In a study published in the Journal of the American Medical Association (JAMA), Michael O. Mensah, MD, MHS, MPH, a postdoctoral fellow from the Department of Psychiatry at Yale School of Medicine, sheds light on the racial, ethnic, and gender disparities within the US postgraduate trainee workforce and their correlation with compensation among different clinical specialties.
Mensah's research, which analyzed data spanning seven years, revealed significant disparities in diversity and compensation among medical specialties, emphasizing that different specialties value racial and gender diversity to varying degrees. These disparities are of considerable concern, given the increasing diversity among medical students during the same period.
One of the most surprising findings of the study was the substantial variation in diversity among specialties and the strong correlation of this variation with compensation levels. Despite a growing pool of diverse interns and residents, some specialties still exhibit striking underrepresentation of certain groups.
Mensah pointed out that "colorblindness," an approach that ignores the role of race in healthcare disparities, is a significant concern, particularly in light of the Supreme Court's recent decision to end affirmative action in admissions of higher education, endorsing a colorblind approach. In an opinion piece after the ruling, Mensah noted that adopting colorblindness as a social norm in medicine endangers the credibility of the healthcare industry. Instead, he emphasized the need to embrace social and structural explanations for racial inequities, and to strengthen diversity efforts threatened by the SCOTUS decision.
The study also explored possible connections between discrimination, attrition, and specialty culture, highlighting the toxic elements within some specialties. Mensah likened toxic specialty culture to "hazing," where medical students or trainees face mistreatment and exclusion in certain specialties to prove their worthiness. These experiences can impact the specialty choices of medical students, especially those from underrepresented backgrounds.
“These experiences can make a big impression on students, especially if, like most minoritized medical students, they haven’t been exposed to medicine before medical school,” Mensah said via an email exchange. “Their experiences are not always wholesome. As I wrote about at the time, as a medical student my distasteful experiences in some clinical settings excluded those specialties from consideration for the Match. During one rotation, I was repeatedly bullied by trainees and excluded from clinical experiences. Both of my sisters who practice medicine—one of whom is a resident here at Yale—report similar experiences of exclusion and targeting. These experiences are not only distasteful, but also inform medical student evaluations, which factor into whether a medical student can “match” into their specialty of choice. So bullying and mistreatment—similar to hazing in other contexts—can inform which specialty a medical student chooses. Relatedly, a new NEJM article explains how mistreatment on the basis of race threatens the mental health and credentialing of racialized trainees.”
On a more positive note, Mensah suggested that specialty cultures that address racism as a social determinant of health may influence specialty choices, particularly for racially underrepresented medical students. Such recognition can signal to students that their experiences matter and that a specialty values racial and gender diversity among its trainees and future colleagues.
When asked about potential future research, Mensah expressed a strong commitment to expanding his work. He aims to analyze whether the trends observed in this study are present in other contexts, such as compensation outside of academic medicine, which constitutes the majority of the physician workforce. He believes that further research will help the medical profession mobilize and organize against the forces of racism, sexism, and profit extraction.
Mensah's study highlights the pressing need to address disparities in workforce diversity and compensation in clinical specialties. The findings serve as a call to action for the medical community to inspect "colorblindness" and to prioritize diversity and racial equity. As the medical field continues to evolve, embracing a more inclusive and equitable approach is crucial for building a healthcare system that serves all individuals.
Mensah welcomes collaboration and hopes to inspire more projects in this area of research. Medical students, trainees, faculty and others interested in similar research can contact Mensah at micheal.mensah@yale.edu.