Where are the rest of us? Improving representation of minority faculty in academic medicine

Objectives: Low numbers of underrepresented minority faculty members in academic medicine (black,Hispanic, Asian/Pacific Islander,Native American/Alaskan) continue to be a concern for medical schools because there is higher attrition and talent loss among this group. Although much has been written on this topic, there has not been a systematic reviewof the indexed literature published. Methods: We searched MEDLINE, Web of Knowledge, ProQuest, and Google Scholar for articles relating to minority faculty and identified relevant articles. We then graded the evidence using the Strength of Recommendation Taxonomy. The same criteria were applied to extract evidence-based observations of challenges faced byminority faculty and provide recommendations. Results: Of the 548 studies identified and reviewed, 15 met inclusion criteria for this literature review. Of the 15, 9were cross-sectional studies and 6 were analyses of existing Association of American Medical Colleges workforce data. The cross-sectional studies documented perceived bias in the recruitment of faculty, quantified the lack of minority mentors, and revealed that black and Hispanic faculty members aremore prevalent in states with higher minority populations. Studies using the Association of American Medical College workforce data also documented evidence of promotion bias, the lack of diversity in academic plastic surgery, and the lack of minority researchers funded by the National Cancer Institute. Conclusions: This systematic review provides evidence that racism, promotion disparities, funding disparities, lack of mentorship, and diversity pressures exist and affect minority faculty in academicmedicine. Based on these observed challenges, this review also provides specific recommendations that could improve representation of minority faculty members in academic medicine. These recommendations include implementing proven pipeline programs to increase the number of minoritymedical students, a systemwide adoption of proven culture change initiatives, reexamination of assignments to ensure equitable time distribution, and a reduction of medical school debt.