Minority Faculty Recruitment, Retention and Advancement: Applications of a Resilience-based Theoretical Framework

U.S. Demographic Changes

The demographic landscape in the United States has changed dramatically in the last ten years. According to the latest U.S. Census data,¹ African Americans (12.3%), Hispanics (12.5%) and American Indians/Alaska Natives (0.9%) together represent over 25% of the total U.S. population. Over the last decade, the Hispanic population alone increased by a notable 57.9%.² It appears that populations that historically have been called minorities are on their way to becoming majorities. This demographic transformation has already occurred in 19 Census-designated areas in California, Texas, and Florida and to a lesser extent in New Jersey.²

Minority Faculty in U.S. Medical Schools

The racial makeup of the nation's medical school faculty, vhowever, presents a starkly different picture. African Americans, Hispanics, and Native Americans/Alaska Natives are, according to the Association of American Medical Colleges' (AAMC) definition, "underrepresented in medicine"³ and constitute "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population."³ In 2004, the most recent year for which data are available, only 7.2% of full-time faculty in U.S. medical schools were African American, Native American/Alaska Native, or Hispanic.⁴ Disturbingly and in spite of multiple local, federal, and private initiatives, we have made little progress in increasing the diversity of medical school faculty. Reasons cited to explain the failure in reaching this goal include "inadequate or inappropriate career counseling, admission policies, relatively high attrition rates after matriculation, substantial costs of education and lack of appropriate mentors and role models" [p. 14].⁵

Multiple published scientific studies have concluded that academic minority physicians are less satisfied with their jobs than their non-minority colleagues,⁶ more likely to report experiencing ethnic harassment and racial/ethnic bias,^7,8 have lower promotion rates,^9,10 and more frequently report that they are considering leaving academic medicine.⁶ Minority faculty explaining these disparities have cited structural barriers such as lack of mentorship, poor retention efforts, and cultural homogeneity that "hinder their success and professional satisfaction after recruitment" [p. 569].¹¹ Even during residency training, minority trainees have expressed feeling that they received "less positive and even biased mentoring during their training" creating a barrier to their consideration of academic careers" [p. 632].¹²

Minority faculty members face interrelated challenges of under-representation and different treatment in U.S. medical schools. The impact of these twin burdens extends beyond the purely academic environment to one involving patient care and health outcomes. Minority physicians are more likely to treat minority patients¹³ and to practice medicine in underserved areas.^14,15 Minority academic physicians, while recipients of differential treatment themselves, are pivotal in addressing inequities in our health care system and the associated disparities in health status and outcomes.

Most of the published literature regarding minority faculty has focused on quantifying and tracking the degree of under-representation over time, identifying disparities in promotion and tenure and highlighting specific faculty development programs.^4,9,10,14,16 More recently, researchers have started to measure the perception of racial and ethnic discrimination in academic medicine.⁷ However, there are significant gaps in our knowledge and understanding of the enablers or facilitators of academic success of minority faculty. Are there, for example, protective mechanisms or buffers that mitigate the adverse effects of disparate treatment in academic promotion, inadequate mentorship, or unequal access to academic opportunities? Should there be an academic survival toolkit of some sort that widens the traditional scope of professional competencies to include personal competencies? Might training that focuses on assertiveness, cross-cultural power dynamics, negotiation, and networking skills benefit minority faculty? Is there a successful stress-coping model for minority academic physicians?

The theoretical framework implicit in the published literature on minority faculty narrowly focuses on barriers and adverse outcomes.^5–7,9–12 Conversely, intrinsic factors that may contextualize and affect minority faculty recruitment and retention outcomes positively have scarcely been discussed. For example, Price et al. identifies "subtle disadvantages experienced by...