural diversity in the health care workforce may be something that many have not thought about or considered a topic of concern.  It is a concept that health care providers, health care delivery systems, and hospitals need to have on their radar. Having a culturally diverse workforce is a matter of patient safety.  Employing a diverse workforce increases the likelihood of having employees who understand how a wide cross section of patients looks at disease, its diagnosis and treatment.  A diverse workforce may also address the language barriers and cultural disconnect that may exist in some health care delivery systems.

In order to meet the increasing culturally diverse patrons of health care, there will be a need to have a corresponding change in the health care workforce. There will also be a burden on medical schools and residency training programs to produce culturally competent physicians, and to increase the number of physicians who are able to interact with and treat a culturally diverse patient population.

Carmen R. Green, MD, is an alumna of the RWJF Health Policy Fellows program. She is the associate vice president and associate dean for health equity and inclusion at the University of Michigan Health System, and a professor of anesthesiology, obstetrics and gynecology, and health management and policy. This is part of a series of posts looking at diversity in the health care workforce.

More than a decade into the 21st century, Americans still face diminished health and tremendous variations in health care, depending on what they look like, where they come from, where they live, what they earn, and other factors. Significant and persistent variability in clinician decision-making also exists based upon these factors.

The reasons for these inequities lie in part in disparities in the infrastructure for screening, diagnosing, treating and supporting patients leading to unequal treatment.

In an increasingly aging, female, and diversifying society, it is vital to have a diverse workforce to not only help put patients of varying backgrounds at ease but to provide care that is responsive to their needs and to achieve the best health care outcomes. It may be difficult for underrepresented and vulnerable people to trust the health care system if the employees largely come from the same place and have one perspective. Some of those perceptions actually become realities as biases can negatively affect patients that are marginalized and lower on the socioeconomic totem pole.

Kim D’Abreu is Senior Vice President for Access, Diversity, and Inclusion in the Policy Center at the American Dental Education Association.  D’Abreu was previously the deputy director for the Pipeline Profession and Practice: Community-Based Dental Education program of the Robert Wood Johnson Foundation. This is part of a series of posts looking at diversity in the health care workforce.

Words Matter

The words we use matter. That’s why the American Dental Education Association (ADEA) is shifting the conversation away from the “deficit model” for recruiting students from underserved backgrounds.  ADEA is specifically avoiding language that suggests “the numbers just aren’t there” or “the pool is not qualified.” When we describe underserved students as low-income or less prepared educationally, it suggests that the problem lies with them. It undervalues the students and ignores the wealth that they bring to the table in terms of cultural competence, initiative, and willingness to provide care to communities that need it most. But far worse, the deficit model allows the real institutional obstacles that these students face to remain in place.

Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice. As a Robert Wood Johnson Foundation New Connections grantee, his research focuses on the social and economic conditions structuring disparities in the health of African American males. His work seeks to identify sources of individual, cultural, and organizational social capital to promote health behaviors, and health care access and utilization, to advance and improve the health and well-being of African American males. This is part of a series of posts looking at diversity in the health care workforce.

I became a public health professional because I recognized a need to find opportunities and strategies to prevent the chronic diseases I saw silently killing African Americans in the community where I grew up. I vividly recall as a child the whispers surrounding the deaths of community members about cancer, diabetes (or sugar-diabetes, as it is commonly referred to in many communities still today), heart attacks, and strokes. I knew there was stigma and fear, but never heard of programs, interventions, or opportunities to stop these trends.

My interest in addressing these problems led me to pursue summer programs and internships during high school that allowed me to witness amputations of uncontrolled diabetic patients who had a range of clinical and social co-morbid conditions. Many of these amputees were living in poverty, they had Medicare or Medicaid, and the majority happened to be African American. This experience raised the question about prevention: How could I prevent African American men and women from having amputations? I never heard this conversation around prevention in my community. Many people seemed to accept the reality of developing these chronic conditions as a fate that could not be controlled.

I knew there had to be another way.

Gary H. Gibbons, MD, is director of the National Heart, Lung, and Blood Institute at the National Institutes of Health. He is an alumnus of the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. This is part of a series of posts looking at diversity in the health care workforce.

Growing up in a predominantly African American neighborhood in Philadelphia, high blood pressure, strokes, and heart attacks were common. When I got to medical school, I asked one of my professors why the African American community tended to have a higher prevalence of these medical conditions. He introduced me to biomedical science for the first time and challenged me to pursue that question on my own. I've continued to look for the answer to that provocative question ever since.

Similar to that early experience, mentorship has been a determining factor in my career trajectory. I might not have pursued a research career at all if it hadn't been for Harvard Medical School professor A. Clifford Barger who inspired me to ask and answer difficult research questions. The Robert Wood Johnson Foundation’s Harold Amos Program pushed me further with their emphasis on mentorship, which gave me a sense of community with the many scholars interested in the same research problems. It was my experience with a National Institutes of Health T32 training grant when I was starting out as an investigator that inspired me to give back to a younger set of minority researchers by becoming a K Award mentor and leading a T32 program at Morehouse School of Medicine.

Adejoke Ayoola, PhD, RN, is an assistant professor with the Calvin College Department of Nursing in Grand Rapids, Michigan, and a Robert Wood Johnson Foundation Nurse Faculty Scholar.  This is part of a series of posts looking at diversity in the health care workforce.

Nurses in the United States are caring for a progressively more diverse population. In 2008, ethnic and racial minority groups accounted for about one third of the United States population. According to the United States Census Bureau, people from ethnic and racial minority groups— namely Hispanic, black, Asian, American Indian, Native Hawaiian and Pacific Islander—will together outnumber non-Hispanics over the next four decades. Minorities, now 37 percent of the U.S. population, are projected to comprise 57 percent of the population in 2060. The total minority population would more than double, from 116.2 million to 241.3 million over the period (U.S. Census Bureau, 2012).  So it is essential to have a nursing workforce that will reflect the population of the United States so as to deliver cost-effective, quality care and improve patients’ satisfaction and health outcomes, especially among ethnic and racial minorities.

The importance of promoting diversity in the nursing workforce is acknowledged by various nursing agencies and health organizations, including the American Association of Colleges of Nursing (AACN, 2013).  Diversity in the nursing workforce provides opportunities to deliver quality care which promotes patient satisfaction and emotional well-being. 

When I take my students to the hospital for their clinical rotations in acute care, I often assign those who are Spanish-speakers to Spanish-speaking patients. It has often been a win-win situation for both my students and the patients. Recently we cared for a Hispanic patient who did not speak English and had just given birth to her first baby. Her face lit up when my student spoke to her in Spanish! There was no one else with the woman, so the student’s ability to interact with her in a language she understood made a big difference. We noticed positive progress in the patient’s emotional and physical state as a result of her interaction with the student during the shift.

Felix German Contreras, 22, of Atlantic City, N.J., credits his 2012 participation in the Robert Wood Johnson Foundation-funded Summer Medical and Dental Education Program (SMDEP), and his teachers at the Yale University site, for opening new doors to opportunities. A naturalized U.S. citizen, Contreras emigrated to the U.S. with his family at age 6. He will graduate from Atlantic Cape Community College next year and plans to attend Yale School of Medicine. Started in 1988, more than 21,000 alumni have completed SMDEP, which today sponsors 12 university sites with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.

Living as an immigrant and student with only part-time employment is a daily battle. But I will never allow these challenges to slay my dreams. With so many struggles, I am often asked: “Felix, how do you do it?”

I cannot help but smile when I reply, as it is not a secret; nor do I believe it is a talent—it is simply a strong work ethic. I have realized the best things in life are the hardest to obtain.

My doors to new unexpected opportunities were opened when a late-night online search in 2012 led me to the Summer Medical and Dental Education Program. I applied and was accepted at the six-week program’s Yale University site. It was there where I met mentors and students with similar aspirations to improve communities through medicine. Not only did the intensive program place me on a sure-footed path toward a health sciences career, my English improved tremendously through rigorous reading and writing. You can’t believe how much six weeks can give someone who is eager to receive. SMDEP exposed me to countless possibilities on the other side.

Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.

Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:

• Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
• According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
• Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.

Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.

Catherine J. Malone, MBA, DBA(c), is a program associate working in the areas of diversity and nursing for the Robert Wood Johnson Foundation. This is the first in a series of posts looking at diversity in the health care workforce.

As a member of the Robert Wood Johnson Foundation’s (RWJF) Human Capital team leading the group’s diversity efforts and the Foundation’s Diversity Team, I would like to share some of our work in this area. I must start by noting that “diversity” means different things to different people. At RWJF we recognize and value all types of diversity and therefore have a broad definition of the term which is described in the Foundation “Diversity Statement” below:

“Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.”