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Chin MK, Đoàn LN, Russo RG, Roberts T, Persaud S, Huang E, Fu L, Kui KY, Kwon SC, Yi SS. Methods for retrospectively improving race/ethnicity data quality: a scoping review. Epidemiol Rev 2023; 45:127-139. [PMID: 37045807 DOI: 10.1093/epirev/mxad002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 02/27/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Improving race and ethnicity (hereafter, race/ethnicity) data quality is imperative to ensure underserved populations are represented in data sets used to identify health disparities and inform health care policy. We performed a scoping review of methods that retrospectively improve race/ethnicity classification in secondary data sets. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searches were conducted in the MEDLINE, Embase, and Web of Science Core Collection databases in July 2022. A total of 2 441 abstracts were dually screened, 453 full-text articles were reviewed, and 120 articles were included. Study characteristics were extracted and described in a narrative analysis. Six main method types for improving race/ethnicity data were identified: expert review (n = 9; 8%), name lists (n = 27, 23%), name algorithms (n = 55, 46%), machine learning (n = 14, 12%), data linkage (n = 9, 8%), and other (n = 6, 5%). The main racial/ethnic groups targeted for classification were Asian (n = 56, 47%) and White (n = 51, 43%). Some form of validation evaluation was included in 86 articles (72%). We discuss the strengths and limitations of different method types and potential harms of identified methods. Innovative methods are needed to better identify racial/ethnic subgroups and further validation studies. Accurately collecting and reporting disaggregated data by race/ethnicity are critical to address the systematic missingness of relevant demographic data that can erroneously guide policymaking and hinder the effectiveness of health care practices and intervention.
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Affiliation(s)
- Matthew K Chin
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Lan N Đoàn
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Rienna G Russo
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Timothy Roberts
- NYU Langone Health Sciences Library, NYU Grossman School of Medicine New York, NY 10016, United States
| | - Sonia Persaud
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
- Department of Health Policy and Management, CUNY School of Public Health & Health Policy, New York, NY 10027, United States
| | - Emily Huang
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Lauren Fu
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
- Georgetown University, Washington DC 20007, United States
| | - Kiran Y Kui
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY 10032, United States
| | - Simona C Kwon
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Stella S Yi
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
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Tello C, Goode CA. Factors and barriers that influence the matriculation of underrepresented students in medicine. Front Psychol 2023; 14:1141045. [PMID: 37303920 PMCID: PMC10247986 DOI: 10.3389/fpsyg.2023.1141045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023] Open
Abstract
Despite many initiatives over more than 4 decades, the diversity of United States physicians still does not reflect the diversity of the United States population. The present study undertakes a literature review of the last 30 years to investigate barriers and protective factors underrepresented college students encounter as applicants for medical school. Known barriers that influence matriculation into medical school were analyzed such as academic metrics and test scores. Additionally, elements that are less well studied were investigated such as factors perceived as barriers by underrepresented applicants in addition to protective factors that allow them to persist in their journey in the face of difficulties and adversity.
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Affiliation(s)
- Cynthia Tello
- American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
- Graduate College of Biomedical Sciences and College of Dental Medicine, Western University of Health Sciences, Pomona, CA, United States
| | - Christine A. Goode
- Graduate College of Biomedical Sciences and College of Dental Medicine, Western University of Health Sciences, Pomona, CA, United States
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Martínez LE, Anaya YBM, Santizo Greenwood S, Diaz SFM, Wohlmuth CT, Hayes-Bautista DE. The Latino Resident Physician Shortage: A Challenge and Opportunity for Equity, Diversity, and Inclusion. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1673-1682. [PMID: 35731597 DOI: 10.1097/acm.0000000000004793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study is to examine the number of Latino physicians in residency training and Latino resident physician trends in the nation's 10 largest medical specialties in the United States and in the 4 states with the largest Latino populations: California, Florida, New York, and Texas. METHOD The authors used data from the United States Census Bureau's American Community Survey to determine Latino populations and a special report from the Association of American Medical Colleges to determine rates of Latino resident physicians in the United States and in California, Florida, New York, and Texas from 2001 to 2017. Rates of Latino residents in the nation's 10 specialties with the largest number of residents were also determined. RESULTS From 2001 to 2017, the United States had an average of 37 resident physicians per 100,000 population. At the national level, however, Latino residents were underrepresented, with only 14 per 100,000 Latino population. At the state level, California and Texas, the 2 states with the largest Latino populations (39.4% and 39.7% of their population, respectively), had 5 and 9 Latino residents per 100,000 Latino population, respectively. Latino residents in California, Texas, Florida, and New York were also very underrepresented in the primary care specialties examined. CONCLUSIONS The findings show a severe shortage of Latino resident physicians. While a similar shortage also exists in primary care specialties, the majority of Latinos in states with large Latino populations are consistently choosing to train in primary care. Investment and greater improvement in the representation of certain population groups in medicine and for combating the inequities existing in the current educational system is needed. The authors offer recommendations to increase the number of Latinos in residency programs and for increasing the number of Spanish-speaking physicians and Latino international medical graduates in residency programs.
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Affiliation(s)
- Laura E Martínez
- L.E. Martínez is a postdoctoral fellow, Department of Obstetrics and Gynecology, and researcher, Center for the Study of Latino Health and Culture (CESLAC), David Geffen School of Medicine at UCLA, Los Angeles, California; ORCID: https://orcid.org/0000-0002-9804-6001
| | - Yohualli Balderas-Medina Anaya
- Y.B.-M. Anaya is assistant clinical professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; ORCID: https://orcid.org/0000-0002-3454-7667
| | - Seira Santizo Greenwood
- S. Santizo Greenwood is chief of staff, CESLAC, David Geffen School of Medicine at UCLA, Los Angeles, California; ORCID: https://orcid.org/0000-0003-3055-076X
| | - Sonja F M Diaz
- S.F.M. Diaz is founding director, Latino Policy and Politics Institute, Luskin School of Public Affairs at UCLA, Los Angeles, California; ORCID: https://orcid.org/0000-0001-9589-9837
| | - Cinna T Wohlmuth
- C.T. Wohlmuth is program director, Obstetrics and Gynecology Residency Program, Adventist Health White Memorial Medical Center, Los Angeles, California
| | - David E Hayes-Bautista
- D.E. Hayes-Bautista is distinguished professor of medicine and director, CESLAC, David Geffen School of Medicine at UCLA, Los Angeles, California; ORCID: https://orcid.org/0000-0001-8363-9034
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Sánchez G, Nevarez T, Schink W, Hayes-Bautista DE. Latino Physicians in the United States, 1980-2010: A Thirty-Year Overview From the Censuses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:906-12. [PMID: 25629948 DOI: 10.1097/acm.0000000000000619] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE To update and extend a 2000 study on the California Latino physician workforce, the authors examined the Latino physician workforce in the 30-year time frame spanning 1980 to 2010, comparing changes in the rates of physicians per 100,000 population for the Latino and non-Hispanic white (NHW) populations in the United States as a whole and in the five states with (in 2010) the largest Latino populations. METHOD The authors used detailed data from the U.S. Census (Public Use Microdata Samples for 1980-2010) to identify total population, total number of physicians, and Spanish-language ability for both the Latino and NHW populations. They examined nativity for only Latinos. RESULTS At the national level, the NHW physician rate per 100,000 of the NHW population increased from 211 in 1980 to 315 in 2010 while the Latino physician rate per 100,000 of the Latino population dropped over the same period from 135 to 105. With small variations, the same trend occurred in all five of the states examined. At the national and state levels, Latino physicians were far more likely to speak Spanish than NHW physicians. Over the 30-year period, the Latino physician population has evolved from being primarily foreign born to being about evenly split between foreign born and U.S. born. CONCLUSIONS The Latino physician shortage has worsened over the past 30 years. The authors recommend immediate action on the national and local level to increase the supply of Latino physicians.
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Affiliation(s)
- Gloria Sánchez
- G. Sánchez is associate clinical professor, David Geffen School of Medicine, University of California, Los Angeles (UCLA), and family medicine associate residency program director, Los Angeles County Harbor-UCLA Medical Center, Los Angeles, California. T. Nevarez is associate clinical professor, David Geffen School of Medicine, University of California, Los Angeles (UCLA), and family medicine residency program director, Los Angeles County Harbor-UCLA Medical Center, Los Angeles, California. W. Schink is retired chief of research division, California Department of Social Services, Sacramento, California. D.E. Hayes-Bautista is distinguished professor of medicine and director, Center for the Study of Latino Health and Culture, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Manetta A, Boker J, Rea J, Stephens F, Koehring N. A study of the physician workforce supply for the latino population in California. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:127-32. [PMID: 17264687 DOI: 10.1097/acm.0b013e31802d8798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE To determine the physician supply during two decades to the workforce available to California Latinos from two separate training tracks at the University of California, Irvine School of Medicine (UCI)--the Fifth Pathway Program (FPP) and the traditional medical school curriculum. METHOD In 2002, the authors compared two groups of physicians practicing in California to ascertain the percentage of Latino patients in their practices. One group had completed the FPP (n = 229) during the period 1971-1991, and UCI graduates from the same period composed the second group (n = 960). The authors also examined Latino population statistics for California communities where physicians located their practices. RESULTS Both groups practiced in California (71.5%) and in primary care (59.9%) at the same rates. Women were underrepresented among FPP physicians (12.2% versus 33.3%). FPP physicians self-reported seeing significantly more Latino patients (14.3% versus 9.2%; P < .001). However, the groups did not significantly differ in the rates at which they practiced in communities with 40% or more Latino residents (18.1% versus 12.9%). CONCLUSIONS Reactivating the FPP may increase the raw number of physicians in California, but two decades of this program did not recruit physicians to practice in California's Latino community at a rate much above that for traditional medical school graduates, especially for communities having the highest Latino population densities.
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Affiliation(s)
- Alberto Manetta
- Department of Obstetrics and Gynecology and Internal Medicine, Division of Epidemiology, University of California, Irvine, School of Medicine, Irvine, California, USA.
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Boulet JR, Swanson DB, Cooper RA, Norcini JJ, McKinley DW. A comparison of the characteristics and examination performances of U.S. and non-U.S. citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995-2004. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S116-9. [PMID: 17001120 DOI: 10.1097/00001888-200610001-00029] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND International medical graduates (IMGs) make up a substantial part of the U.S. physician workforce. Unfortunately, little is known about the demographic and performance characteristics of these doctors, especially over time. METHOD Educational Commission for Foreign Medical Graduates (ECFMG) applicants from 1995-2004 were studied. The characteristics and examination performances of U.S. citizen and non-U.S. citizen IMGs were contrasted. RESULTS ECFMG applications from U.S. citizen IMGs have been increasing. Compared to non-U.S. citizen IMGs, these individuals perform less well on some of the certification examinations, especially in the last 5 years, but are more likely to eventually achieve certification. Based on those medical students/graduates who took the examinations, the performance of U.S. citizen IMGs varied considerably from one medical school to another. CONCLUSION The composition of the pool of ECFMG-certified IMGs available for graduate medical education has changed over the past 10 years. Shifts in the characteristics and abilities of IMGs are likely to have some future impact on health care delivery in the United States.
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Affiliation(s)
- John R Boulet
- Research and Data Resources Foundation for Advancement of International Medical Education and Research (FAIMER), 3624 Market Street, Philadelphia, Pennsylvania 19104, USA.
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Pacheco M, Weiss D, Vaillant K, Bachofer S, Garrett B, Dodson WH, Urbina C, Umland B, Derksen D, Heffron W, Kaufman A. The impact on rural New Mexico of a family medicine residency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:739-44. [PMID: 16043528 DOI: 10.1097/00001888-200508000-00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To determine the impact on rural New Mexico of the large, decentralized University of New Mexico (UNM) family medicine residency. METHOD A cross-sectional study was conducted of all 317 residency's graduates from 1974 to 2004. Location of current practice was correlated with the residents' gender, ethnicity, medical school of origin, and whether most training took place in the urban program or one of three rural programs. The residency's impact on rural communities was assessed. RESULTS There was no significant gender difference between graduates who went into urban or rural practice. Compared with non-minority graduates, a significantly greater percentage of ethnic minority graduates were in rural and urban New Mexico practices and fewer in out-of-state practices. A greater percentage of graduates who had been medical students in New Mexico practiced in both rural and urban New Mexico areas compared with graduates of out of state medical schools. Finally, a greater percentage of graduates from the three rural family medicine residencies remained in the state and practiced in rural areas compared with graduates from the urban program. The graduates' contributions to the school of medicine and to rural New Mexico are described. CONCLUSIONS Graduates of UNM's family medicine residency have contributed significantly to the state's rural health workforce. Ethnic minority status, graduation from New Mexico's medical school, and training in one of the three rurally based residencies favored in-state and rural retention, while gender had no significant effect. The rural orientation of the residencies offered rural communities economic benefits.
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Affiliation(s)
- Mario Pacheco
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, 2400 Tucker NE, Albuquerque, NM 87131, USA
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Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model. Soc Sci Med 2004; 59:2195-205. [DOI: 10.1016/j.socscimed.2004.03.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Polsky D, Kletke PR, Wozniak GD, Escarce JJ. Initial practice locations of international medical graduates. Health Serv Res 2002; 37:907-28. [PMID: 12236390 PMCID: PMC1464010 DOI: 10.1034/j.1600-0560.2002.58.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the influence of place of graduate medical education (GME), state licensure requirements, presence of established international medical graduates (IMGs), and ethnic communities on the initial practice location choices of new IMGs. DATA SOURCES The annual Graduate Medical Education (GME) Survey of the American Medical Association (AMA) and the AMA Physician Masterfile. STUDY DESIGN We identified 19,940 IMGs who completed GME in the United States between 1989 and 1994 and who were in patient care practice 4.5 years later. We used conditional logit regression analysis to assess the effect of market area characteristics on the choice of practice location. The key explanatory variables in the regression models were whether the market area was in the state of GME, the years of GME required for state licensure, the proportion of IMGs among established physicians, and the ethnic composition of the market area. PRINCIPAL FINDINGS The IMGs tended to locate in the same state as their GME training. Foreign-born IMGs were less likely to locate in markets with more stringent licensure requirements, and were more likely to locate in markets with higher proportions of established IMG physicians. The IMGs born in Hispanic or Asian countries were more likely to locate in markets with higher proportions of the corresponding ethnic group. CONCLUSIONS Policymakers may influence the flow of new IMGs into states by changing the availability of GME positions. IMGs tend to favor the same markets over time, suggesting that networks among established IMGs play a role in attracting new IMGs. Further, IMGs choose their practice locations based on ethnic matching.
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Affiliation(s)
- Daniel Polsky
- University of Pennsylvania, Division of General Internal Medicine, Philadelphia 19104, USA
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