Racial Diversity Among American Cardiologists: Implications for the Past, Present, and Future

Abstract

In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular disease and are less likely to receive high-quality, evidence-based medical care as compared with their White American counterparts. Although the United States population is diverse, the cardiovascular workforce that provides its much-needed care lacks diversity. The available data show that care provided by physicians from racially diverse backgrounds is associated with better quality, both for minoritized patients and for majority patients. Not only is cardiovascular workforce diversity associated with improvements in health care quality, but racial diversity among academic teams and research scientists is linked with research quality. We outline documented barriers to achieving workforce diversity and suggest evidence-based strategies to overcome these barriers. Key strategies to enhance racial diversity in cardiology include improving recruitment and retention of racially diverse members of the cardiology workforce and focusing on cardiovascular health equity for patients. This review draws attention to academic institutions, but the implications should be considered relevant for nonacademic and community settings as well.

Keywords: determinants of health; disparities; diversity; health equity; medical education; social.

Figure 1.. Contemporary trends in underrepresentation in medicine.

Pie charts representing different race groups among the United States population, as well as racial representation at different stages along the academic career pathway. Persons listed as unknown or “other” race groups were not included, thus the totals may not equal 100%. Data for the total population are from the United States Census Bureau (updated in 2019). Information about principal investigators are from the National Institutes of Health (NIH, updated in 2014). The remainder of the data come from the Association of American Medical Colleges (AAMC, updated in 2020).

Figure 2.. Cardiovascular disease (CVD) prevalence in adults.

Data are displayed by sex among four racial groups and are complied from the American Heart Association’s (AHA) heart disease statistics. Prevalence is based on 2015 to 2018 data, among adults 20 years of age and older. Diagnostic codes include hypertension, stroke, coronary heart disease, heart failure, and arrhythmia (ICD-9 390 to 459; ICD-10 I00 to 199). The overall prevalence of CVD in the United States from 2015 to 2018 was 49.2%, as depicted by the dotted line. Prevalence for Indigenous Americans was not included due to insufficient data.

Figure 3.. Value-Added Approach to Diversity Through Holistic Review.

Adapted from the Association of American Medical Colleges (AAMC) Experiences-Attributes-Metrics Model, holistic review is a wide-lens assessment of an applicant’s experiences, attributes, and metrics. This approach gives value to life experiences prior to medical school or residency (“distance traveled”), education, leadership skills, and community service. The metrics of test scores, grades, and awards are considered in conjunction with experiences and attributes, not as independent values that are the deciding factors.