AAP Voices Blog

As we look around at our respective hospitals, medical offices, and classrooms, we can see that the pediatric workforce has persistently not reflected the diversity of the U.S. population, particularly for those who are underrepresented in medicine.

The Association of American Medical Colleges defines this group as those who self-identify as a member of a racial/ethnic group historically underrepresented in medicine: African American/Black, Hispanic/Latino, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander. A recent study in Pediatrics that I co-authored shows that, in over a decade, there has been little to no improvement in this underrepresentation among pediatric residents and fellows, who are our future pediatric workforce.

The diversity of the U.S. population continues to increase, with 33% of individuals identifying as underrepresented, yet only 13.8% of pediatricians identify as those who are underrepresented in medicine. By 2060, it is projected that almost two-thirds of U.S. children will be of color.

“Given the pervasive health disparities for children of color, which have been exacerbated by the COVID-19 pandemic, it is imperative that the pediatric workforce reflect the diversity of the population we serve, and that pediatricians adopt inclusive practices.”

Given the pervasive health disparities for children of color, which have been exacerbated by the COVID-19 pandemic, it is imperative that the pediatric workforce reflect the diversity of the population we serve, and that pediatricians adopt inclusive practices.

The American Academy of Pediatrics has made great strides in developing agendas to promote diversity, equity, and inclusivity. For example, the recently adopted AAP Equity Agenda will guide the Academy’s goal of actualizing health equity. Given the recent Pediatrics article, I am particularly excited about the “Workforce and Leadership” domain of the Equity Agenda, which has the goal of diversifying and strengthening the pathway to a pediatric career and leadership.

In addition, the AAP recently released guidance on inclusive and anti-biased language, “Words Matter,” which is consistent with the Equity Agenda and the AAP Diversity and Inclusion Statement. This guidance on use of inclusive language recognizes the evolution of terminology and encourages cultural humility and open dialogue. For example, the AAP recommends considering terms that describe underlying structural causes to health disparities to create a narrative that addresses larger societal problems, rather than focusing on personal behaviors.

In addition to race and disability, it also covers gender identity and sexual orientation and encourages the use of language that does not assume heterosexual orientation or cisgender identity.

On my work badge, I recently started wearing a rainbow heart pin and another pin that displays my pronouns (she/her/ella). Anecdotally, I have noted an increase in patients disclosing to me that they identify as a lesbian, gay, bisexual, transgender, or questioning/queer after I began sporting these pins. For example, although I had been caring for Marcus for the past three years and thoroughly covered the HEADSS (home, education, activities/employment, drugs, suicidality, and sex) assessment, this year he looked at my pins, said they were “cool,” and then disclosed that he wasn’t sure about his gender identity and might be attracted to boys.

Whether this newfound openness was due to the pins, I can’t be sure, but certainly creating a welcoming and inclusive clinical environment for all patients is important. Even the small act of wearing a pin that indicates allyship can send a powerful signal of acceptance and safety for young patients.

This inclusiveness extends to the work environment, such as supporting and elevating colleagues and trainees from underrepresented groups in ways that do not contribute to the “minority tax,” or the added burden of responsibilities in the name of diversity. As Dr. Allison Empey wrote in a 2021 ALF resolution, underrepresented in medicine “medical students, residents, fellows and faculty face unique challenges in medicine – stereotype threat, social isolation, homophily, microaggressions, and macroaggressions, to name a few.”

Recognizing one’s own bias, such as taking the Implicit Association Test for race, is a start. Becoming a mentor or sponsor is another valuable way to positively influence the career trajectory of doctors of color. It’s also important to voice support for the hiring and promotion of people of color and to call attention to inequities.

Speak up to show allyship and to help effect change. It can be as simple as backing a Black or Brown colleague’s opinion or ensuring that others don’t talk over a person of color when leading a meeting.

Lastly, as Drs. Poitevien and Blankenberg wrote in the commentary accompanying the aforementioned Pediatrics study, “If we truly intend to diversify our workforce and ultimately provide care to our patients free from bias and racism, we must work actively to be antiracist.”