Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
RAND Corporation, Boston, Massachusetts.
JAMA Netw Open. 2024 Mar 4;7(3):e242961. doi: 10.1001/jamanetworkopen.2024.2961.
Despite the widely recognized importance of racial and ethnic concordance between patients and clinicians, there is a lack of studies on clinician diversity in medically underserved areas and whether it aligns with the changing demographic landscape.
To assess trends in National Health Services Corps (NHSC) clinician diversity and racial and ethnic concordance between NHSC clinicians and the populations in underserved areas from before to after the 2009 NHSC expansion.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, population-based study compared trends in the diversity of NHSC clinicians practicing in health professional shortage areas (HPSAs) and the HPSA populations during 2003 to 2019 using the Health Resources and Services Administration's NHSC Field Strength Database and Area Health Resources Files. The analysis was performed from February through May 2023.
Concordance was measured with an annual community representativeness ratio defined as the ratio of the proportions of same race or ethnicity NHSC clinicians to HPSA population.
There were a total of 41 180 clinicians practicing in HPSAs from 2003 to 2019; the median (IQR) age was 34 (30-41) years. Among 38 569 NHSC clinicians who reported gender, 28 444 (73.7%) identified as female and 10 125 (26.3%) identified as male. The average annual number of NHSC clinicians increased from 3357 in 2003 to 2008 to 9592 in 2009 to 2019. Before 2009, 1076 clinicians (5.3%) identified as Black, 9780 (48.6%) as Hispanic, 908 (4.5%) as other, and 8380 (41.6%) as White. During this period, concordance was low among non-Hispanic White and Black individuals due to clinician underrepresentation relative to the population, yet Hispanic clinicians were overrepresented. Following the 2009 NHSC expansion, the main change was the sharp decline in the proportion of Hispanic clinicians, to 1601 (13%) by 2019; while concordance was achieved for non-Hispanic White and Black individuals, Hispanic clinicians became underrepresented relative to population. The results held across 3 specialties: primary care, mental health care, and dental care.
This cross-sectional study of trends in racial and ethnic concordance found that while the NHSC expansion starting in 2009 improved clinician-population concordance for non-Hispanic White and Black individuals, it reversed a prior trend for Hispanic individuals among whom clinicians became underrepresented relative to the population. Targeted NHSC clinician recruitment efforts are needed to improve concordance for Hispanic individuals in underserved areas, especially given Hispanics' projected growth in the US.
尽管患者和临床医生之间的种族和民族一致性被广泛认为很重要，但在服务不足地区的临床医生多样性方面，以及这种多样性是否与不断变化的人口结构相一致，缺乏研究。
评估国家卫生服务团（NHSC）临床医生多样性的趋势，以及 NHSC 临床医生与服务不足地区人口之间的种族和民族一致性，从 2009 年 NHSC 扩张之前到之后。
设计、地点和参与者：这项横断面、基于人群的研究使用卫生资源和服务管理局的 NHSC 现场力量数据库和区域卫生资源文件，比较了 2003 年至 2019 年期间在卫生专业短缺地区（HPSAs）执业的 NHSC 临床医生多样性趋势和 HPSA 人群的趋势。分析于 2023 年 2 月至 5 月进行。
一致性通过每年的社区代表性比率来衡量，该比率定义为具有相同种族或族裔的 NHSC 临床医生与 HPSA 人口的比例。
共有 41180 名临床医生在 2003 年至 2019 年期间在 HPSAs 执业；中位数（IQR）年龄为 34（30-41）岁。在报告性别的 38569 名 NHSC 临床医生中，28444 名（73.7%）为女性，10125 名（26.3%）为男性。NHSC 临床医生的平均年度数量从 2003 年至 2008 年的 3357 人增加到 2009 年至 2019 年的 9592 人。在 2009 年之前，1076 名临床医生（5.3%）被认定为黑人，9780 名（48.6%）为西班牙裔，908 名（4.5%）为其他族裔，8380 名（41.6%）为白人。在此期间，由于相对于人口来说，临床医生的代表性不足，非西班牙裔白人和黑人的一致性较低，但西班牙裔临床医生的代表性过高。在 2009 年 NHSC 扩张之后，主要的变化是西班牙裔临床医生的比例急剧下降，到 2019 年降至 1601 人（13%）；虽然非西班牙裔白人和黑人的一致性得到了实现，但西班牙裔临床医生相对于人口来说变得代表性不足。这一结果在三个专业领域都得到了体现：初级保健、精神保健和牙科保健。
这项关于种族和民族一致性趋势的横断面研究发现，虽然 2009 年开始的 NHSC 扩张改善了非西班牙裔白人和黑人患者与临床医生的一致性，但它扭转了西班牙裔患者的先前趋势，使临床医生相对于人口的代表性不足。需要有针对性地招募 NHSC 临床医生，以改善服务不足地区西班牙裔患者的一致性，特别是考虑到西班牙裔在美国的预期增长。
