Increasing diversity of the physician workforce is a dominant activity in today’s healthcare system and the goal of the millions of dollars spent by hospitals and medical schools on their diversity bureaucracies. One of the most cited studies to support the rather unlikely notion that merely diversifying a hospital staff will improve patient outcomes is a study published in the Journal of the National Medical Association in 2019 by Gomez and Bernet (J Natl Med Assoc. 2019 Aug; 111(4): 383-392). It has been cited hundreds of times in various medical articles touting the benefits of diversity, likely because of the title, “Diversity improves performance and outcomes.” As it turns out, this article is often the only citation used to assert that diversity improves clinical outcomes. The vast majority of studies of the benefits of diversity claim that physician-patient racial concordance improves short term patient satisfaction and feelings of comfort with their physician. While comfort is pleasant, the goal of the patient-physician interaction is a successful therapeutic outcome.
In 2023 alone, 16 articles with titles like “Addressing kidney health disparities with new national policy: the time is now” call for more diversity of the health care workforce and cite the single study purporting to show improved outcomes. However, if one reads beyond the title, which is apparently rarely done, the story is very different.
The article by Gomez and Bernet is actually a compilation of 16 reviews of the effects of a diverse workplace, but only three of the 16 studies are concerned with diversity in healthcare. The rest were in finance, education, or other workplaces. Of the three reviews of healthcare, the articles only dealt with patients’ satisfaction and willingness to accept recommendations for care, not the results of treatments. The first study provides no evidence that racial concordance benefits patients. Rather, it concludes:
Little evidence of clinical benefit resulting from sex or race/ethnicity concordance was found. Greater matching of patients and providers by sex and race/ethnicity is unlikely to mitigate health disparities.
In a second study, the authors reach the same conclusion:
No significant association between concordance and impressions, such as, whether the patient felt the doctor “knew enough or asked enough questions about your health.”
The third article – which Gomez and Bernet incorrectly classify as a meta-analysis (a technique for compiling the results of various studies) – links to two 20-year-old studies that find positive associations between racial concordance and patient satisfaction. Remarkably, Gomez and Bernet omit mention of a 2009 systematic review of racial concordance studies in medicine that concludes that “there are inconclusive results in minority patients’ preference, satisfaction, and communication domains.” In other words, even the narrow assertion that provider-patient racial concordance is associated with higher patient satisfaction rests on cherrypicked data.
So, many articles that claim that diversity improves patient outcomes cite a paper with an intriguing title that claims a result that does not exist. The “evidence” in favor of such claims proves to be a shell game.
In the same fashion, Dr. Quinn Capers IV wrote an opinion piece in the New England Journal of Medicine extolling the virtues of diversity in the physician workforce and cites only one study to justify the idea that merit and ability of the trainees cannot be determined from performance on standardized tests. A key proposal by the diversity world is to do away with all standards to achieve “equity.” The study he cites shows that based on standardized exam scores of trainees at Northwestern University Feinberg School of Medicine and McGaw Hospital, one cannot differentiate the residents chosen for highly desired slots as “chief” residents from the rest of the pool of trainees. Therefore, according to Capers, grades do not matter in assessing quality of candidates for training positions.
This analogy is facially absurd. Northwestern McGaw University Hospital is ranked among the top ten hospitals in the United States, so all members of its resident staff are likely to be among the most qualified graduates of American medical schools. Sure enough, the grades achieved by the chief residents and the other residents reported in the study (251.06 ± 13.80 versus 252.51 ± 14.21) would place all the trainees in the top 10% of all medical school graduates. So, among the very best students in the United States, there is not much difference in test scores. This is hardly an argument for sacrificing merit for diversity.
These examples highlight the intellectual dishonesty of the diversity movement. One doubts that the public is willing to sacrifice the quality of American healthcare to satisfy a political goal of a dissembling corps of racialist medical school and healthcare administrators.
Dr. Stanley Goldfarb is the chairman of Do No Harm and is a former Professor and Associate Dean for Curriculum at the University of Pennsylvania School of Medicine.
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