Building the Diverse Health Workforce of the Future

By Michael V. Drake

In the spring of 2020, as COVID-19 was beginning to spread rapidly in communities across the United States, medical personnel at the University of California, San Francisco, began to notice a trend. Many of their early COVID-19 patients were Latino and included significant numbers of health care workers and their families. The experiences of this first wave of patients illustrated a fact now widely recognized: communities of color have been—and continue to be—disproportionately affected by the pandemic. Individuals in these communities have been more likely to become infected, often due to jobs that could not be moved online. And due to a variety of factors, including preexisting health conditions and lack of access to health care, they have suffered especially profound health and economic impacts.

Although the pandemic has intensified awareness of these interrelated issues, they are of course not new. For too long in our country, racial discrimination and a fragmented and inconsistent health care system have contributed to adverse outcomes in communities of color. These effects are further compounded by a lack of diversity in the health professions. We know that individuals from underrepresented groups are less likely to be insured, less likely to have access to quality health services, and more likely to suffer and die from certain illnesses, including asthma and diabetes. The pandemic has amplified this existing inequality. According to recent research by the University of California, Los Angeles, Fielding School of Public Health, the rate of confirmed COVID-19 infections in California’s nonwhite population has ranged from 1.5 to more than five times as high as the rate among white Californians.

Communities of color have been—and continue to be—disproportionately affected by the pandemic.

An important contributing factor to these troubling outcomes is the fact that tens of millions of Americans live in geographic areas with shortages of health care providers and services. In California, these areas include the San Joaquin Valley in the center of the state and the Inland Empire in the south—two of the fastest-growing and most diverse parts of the state. During the pandemic, the combination of preexisting workforce shortages and skyrocketing demands for care has made it even harder for providers to deliver quality care to their patients.

Beyond these shortages, we must also confront the fact that our nation’s existing pool of health professionals does not reflect the diversity of our communities. This lack of diversity hampers our efforts to treat and cure many of our fellow Americans, and—as the data show—has prevented us from responding as effectively and equitably as possible during the COVID-19 crisis. Research shows that a more diverse health workforce provides real benefits for patients, from better communication with doctors to higher levels of patient trust and satisfaction.

The rate of confirmed COVID-19 infections in California’s nonwhite population has ranged from 1.5 to more than five times as high as the rate among white Californians.

Today, we are still grappling with successive pandemic waves while looking ahead to a future with dangers that continue to evolve. As we move forward, it is clear that we must make sustained investments in programs and proven strategies that will reduce deep inequities in our health care system, support a more robust and diverse health workforce, and build a more resilient, equitable health care system for the future.

The good news is that we already know what works.

First, we must train and support more health care workers—especially those from underrepresented groups. Optimal clinical care depends on a wide range of health professionals working together—from physicians to nurses to pharmacists to community health workers.

At the University of California, we operate six innovative Programs in Medical Education (UC PRIME) focused on developing the next generation of physician leaders with specialized training in caring for underserved populations in rural and urban areas. In the 2020–21 academic year, 365 medical students were enrolled in UC PRIME initiatives, with 67% of them from groups underrepresented in medicine. In recognition of the programs’ extraordinary success in the recruitment of students from underrepresented groups and steady focus on meeting the needs of underserved groups, the 2021–22 California state budget boosted funding for these programs while providing new funds to launch additional PRIME initiatives focused on Black/African American and Native American/American Indian populations. This collaborative effort among the UC system, the state of California, and community leaders—now thriving for 17 years and counting—can serve as a model for other professions and other regions across the country.

This collaborative effort among the UC system, the state of California, and community leaders—now thriving for 17 years and counting—can serve as a model for other professions and other regions across the country.

Second, academic health centers must establish and expand relationships with diverse institutions of higher education—including historically Black colleges and universities (HBCUs), Hispanic-serving institutions, and tribal colleges—to further diversify the pipeline for educational programs in the health sciences. Since it was established in 2012, our UC-HBCU Initiative has helped 699 HBCU scholars spend a summer at UC campuses, conducting cutting-edge research with UC faculty. Many of these scholars go on to apply to UC graduate and health sciences programs and work in the health sector. These are important avenues for building relationships and trust with communities that are underrepresented in the health professions.

Third, universities must increase faculty diversity in the academic health sciences and other fields. We know that students are more likely to thrive academically and professionally when they have access to instructors from diverse races, ethnicities, and backgrounds who understand their experiences and perspectives. At UC, our president’s and chancellor’s postdoctoral fellowships provide support for outstanding scholars from underrepresented populations in all fields. Together with efforts that provide hiring incentives, mentorship support, and other resources for scholars and practitioners from diverse groups, we are making progress toward a faculty that better reflects the diversity of the communities we serve.

Finally, the pandemic has shown us that we must invest in building a broad and inclusive pipeline of health professionals that extends beyond the clinical workforce. The contributions of epidemiologists, virologists, veterinary scientists, and other health professionals—including the researchers who developed COVID-19 tests and vaccines—are critically important for building a strong and effective health care system in which a diversity of perspectives and approaches is reflected at every level.

The pandemic has shown us that we must invest in building a broad and inclusive pipeline of health professionals that extends beyond the clinical workforce.

The process of launching and expanding initiatives like these isn’t easy. I have found that the common denominator in institutions that are successful in promoting diversity, equity, and inclusion is this: the people involved are intentional about their efforts. They have measurable, concrete goals. They have a method to achieve those goals. And they stick with it, regardless of budgetary, political, or other hurdles.

Ultimately, achieving systemic change will require not only ongoing commitments like these by individual institutions, but also meaningful partnerships across every sector of our society. Universities and academic health centers must work closely with elected officials, business leaders, and community organizations to ensure that these types of programs have the leadership, funding, and support they need to take root and flourish. In California, we are fortunate to have the support of the governor and state legislature in achieving these goals.

Across the country, many communities are making progress in addressing these issues. Yet the pandemic continues to show us just how far we have left to go. Actively investing in these priorities at the local, state, and federal levels will go a long way toward creating a more equitable, accessible, and inclusive health care system that truly serves us all.