Pharmaceutical representatives need to be aware of many types of trends in order to optimally detail their physicians. One
of the most important (and sometimes overlooked) of these trends is the increasing ethnic and cultural diversity of the United
States over the past several decades, which continues at a growing rate.
This is the first in a series of columns that will examine diversity among physicians and patients in the United States. Demographic
data such as age and sex also will be covered. The ways in which patients from various cultural backgrounds view diseases
and relate symptoms to their physicians will be discussed as well. This will be followed by strategies for physicians to deal
with these concerns. Finally, representatives will be given advice on how to deal with physician and patient diversity, from
this doctor's standpoint.
The population shift
The United States Census Bureau divides the population into five major groups: White, Non-Hispanic; Black; American Indian,
Eskimo and Aleut; Asian and Pacific Islander; and Hispanic Origin (of any race). The racial composition of our country's population has changed greatly over the past few decades, and this change is projected
to continue. The two most prominent trends have been a decrease in the White segment of the population and an increase in
the Hispanic segment. For instance, in 1990, the White segment was 75.7%. It decreased to 68.3% by 2002, and it is expected
to steadily decrease to 52.2% by 2050. By contrast, the Hispanic segment was 9% in 2000, 13.2% in 2002 and is projected to
be 22.5% by 2050. In 2004, the percentage of U.S. physicians of Hispanic background was only 2.8%. So from a purely quantitative
perspective, one potential issue to be aware of is that many Americans have been, and will continue to be, in increasing numbers,
treated by physicians with backgrounds different from their own.
Other less dramatic quantitative trends are increases in the Black and Asian populations. By 2050, it is projected that racial
and ethnic minorities will account for approximately 50% of the U.S. population.
Increasing diversity in medicine
The American medical community does express a need for the makeup of doctors from various racial backgrounds to more closely
mirror the racial composition of the population. http://Aspiringdocs.org/, a resource of the Association of American Medical Colleges (AAMC), for example, cites "an overall shortage of physicians,
but the need is, and will continue to be, particularly great for minority physicians."
In 2004, White physicians clearly predominated over all other groups in the United States. Although the race and ethnicity
of a little more than half the doctors practicing in the U.S. were unknown, 37% of those whose race was known were White.
Of the roughly 50% whose race was unknown, 27.6% were presumed to be mostly White (Canadian graduates and U.S. graduates before
1978). So, that means that roughly three-fourths of doctors practicing in the United States. in 2004 were White.
What's the difference?
Before discussing the argument for people of various races being better served by physicians of similar backgrounds, the opposite
point should be raised. In other words, "who cares" if the patient and doctor are of different races, cultures or religions?
If the physician is competent and cares about his or her patients, and the patients are comfortable and able to communicate
well with the physician, there should be no problem. This is, in fact, very often the case. But the problem is when this doesn't happen.
The case for physician diversity
There are three major reasons, all backed by research, that support the need for diversity among physicians. They are: improved
access, increased patient satisfaction and culturally competent care.
