Why the US Needs a Racially and Ethnically Diverse Health Care Workforce 

Since the June 2023 Supreme Court ruling prohibiting the use of race in higher education admissions, fewer students from racial and ethnic minority groups are entering medical schools or schools for other health professions. 

According to the Association of American Medical Colleges, fewer Black, Latino, American Indian/Alaska Native students entered medical school in 2024-25 — and in most cases, the decrease was in the double digits. Black or African American matriculants declined 11.6% to 7% of total matriculants, the third year in a row of declines. Hispanic, Latino, or of Spanish Origin matriculants fell 10.8% to 5.8% of the total. 

And if fewer students of color are entering medical school, it’s likely that within a few years, fewer students of color will be coming out of those schools — and the health care workforce would then be less racially and ethnically diverse and less representative of the US population.  

The high court ruling focused on input, not output. In other words, it looked primarily at who was entering med school, not who would be taking care of patients a few years later. Yet evidence (some still observational) shows that a racially, ethnically, and linguistically representative workforce, which can provide what is sometimes called concordance between patient and clinician, can be good for the health of patients and communities. (Nearly 25% of the US population are members of racial and ethnic minority groups and 19.5% are Hispanic, and these percentages are growing.)  

“We have significant and persistent ethnic and racial health disparities in this country,” said Elaine Batchlor, MD, MPH, the chief executive officer of MLK Hospital, a private safety net in South Los Angeles. “We have to lean into that,” added Batchlor, who served on the committee that produced the National Academies of Sciences, Engineering, and Medicine report last year called Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All. 

“Not having a representative workforce is bad for our nation’s health,” said fellow National Academies committee member Vincent Guilamo-Ramos, PhD, RN, MPH, NP, executive director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing. 

Mississippi State Representative Zakiya Summers recounts a story of a local White nurse who suggested to a Black nursing colleague that a Black pregnant patient in their OBG-GYN office be referred to a mental health specialist because she was repeatedly tapping her head. Her colleague explained that the woman had an itchy weave or wig. “It’s so important to have a health professional who is reflective of the community that they serve,” Rep. Summers said. “The nurse might have funneled [that patient] into a system that she didn’t need to be in and that could have caused other challenges.” As a former board member of the Mississippi Sickle Cell Foundation, Rep. Summers has also heard many firsthand accounts of Black patients with sickle cell anemia who did not receive adequate pain medication from White physicians in the emergency room because they were perceived as drug-seeking. 

Increasingly, research supports the benefits of concordance. For instance, a study of 1.8 million hospital births in Florida from 1992-2015, published in PNAS in 2020, found that provider concordance significantly improved mortality for black infants—who die at three times the rate of white newborns. Another research project looked at adult patients at Kaiser Permanente Southern California diagnosed with hypertension. Concordance with language, gender, and race (in that order) all contributed to better hypertension control.  

As Guilamo-Ramos explained, being a Latino male nurse practitioner doesn’t mean he can’t take excellent care of patients who don’t look or sound like him. He has and he does. It doesn’t mean he, as a Latino male nurse practitioner, can’t get good care from providers who don’t look and sound like him. He has and he does. But having concordance with his Latino patients can influence the interpersonal aspects of care, including communication, shared decision-making, and also trust — with trust being in dangerously short supply in much of the health sector these days. And interpersonal elements are at the core of a strong patient-provider relationship, contributing to patient adherence to recommendations and satisfaction with care. 

“It makes sense that you relate to them, and they relate to you, and that you have a better chance of having more positive outcomes,” Guilamo-Ramos said. “The lived experience, what you bring from your own background, matters.”  

“We need people who can actually provide the best care to an increasingly diverse — all different kinds of diversity — overall US population. And in the meantime, since we’ve got a workforce that is not representative, we need guidance on how health professions programs can do more to train that workforce to better be in alignment with the communities that they serve. Both of those things are true,” he added. 

So how can policymakers and institutions of higher learning comply with the law — and acknowledge the political climate — and still develop the high quality, excellent, and yes, diverse, health workforces that the country needs? 

Leveraging Holistic Admissions and Pipeline Programs 

While certain tools to foster diversity can no longer be employed, some programs and practices based on socioeconomic or geographic factors can still pass muster. That is true of admissions to medical and other health professional schools. And it’s true of pipeline programs, some dating back a few decades and some more recent, designed to help students (of any race or ethnicity, urban or rural) to develop the interests, skills and competencies to help them get the education and training they need to become a doctor or nurse or dentist or pharmacist or other health provider. 

Medical schools may not be able to use the kind of affirmative action policies that the Court ruled out, but they can and do use what Elena Fuentes-Afflick, chief scientific officer of the Association of American Medical Colleges, described as a range of strategies that align with their mission that facilitate access to medical education, including pathway programs, and “holistic admissions.” Medical schools can align their admissions with community health and workforce needs without changing admissions standards, she said on a recent panel for the Association of Health Care Journalists. 

The medical school admissions tests known as MCATs still matter — but they aren’t used to rigidly cull the applicant pool at the outset. Data shows that students who have strong MCATS do well — even if their scores aren’t the very best possible. Medical schools may take into account what’s now called “distance traveled,” said another person familiar with the admissions process. Someone born to privilege, whatever their race or ethnicity, doesn’t have to “travel” as far to the brink of medical school as someone who was born to a poor family where no one had gone to college or who grew up in a home where English was not spoken. And that “distance traveled” says a lot about how well they will fare. “It’s not ‘extra points,’” he said. “It’s let’s look at ‘Is this the person I want in my class as a learner?’”  

Pipeline programs, which serve many kinds of students, are still in place, said Atul Grover, MD, PhD, an expert on medical education affiliated with both Johns Hopkins and George Washington universities. Some help college students bolster the skills they need to continue on to graduate and professional schools. Others support high schoolers — or even reach down into earlier grades, encouraging younger children to develop interest and ability in health and science. Intervening early is absolutely essential, Grover noted, in a place like Detroit where so many young Black males drop out of high school. Such middle and high school programs build skills, and they provide role models and mentors, aligning with some of the recommendations of the National Academy on cultivating a future, diverse workforce. 

In Chicago for instance, both the University of Chicago and the University of Illinois in Chicago run health and science prep programs. 

The University of Illinois’ Pre-Health Scholars Program and Initiatives, which dates back to 1978, has helped recruit and support undergraduates so they can enter fields ranging from medicine to social work. “We carefully monitor their progress to see what works and what may need improvement,” the school says. 

The Pritzker School of Medicine at the University of Chicago runs summer programs for high school and college students, to “prepare and inspire” them for top medical schools. The program includes research projects, mentored by faculty, relevant to medicine or other STEM fields. The Pritzker initiative draws many different kinds of students — from all racial and ethnic groups — who come from low-income backgrounds, or don’t have family members who have gone to college, or come from communities with health professional shortages.  

The University of New Mexico aims to spark interest and preparation in middle school — but it flipped the script. Instead of pulling in middle schoolers, the university has run special programs for middle school science teachers. They come to campus for four weeks in the summer and become immersed in a research project, creating skills and excitement they can take back to their classrooms.   

Rep. Summers points to the work of the Office of Mississippi Physician Workforce, which monitors and evaluates the composition and distribution of Mississippi’s physician workforce. The office develops policies for graduate medical education and physician training, retention and distribution, and more. She would like to see funding for the office to recruit from middle and high schools in rural and medically underserved areas, and also provide career coaches for health care jobs in prison populations. 

The emphasis on recruiting health professions students interested in serving communities similar to those they grew up in is grounded in both research —and everyday experience, said Adrienne Martinez-Hollingsworth, PhD, RN, the director of research and evaluation at the AltaMed Institute for Health Equity. AltaMed is the largest federally qualified health center in the United States, with multiple sites in South and East Los Angeles and Orange County. 

Improved Patient Care 

Martinez-Hollingsworth described AltaMed’s recent research that has found that flu vaccine uptake, for instance, increased among patients who had “culturally congruent physicians” trained in Mexico. “That’s a really quick win in terms of your longevity,” she said. They also found an uptick in colorectal cancer screening, which has historically lagged in minority communities.  

AltaMed’s approach to patient care in South and East Los Angeles includes things that the patient may never quite see – but will come to realize is there.  

“You are assigned to a physician — and they are aware of you as a person. They don’t just think about you when you show up for the appointment that day,” Martinez-Hollingsworth said. 

“The real beauty of culturally congruous providers is that, potentially, you’re encouraging a meaningful, long-term relationship, where the nuance of who you are is embedded in your family history, your social history, your determinants of health, positive and negative. That’s all part of the way this doctor conceives of how you can be your healthiest self.” 

For Guilamo-Ramos, the pushback against DEI isn’t just bad for the health of patients and communities, it’s downright shocking. 

“It’s something that we should have been proud of, that we were more diverse, more equitable, more inclusive,” he said. “But now it’s like the tattoo of shame. And it’s going to hurt all of us that this happened.”