Dr. Dennis Spencer - Promoting Academic Medicine Workforce Diversity through Pre-Faculty Development
With Dr. Dennis Spencer · hosted by Dr. Em Gootee
Chapter 1 of 8 · Fundamentals
Speaker introduction
Introduction of Dr. Dennis Spencer
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What the experts said
In adult gastroenterology from 2010 to 2017, faculty representation for Black and Hispanic physicians remained flat around 5-6%, showing stagnation.
At Harvard Medical School system in 2018, 10% of trainees (484 of 4,776) identified as underrepresented in medicine, but only 5.2% (15 of 289) of those transitioning to faculty were URM, showing decreased transition rate.
From 1990 to 2020 at HMS, there were fluctuations in Hispanic and Black faculty numbers, with notable decreases during the first Trump term when people left academia.
Tufts medical school campuses in Boston and Maine went from 27 Black students in 2023 to only 2 total (one per campus) in 2024-2025 following the Supreme Court ruling.
Workforce diversity improves institutional excellence through increased overall satisfaction and productivity, and expands research agendas by including questions that might not otherwise be considered.
BNGAP conducted focus groups and surveys of 601 medical students at national meetings, finding this interested group still described obstacles to academic careers including concerns about the promotion process.
Qualitative research across different demographic groups identified common themes: family pressures and socioeconomic factors, self-doubt and imposter syndrome (prevalent across race/ethnicity and gender), and challenges finding safe spaces and mentors especially for gender minorities.
BNGAP has delivered seminars to approximately 1,100 college/post-doc learners (23 implementations), 2,500 medical students/residents/fellows, and almost 700 leadership seminar participants, with intentional overrepresentation of underrepresented groups.
BNGAP has produced 55 journal articles and book chapters with 261 co-authors, intentionally including diverse learners as co-authors to build their academic productivity and competitiveness for residency, fellowship, and faculty positions.
BNGAP's Academic Medicine Writing Fellowship, partnered with MedEdPORTAL associate editors, teaches specific competencies for publishing in medical education, which requires different skills than other academic journals.
With Josiah Macy Foundation support, BNGAP developed core pre-faculty competencies through modified Delphi process with educational leaders including deans and department chairs, creating foundational and focused competency domains.
BNGAP's performance dashboard allows learners to enter CV activities that are banked into specific competencies, taking approximately 2.5 hours for initial setup, then generating both traditional CV and competency-based output showing beginner/intermediate/competent levels.
Exit interview data from trainees leaving academic medicine commonly cite not feeling wanted or welcomed as a reason for departure, questioning why they should persist in an environment perceived as unwelcoming.
Medical school debt burden and perception of academic medicine as less lucrative than private practice influences career decisions, particularly for those from rural areas or certain demographics including Native Americans who face pressure to earn money.
Many trainees lack awareness of loan repayment programs for service in underserved areas through academic centers, which could address debt concerns while allowing academic careers.
Environmental improvements require recognizing implicit biases and behavioral change; people generally try to be good and don't wish to create negative environments, but fail to see their own biases.
Small institutional gestures matter for inclusion, such as recognizing Ramadan and providing opportunities to break fast for learners who are fasting all day, similar to how Christmas trees and menorahs are displayed for other groups.
By 2045, census projections expect the US to be a minority-majority country.
In 2023, Black individuals represented 13.6% of US population but only 7.6% of medical school graduating class, roughly half the population representation.
Black physicians represented 6.3% of active residents in 2023, 5.6% of practicing US physicians in 2022, and 4.3% of medical school faculty.
Hispanic individuals represented 19% of US population but 6.2% of medical school faculty workforce.
In 2025, pediatric anesthesiology residents/fellows were 7.3% Black identified and cardiac anesthesia trainees showed similar patterns of underrepresentation.
General surgery residency in 2025 was 7.7% Black identified and 10.5% Hispanic identified; pediatric surgery fellowships were 7.1% Black and 9.4% Hispanic.
Women now represent over 50% (51-53%) of entering medical school classes, achieving gender parity at entry level.
Nationally, underrepresented in medicine faculty increased to 9.6% of workforce over 20 years, representing almost 2 percentage points growth, but still below the approximately 22% population representation.
In 2013, no Asian-identified individuals served as deans of allopathic medical schools; by 2023 this increased to 5, still far below the over 20% Asian representation in medical school classes, illustrating the 'bamboo ceiling.'
Women represented only 9.2% of department chairpersons in 2013, increasing to 26% in 2023, and 25% of deans, still below the 50% workforce representation.
Osteopathic schools had 33% women chairs in 2023, higher than allopathic schools, and women in leadership were more common on West Coast and Puerto Rico, least common in Northeast.
In 2005, fewer African-American men applied to medical school than in 1976, showing a concerning reversal despite 40 years of diversity efforts.
Black matriculant numbers to medical school remained very stagnant for almost 30 years with only occasional increases.
Between 2000 and 2023, 60 new medical schools opened (many osteopathic, some allopathic), but this did not significantly change diversity; white student percentage remained essentially unchanged at 52.5% vs 52%.
After the 2024 Supreme Court ruling against race-conscious admissions, applications from Hispanic and Black students increased, but matriculants decreased by 10-11%.
AAMC matriculating student questionnaire data shows students identifying as minority express lower interest in academic medicine at medical school entry compared to non-minority peers.
Interest in academic medicine among underrepresented minorities further decreases during medical school and worsens during residency, not improving despite exposure to faculty.
Diversity improves patient outcomes and satisfaction when there is culturally competent concordant care or providers seen as allies, with patients more compliant and feeling part of a team.
In 2019, ACGME added diversity and inclusion to Common Program Requirements, but in September 2024 retired this accreditation standard due to federal prohibitions on requiring or suggesting such focus, and closed the DEI department.
ACGME stated programs retain flexibility to pursue diversity efforts aligned with their own institutional values despite removal of accreditation requirements.
A 2024 Journal of Surgical Research study found women medical students interested in surgery had the same scholarly productivity and number of publications as male counterparts, contradicting the common perception of this as a barrier.
Parity studies show women faculty members with 20 years of service have different promotion likelihood compared to male counterparts, suggesting implicit bias in promotion processes or self-promotion challenges.
Macro-level pipeline programs often have disconnects, such as summer workshops for underrepresented children who cannot attend because their families need them to work during summer.
Lack of role models and mentors who look like them contributes to imposter syndrome and prevents children from even considering medicine, let alone specific specialties.