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Abstract
Background: Ensuring the strength of the physician workforce is essential to optimizing patient care. Challenges that undermine the profession include inequities in advancement, high levels of burnout, reduced career duration, and elevated risk for mental health problems, including suicide. This narrative review explores whether physicians within four subpopulations represented in the workforce at levels lower than predicted from their numbers in the general population—women, racial and ethnic minorities in medicine, sexual and gender minorities, and people with disabilities—are at elevated risk for these problems, and if present, how these problems might be addressed to support patient care. In essence, the underlying question this narrative review explores is as follows: Do physician workforce disparities affect patient care? While numerous articles and high-profile reports have examined the relationship between workforce diversity and patient care, to our knowledge, this is the first review to examine the important relationship between diversity-related workforce disparities and patient care.
Methods: Five databases (PubMed, the Cochrane Library of Systematic Reviews, EMBASE, Web of Knowledge, and EBSCO Discovery Service) were searched by a librarian. Additional resources were included by authors, as deemed relevant to the investigation.
Results: The initial database searches identified 440 potentially relevant articles. Articles were categorized according to subtopics, including (1) underrepresented physicians and support for vulnerable patient populations; (2) factors that could exacerbate the projected physician deficit; (3) methods of addressing disparities among underrepresented physicians to support patient care; or (4) excluded (n=155). The authors identified another 220 potentially relevant articles. Of 505 potentially relevant articles, 199 (39.4%) were included in this review.
Conclusions: This report demonstrates an important gap in the literature regarding the impact of physician workforce disparities and their effect on patient care. This is a critical public health issue and should be urgently addressed in future research and considered in clinical practice and policy decision-making.
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Details
1 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
2 Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
3 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, and Massachusetts General Hospital, Boston, Massachusetts
4 Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Network, Boston, Massachusetts
5 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brigham and Women's Hospital, and Spaulding Rehabilitation Network, Boston, Massachusetts
6 National Patient Advocate Foundation, Washington, District of Columbia
7 Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; American Psychiatric Association, Washington, District of Columbia
8 Department of Psychiatry, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
9 Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts