Strategies for Developing an Inclusive Geriatric Physician Workforce for Older Adults in the U.S

The “geriatric imperative” has been part of the aging discourse for more than 30 years but neither geriatric practice nor older adults are homogenous. As the U.S. population ages, elders will become more racially and ethnically diverse; and, their health outcomes will be shaped by lifetime experiences with systemic discrimination and racism. Already, COVID-19 has made clear that older adults and non-Whites, particularly African Americans and Hispanics, disproportionately bear the burden of disease and illness. Research suggests health disparities will continue unless there is change within the health care system. The Institute of Medicine (2001) reported on the problematic nature of the stark contrast between the diversity of patients and the physicians caring for them, including issues with patient trust and communication, yet no significant movement has been made to diversify the physician workforce. Despite being 13% and 16% of the U.S. population, respectively, African Americans and Hispanics make up just 5% and 6% of the practicing physician workforce. Further, practicing geriatricians represent less than 1% of physicians with very few physicians of color. There is a need for more African American and Hispanic geriatricians. In this systematic review, we examine recruitment and retention efforts targeting students of color, and curricula of geriatric medical programs in the U.S. We offer recommendations toward incentivizing physicians of color to enter geriatrics, strategies to support decolonization of geriatric medical curricula in undergraduate medical education programs, and the development of mentorship and pipeline programs to increase diversity in the geriatric physician workforce.

Mission-Based Filters in the Electronic Residency Application Service: Saving Time and Promoting Diversity

ABSTRACT Background Holistic review promotes diversity, but widespread implementation remains limited. Objective We aimed to develop a practical approach to incorporate holistic review principles in screening applicants in the Electronic Residency Application Service (ERAS) and to assess the impact on diversity. Methods Three residency programs (internal medicine [IM], pediatrics, and surgery) at McGovern Medical School developed filters to identify applicants with experiences/attributes aligned with the institutional mission. These filters were retroactively applied to each program's 2019–2020 applicant pool using built-in ERAS capabilities to group applicants by user-defined features. We compared the demographics of applicants reviewed during the cycle with those identified retrospectively through experiences/attributes filters. Results The IM, pediatrics, and surgery programs received 3527, 1341, and 1313 applications, respectively, in 2019–2020. Retrospective use of experiences/attributes filters, without scores, narrowed the IM applicant pool for review to 1301 compared to 1323 applicants reviewed during actual recruitment, while the pediatrics filters identified 514 applicants compared to 384 at baseline. The surgery filters resulted in 582 applicants, but data were missing for baseline comparison. Compared to the baseline screening approach utilizing scores, mission-based filters increased the proportions of underrepresented in medicine applicants selected for review in IM (54.8% [95% CI 52.1–57.5] vs 22.7% [20.4–24.9], P < .0001) and pediatrics (63.2% [95% CI 59.1–67.4] vs 25.3% [20.9–29.6], P < .0001). Conclusions Program directors can leverage existing ERAS features to conduct application screening in alignment with holistic review principles. Widespread implementation could have important repercussions for enhancing physician workforce diversity.