Critical Update for Hispanic/Latinx Heritage Month and Indigenous Peoples’ Day

Oct 16, 2023, 13:30 PM by Melissa P. Upton

Editor's Note: This article originally published on Lablogatory

What is the data regarding the number of physicians- and pathologists-in-training who self-identify as Native American, Alaska Native, Hispanic/Latinx, or Native Hawaiian/Pacific Islander?

Among all resident physicians in ACGME-accredited and in combined specialty training programs on duty as of December 2022, there were a total of 154,231 individuals. The number of physicians in training in Pathology and its subspecialties totaled 2261 individuals.  Looking at the demographic data as self-identified, the following data are striking:

Reference: Data was derived from Table 8 from Brotherton SE, Etzel SI, Graduate Medical Education, 2022-2023, Appendix to JAMA 2023: 330(10):988-1011.

Clearly there is an enormous gap in training of people from Indigenous and Hispanic/LatinX background in both medical training generally and in pathology specifically.  The COVID19 pandemic disproportionately affected people from groups who are considered Under-Represented in Medicine (URIM), which include these groups, as well as individuals who self-identify as African American/Black, and who are also significantly under-represented in pathology and laboratory medicine. 

What about the numbers for the laboratory professions?

With respect to laboratory professionals in practice and in training, I searched unsuccessfully for rigorous data to compare to the data available for physicians in training; however, even from the numbers available, under-representation is a challenge in the laboratory professions.

Please also note that Asian heritage comprises over 50 different language and ethnic groups. Within the United States, some of these groups are disproportionately affected by poverty and adverse social determinants of health.  Therefore, for strategies to improve representation, future analyses should avoid simply lumping individuals into large buckets of self-identified demographic categories. 

To address the adverse health impacts of the social determinants of health for patients from ALL demographic backgrounds, it will be essential to recruit actively from groups who have been both URIM and also from communities grappling with the impact of low income; lack of access to health insurance; lack of access to clean water; lack of access to sanitation services; lack of access to high, quality fresh food; residence in historically redlined neighborhoods that have been zoned for hazardous industries; lack of access to air-conditioning and shade from trees; and over-representation in hazardous work conditions.

Even without addressing these subtleties within ethnic/demographic groups, the data presented in the table convey the obvious fact that we have work to do to increase the numbers of trainees in Pathology (and, by extension, in the laboratory professions) from populations who have been historically under-represented in our training programs and workplaces. ASCP has a great opportunity for focused efforts by our Career Ambassadors, our Pathology Ambassadors, and all members to increase awareness of career opportunities in laboratory medicine and pathology.   Recruitment is an important piece.  Equally important is building and sustaining climates in our training programs and workplaces where people feel welcomed, recognized, invited to participate in transforming our practices to serve our patients better and considered for opportunities to advance and to be considered for leadership positions.  Being hired is not enough. We all need to participate in continuous quality improvement, which means continuous engagement and active participation in decisions that will transform the ways we provide care so that we meet the needs of all our patients, now and in the future.