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					    Committee on Faculty
  Recruitment and Diversity:
The Future Leaders of Medicine
     Report to Board of Visitors
               4/16/05
    The Challenge Ahead of Us
• We are the best medical institution because
  of the talent we attract and retain (students,
  residents, fellows and faculty).
• To maintain this level of excellence and
  train the leaders of medicine in the future
  we have to attract and retain more URM at
  all levels.
 I. Quantitative Outcomes Data
• We are no better or worse than our peer
  institutions in the percentage of URM in our
  medical school (students and faculty).
• The percentages of underrepresented
  minority colleagues decrease as you
  increase in training here. (There are fewer
  mentors and leaders that are URM.)
   Quantitative-Outcomes Data


• We are unable to retain the under
  represented minority faculty that we attract.
 Definition(s) of Underrepresented
          Minority (URM)

• At Hopkins almost all data are Black
  (African American and Foreign Born)
• Hispanic data are most accurate in Medical
  Student Data
     Where do we stand now?
           2003-2004
• Breakdown of Black/Hispanic as % of total:

  – Medical Students      11.3/2.7
  – Residents             7.0/3.3
  – Fellows               4.7/3.0
  – Faculty               3.1/2.8

  – 2002 U.S. Census      12.7/12.6
       Where do we stand now?
         URM Medical Students

• Between the years 2002-2004 the Enrolled
  to Acceptance Ratios are going down.

 Interviewed   Accepted Enrolled
  93           38         21(55%)    2002
  78           39         19         2003
  83           44         13 (30%)   2004
    % Black Faculty by Academic Rank in
              1991 and 2005
4.00%                               29
         1991
 3.50%
         2005                        i


3.00%
                               10
 2.50%


2.00%
            7
 1.50%


1.00%
 0.50%


0.00%
         Professor   Associate Professor Assistant Professor
                Faculty Departures
16.00%
                        Majority
14.00%

                        Minority
12.00%


10.00%


8.00%


6.00%


4.00%


2.00%


0.00%
         1999    2000   2001   2002   2003
         Where are we now?
 New URM Faculty Appointments
• 2002         16/164    9.8%
• 2003         6/139     4.3%
• 2004         16/116    13.8%

• There were NO new appointments at the
  Associate Professor or Above Ranks among
  a total of 14 appointments over 3 years
       II. Qualitative-Process
         (Beyond the Numbers)



• Focus Group (29 Full Time Faculty)
• Survey of Minority and Majority Faculty
  (299 Full Time Faculty)
The Role of Cultural Diversity Climate in
Recruitment, Promotion and Retention of
     Faculty in Academic Medicine

          Eboni G. Price, MD, MPH
      Senior Clinical and Research Fellow
          Lisa A. Cooper, MD, MPH
              Associate Professor
            Department of Medicine
      Johns Hopkins University School of
                    Medicine
   Importance of Racial and Ethnic
    Diversity in Health Professions
• Minority physicians are more likely to care for
  patients of their own race or ethnicity; practice in
  areas that are underserved; and care for poorer,
  sicker patients with less access to medical care1
• Ethnic minority patients report more partnership
  and satisfaction with same-race physicians2
• Diversity in medical school is associated with
  better educational experiences for all students3
  1. Cooper LA and Powe NR, The Commonwealth Fund, July 2004
  2. Cooper-Patrick, JAMA 1999
  3. Whitla, Academic Medicine, 2003
   Diversity in Academic Medicine
• Ethnic minority faculty may serve as important
  role models and mentors to prospective trainees
• However, compared to whites in academic
  settings, ethnic minority faculty are:
     – less likely to be satisfied with their jobs and more
       likely to leave academic medicine4
     – more likely to report ethnic harassment and
       discrimination by colleagues5
• Ethnic disparities in promotion in academic
  medicine are documented nationwide6

4. Palepu, Acad. Med, 2000; 5. Corbie-Smith, Acad. Med., 1999; 6. Fang, JAMA, 2000
             Study Objectives
• Qualitative Phase:
  To explore the perceptions of majority and URM
  faculty regarding cultural diversity and facilitators
  and barriers to success and professional
  satisfaction in academic medicine within this
  context
• Quantitative Phase:
  To determine whether there are differences in
  ratings of experiences of bias, job satisfaction,
  and intentions to leave academic medicine
  among diverse groups of faculty
     Qualitative Study: Methods
• Design: Focus groups and in-depth
  interviews conducted by ethnic-concordant
  moderators and interviewers
• Subjects: Full-time tenure track physician
  faculty (rank associate professor or lower)
• Setting: Johns Hopkins School of Medicine
• Data collection: demographics collected by
  survey; audiotapes transcribed verbatim
  Faculty Demographics (N=29)
Age               33-50    Rank
Gender                       Instructor            3
  Female            11      Assist. Prof.          18
  Male              18      Assoc. Prof.           8
Ethnicity                  Career Track (N=29)
  AA                13       Basic Researcher      7
  Asian             2        Clinical Researcher   9
  Hispanic          3       Academic Clinician     5
  Caucasian         11       Clinician Educator    6
Foreign born         10       Other                2
          Nine clinical departments represented
            Key Questions
• Can you think of daily practices (in the
  workplace) in which advantages or
  disadvantages may occur within an academic
  setting?
• What are your personal experiences as well
  as observations of manifestations of bias in
  academic medicine related to race, ethnicity,
  religion or foreign born status?
• Why do you think racial and ethnic minorities
  are underrepresented in academic medicine?
 Dimensions of Cultural Diversity

Visible Dimensions     • Race/ Ethnicity
                       • Foreign-born status
                       • Gender
Invisible Dimensions   • Religion
                       • Sexual orientation



                            Price et al, JGIM, 2005, In Press
     Daily Practices in Which Cumulative
     Advantages or Disadvantages Occur

Race or ethnicity     • Minority intra-racial
                        networking not possible
                      • Lack of acknowledgement
                        or invisible to colleagues

Foreign-born status   • Lack of leadership support
                        for promotion

Professional          • Informal networking
relationships         • Mentorship
                                Price et al, JGIM, 2005, In Press
  Manifestations of Bias Related to
        Cultural Dimensions
Race or ethnicity    • Disparities in recruitment efforts
                     • Disparities in promotion criteria
                     • Disparities in leadership behavior
                       towards faculty
                     • Differential scrutinizing of
                       professional competence or
                       credentials

Foreign-born status • English language dysfluency
                    • Disparities in recruitment efforts
                                       Price et al, JGIM, 2005, In Press.
      Under-representation of Ethnic
         Minorities in Academics

•   Few in numbers at all levels of training
•   Lack of prior educational opportunities
•   Educational debt or lack independent wealth
•   Poor recruitment and retention efforts



                            Price et al, JGIM, 2005, In Press.
       Suggestions to Improve the
           Diversity Climate

•   Leadership making diversity a priority
•   Increase self-awareness of attitudes
•   Increase diversity in leadership
•   Increase diversity of faculty/staff



                               Price et al, JGIM, 2005, In Press.
               Summary
• Visible dimensions of cultural diversity
  (race/ ethnicity, gender, foreign-born
  status) often provoke bias (subtle or
  overt) and cumulative advantages or
  disadvantages in the workplace that
  impact faculty recruitment, promotion
  and retention
                Hypotheses
Under-represented minority (URM) faculty are:
• More likely than majority faculty to report
  experiences of bias in the workplace
• Less likely than majority faculty to be
  satisfied with:
  – Institutional support for career development or
    professional advancement
  – Institutional cultural diversity climate
• More likely than majority faculty to report
  intentions to leave academic medicine
                 Methods

• Design: Cross-sectional survey
• Subjects: Full-time tenured or tenure track
  physicians on faculty for at least one year
• Setting: Johns Hopkins School of Medicine
• Recruitment : June 2004-Present
   Faculty Characteristics (N=299)*
                                 Majority                URM
Male (%)                           68                     57
Foreign born (%)                   19                     32
Dept of Medicine                   39                     36
Rank (%)
 Assistant Professor                 37                    50
 Associate Professor                 30                    29
 Professor                           31                    21

     * 235 Caucasian, 24 Asians, 24 Black, 4 Hispanic, 12 Other
         Perceptions of Bias:
       Operations and Activities
Please state your level of agreement    % who agree
with the following statements:

                                       Majority   URM
                                                        **
Faculty are recruited to my             48%       21%
department in an unbiased manner

Faculty are promoted in my              47%       39%
department in an unbiased manner

                                                  **p<0.01
          Perceptions of Bias:
        Operations and Activities
Please state your level of agreement        % who agree
with the following statements:
                                           Majority   URM
                                                            *
I have full access to the same              65%       43%
professional opportunities as my
colleagues

All faculty in similar positions at this    10%        7%
institution are paid equivalent salaries
                                                      *p<0.05
         Diversity of Colleagues

Please state your level of       % who are satisfied
satisfaction regarding:

                                 Majority    URM
Racial/ethnic diversity of        44%        14% **
colleagues
Gender diversity of colleagues    54%         54%

                                              **p<0.01
     Networking Opportunities for
        Career Advancement
Please indicate whether you          % who agree
agree or disagree:
Networking activities…            Majority   URM
Occur outside of work in social    24%       50% **
activities
Include ethnic minorities          33%        7% **

Include women                      42%       21%
Include foreign-born faculty       32%       14%
                                              **p<0.01
        Future Career Intentions

                                      % who say yes

Question:                             Majority   URM


Do you believe you will still be in    83%       86%
academic medicine in 5 years?

Do you believe you will still be at    69%       39% *
Johns Hopkins in 5 years?
                                                 * p<0.05
                  Conclusions
Compared to majority faculty, ethnic minorities:
• are more likely to perceive bias in recruitment,
  access to professional opportunities, and networking
  opportunities

• express lower levels of satisfaction with the racial and
  ethnic diversity of their colleagues

• report equally high intentions to remain in academic
  medicine, but fewer intentions to remain at JHU
                Implications
• Incorporate diversity as a core value in the
  overall mission of the School of Medicine
• Engage and train institutional leaders,
  faculty, housestaff, and students regarding
  diversity related policies and expectations
• Recruit and train a more diverse and
  culturally competent physician workforce
• Establish informal, confidential mediation
  process for faculty who experience barriers
         Why should we care?
          Our Accreditations
• The regulatory environment has placed a
  high priority on diversification of SOM
  faculty.
  –   I.O.M.
  –   L.C.M.E.
  –   A.C.G.M.E.
  –   N.I.H.
        Why should we care?
          Our Mission:
• To train the future leaders of medicine.
  – Funding from the NIH for training and research
    awards are increasingly emphasizing minority
    participation and recruitment.
  – Funding from the state is jeopardized unless we
    effectively address increasing health disparity
    among URM groups
        Why should we care?
           Our Mission
• By 2020 45% of the children born in the
  U.S. will belong to racial and ethnic
  minorities. (Baltimore already there!)
• To train the future leaders of medicine:
  – The future leaders should reflect the
    ethnic origins of the patients they care
    for.
        Why should we care?
         Our Core Values:
• Integrity and respect for our colleagues and
  those we treat.
  – Many of our young minority faculty feel less
    valued than their white colleagues.
  – Many of our trainees do not wish to stay
    because they feel that we do not address issues
    of disparity in access and quality of medical
    care in the minority populations we treat.
          Why should we care?
            Our Priorities
– The institution has not placed a priority on the
  recruitment and retention of URM faculty.
– More apparent priorities have been:
   • New Department Directors (no URM)
   • Our #1 hospital and research status
   • Responding to changing regulatory environment
   • Financing new buildings
   • Biotechnology park
   • Status of clinician/educators
   • Safety