A diverse workforce is critical to meeting the diverse needs of our patients. Time and again, we have seen that patients get better care from physicians who look like them, in terms of satisfaction with care, health outcomes and health system usage and expenditures.1-5 We also know that both the family medicine workforce and the family medicine academic workforce (faculty) do not yet reflect the demographic profile of the population of our country.6,7 To help increase the diversity of our overall workforce, we must affect change throughout the continuum of medical education, so that students see a career path in medicine by seeing mentors who look like them and career pathway options, including leadership positions. In 2016 the Council of Academic Family Medicine (CAFM) created a Leadership Development Task Force to address the lack of diversity in academic family medicine leadership, including outlining some of these pathways to leadership for underrepresented minorities and women.8
As follow-up to one of the recommendations set out by this Leadership Development Task Force9 in the March 2021 issue of the Annals of Family Medicine, CAFM shared a baseline set of demographics for the membership of the 4 CAFM organizations along with context for tracking and sharing these data as a way to hold our discipline accountable in achieving our goals of increasing women and minority faculty leaders in academic medicine in the United States.10 This commentary also shared the current efforts of each of the 4 CAFM organizations toward increasing diversity and inclusion of those systemically marginalized and underrepresented in medicine (URiM) and medical leadership.
CAFM is interested in better understanding the current diversity of our organizations’ members and leaders to help set appropriate goals for the future and be able to track our progress towards these goals. Having laid out the current demographics, CAFM has now defined goals for growth among women and URiM leadership and faculty in the United States, described here. CAFM recognizes that there are many pathways to leadership in family medicine8 and a wide variety of roles for our leaders, not all of which are represented here.
These goals are intended to be a starting point for our discipline as something we can measure and compare with other currently available data. By comparing to other currently available data, CAFM is not committing to aligning with or using these data in perpetuity. For these goals, CAFM used the Association of American Medical Colleges (AAMC) definition of URiM, “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”11 In our US context, this includes those who identify as Hispanic/Latinx, American Indian or Alaska Native, Black or African American, or Native Hawaiian/Other Pacific Islander. It does not include those who identify as only White or only Asian. CAFM recognizes that within the broad category of “Asian” there may subgroups who are indeed underrepresented in the medical profession and will continue to explore opportunities to gather more inclusive data as the conversation evolves.
Diversity Goals for Leaders Represented in the CAFM Organizations
For department chairs, program directors, associate program directors, clerkship directors, and research leaders, CAFM has set forth the following goals for the next few years. As noted above, these goals are meant to be a place to start and CAFM will reassess how best to grow and expand these goals as 2025 approaches. We have set a staged series of goals to help reflect the complexities of the demographic measurements and the distance we need to travel to reach ultimate success. These include a target goal, which is the level that would be desirable, and a stretch goal, which would be difficult to achieve but within some level of opportunity.
Target goal: By 2025, increase number of females represented by 15%, increase number of those identifying as Hispanic or Latinx by 15%, and increase by 15% each the number of those identifying as (a) Native American or Alaska Native, (b) Black or African American, and (c) Native Hawaiian/Other Pacific Islander
Stretch goal: By 2025, increase number of females represented by 20%, increase number of those identifying as Hispanic or Latinx by 20%, and increase by 20% each the number of those identifying as (a) Native American or Alaska Native, (b) Black or African American, and (c) Native Hawaiian/Other Pacific Islander
These specific goals by category are shown in Table 1. For example, for the target goal of increasing by 15%, we hope to see an increase in chairs identifying as female from the current 30% to 34% by 2025.
Leader Demographics (Current) and Target/Stretch Goals
In setting these goals for our own organizations, CAFM acknowledges that we do not necessarily have direct control over who is hired into these position types (especially that of department chair). However, the greatest piece of the leadership puzzle is who is in the pool of individuals who might go on to become a leader, in particular the faculty across the discipline.8 Thus, developing these individuals to become strong and capable leaders—and then making sure we communicate about open positions—are 2 of the main tactics to help meet the leadership goals laid out above. With this framing in mind, CAFM felt that goals for the discipline to bring more diversity to the pool of faculty in family medicine were also important.
Family Medicine Faculty Diversity Goals
The most data on faculty available for comparison are gathered by the AAMC. These data only reflect the demographics of medical school faculty and do not include faculty at residency programs who are not affiliated with a medical school, thus give an incomplete picture of the pool of those who the discipline might draw on for future leadership. Acknowledging this limitation, and restating the comment above that CAFM is not committing to using these data in perpetuity but instead as a place to start, CAFM has set forth the following target and stretch goals:
Target goal: By 2025, match the demographics from the AAMC data on 2020 matriculants to medical school
Stretch Goal: By 2030, match the demographics from the 2020 US Census
These specific goals by category are shown in Table 2.
Faculty Demographics (Current) and Target/Stretch Goals
Tracking and Next Steps
As noted above, CAFM will continue to explore how our demographic questions can be more inclusive, recognizing that this might impact their comparability to available data sources or to our own historical data. A new set of categories for race is being developed by the AMA; with the other family medicine organizations, CAFM will work to adopt consistent, inclusive categories when they become available.
CAFM will monitor our progress yearly, sharing data ahead of our annual in-person CAFM meeting in January of each year. To do this, each organization will gather our current data in the fall, depending on the membership cycle of that organization (ideally pulling data at the end of the last membership year instead of the new membership year which may cause inadvertent bias based on who renews early vs late in the membership cycle).
Over the last several years, each CAFM organization has been adding programs and initiatives and creating resources to address diversity and inclusion, as well as working to address bias and inclusion in our own governance structures. More about the efforts of each organization can be found in the March 2021 commentary.10 We remain committed to this important work and ask again for all our members to complete the demographic information in their membership profiles; we need complete information to better monitor our progress!
As part of this ongoing effort, CAFM will continue discussions about what happens if we don’t meet our goals for increasing diversity across the discipline for faculty and leadership. We need to reconvene the Leadership Development Task Force9 if we are not seeing early progress to consider efforts around more resources, tools, advocacy, or other mechanisms.
- © 2022 Annals of Family Medicine, Inc.
