Tuesday, May 6, 2014

This blog is the third in a series on Minority Health Month. Read the first and second blog, or find more information about Altarum’s work in Health Disparities and Health Equity.

Doctor and KidNational Minority Health Month may be over, but it is important that we remain focused on this important issue well into the future, as there is much more work to be done to improve health equity. One area of particular concern is diversity of the health care workforce.

With the passage of the Patient Protection and Affordable Care Act, there has been a focus on increasing the number of health care providers in underserved areas. In 2014, there are approximately 6,000 geographic areas in the United States designated as health professional shortage areas due to a shortage of primary care clinicians.[i] By 2019, it is estimated that approximately 34 million people will gain insurance coverage, placing even greater strain on the primary care workforce.[ii] Aging, population growth, and retirement of existing physicians will also contribute significantly to the need for an expanded primary care workforce.[ii]

While increasing the number of providers is an important goal, it is equally important to increase the diversity and cultural competency of those providers. Approximately one in four Americans is either Black or Hispanic, yet together these two minority groups make up only 9% of the physician workforce.[iii] Currently, only 12% of students graduating from U.S. medical schools are Black, Hispanic, or Native American.[iv]

Racial, ethnic, and cultural diversity is an important aspect of the health care workforce as it affects the way providers interact and connect with patients. Health disparities have been traced to many causes, including language and cultural barriers that can deter minorities from seeking care or lead to suboptimal care.[iii] For example, in 2011, 34% of patients in health centers funded by the Health Resources and Services Administration, including community health centers and migrant health centers, were Hispanic and about one-quarter of patients were determined by the health centers to be best served in a language other than English.[iii] For this population, workforce diversity has been associated with both greater satisfaction with care received and improved patient-provider communication.[iii]

There are many potential strategies for improving workforce diversity. Through the National Partnership for Action (NPA), the National Stakeholder Strategy for Achieving Health Equity was developed to provide a common set of goals and objectives for public- and private-sector initiatives and partnerships to help racial and ethnic minorities reach their full health potential. The blueprint includes three strategies aimed at improving cultural and linguistic competency and the diversity of the health-related workforce:

  • Promote the availability of cultural and linguistic competency training that is sensitive to the cultural and language variations of diverse communities;
  • Recruit, retain, and train racially, ethnically, and culturally diverse individuals through leadership action by healthcare organizations and systems; and
  • Encourage the use of interpreters, translators, and bilingual staff to provide services in languages other than English and encourage financing and reimbursement for health interpreting services.

As an NPA partner, the National Conference of State Legislators (NCSL) has created a comprehensive legislative tracking database to track state bills that, if enacted into law, would affect health disparities. In recent years, many of the proposed bills have focused on the workforce development strategies listed above.

  • State legislators in Indiana, Massachusetts, Missouri, Ohio, Oklahoma, and Washington have recently introduced bills requiring cultural competency training for health care professionals. Massachusetts bill HB 1957 states, “Implementing a framework of cultural competence in health systems is an extended process that ultimately serves to reduce health disparities and improve access to high-quality health care.”
  • Legislators in Minnesota have proposed several bills with the goal of recruiting and training diverse individuals in the health care system. These bills focus on providing grants to minority-run health care professional associations for the purpose of providing collaborative mental, holistic, and culturally competent health care services to minority residents as well as to collaborate on recruitment, training, and placement of minority health care providers.
  • Legislators in Hawaii have proposed a bill that would appropriate funds for interpreters to receive training and certification in medical or healthcare interpretation. Funds would also be used to develop medical glossaries in the primary foreign languages spoken in Hawaii.

With implementation of the Patient Protection and Affordable Care Act, we have made strides in improving access to care by ensuring increased coverage but those strides will be slowed or impeded if the health care workforce is unable to meet the needs of a diverse population. The NCSL will continue to track legislative progress and we expect the database to bring attention to the growing interest in addressing the important issue of healthcare workforce diversity. Altarum looks forward to additional collaboration with the NPA and its dedicated partners, such as the NCSL, as we work beyond National Minority Health Month.

Keep watching as we continue to bring you information on health equity efforts and their outcomes. Don’t forget to follow us on Twitter @Altarum.


[i] Health Resources and Services Administration. (2014). Shortage designation: Health professional shortage areas & medically underserved areas/populations. http://www.hrsa.gov/shortage/

[ii] National Conference of State Legislators. (2011). Primary care workforce. http://www.ncsl.org/research/health/primary-care-workforce.aspx

[iii] Health Resources and Services Administration, Bureau of Health Professionals. (2008). The physician workforce: Projections and research into current issues affecting supply and demand. http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdf

[iv] Association of American Medical Colleges. America needs a more diverse physician workforce. https://www.aamc.org/download/87306/data/physiciandiversityfacts.pdf

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