Table 3.

Proposed Supports for Underrepresented Physicians

Group	Objective	Targeted interventions proposed
All underrepresented physicians	Burnout mitigation Reduce stress Reduce permanent, temporary, and full-time withdrawals from medical practice Remove burnout as disincentive to medical career and/or specialty choice	Well-being programs146 Create and appoint chief wellness officers who implement strategies aimed at the practice environment, teamwork and community building, leadership engagement, compassion for self and colleagues, and support for physicians experiencing distress147 Studies aimed at better understanding the variation in burnout and career regret across specialties57
	Bias training Improve communication Improve health outcomes Improve patient satisfaction Remove bias as a disincentive to medical career and/or specialty choice	Education regarding how explicit (conscious) or implicit (unconscious) bias as well as the continuum from microinequities to macroinequities or aggressions can impact both professional interactions and patient care26,148,149 Completion of the Black-White Implicit Association Test during training to increase awareness of personal implicit bias150 Reduction or avoidance of negative comments from higher ranking physicians or negative interactions with patients150 Use of equitable language during introductions,107 blinded grant applications,112 standardized letters of recommendation,151 and conscious editing to remove negative or stereotypic language from letters of recommendation109 Increased exposure to diversity in educational and workplace settings48,150 Education and competencies for physicians-in-training with respect to meeting the needs of LGBTQ+ and other sexual and gender minority groups and effective incorporation of this information into the medical curriculum and clinical experience152,153 Creation of an affirming climate and improved accessibility to accommodations for students with disabilities4
	Cultural competency and sensitivity training Improve communication Improve patient access to care Accelerate Triple Aim154 Remove cultural differences as a disincentive to medical career and/or specialty choice Improve health outcomes	Enactment and/or recommendation of national mandates and guidelines to improve workforce diversity and require cultural competency training155–162 Frame cultural competency training in terms of developing understanding of both the patient's and the physician's own cultural backgrounds and unconscious biases163 Acknowledge cultural competency as a life-long process, not an end-point, analogous to developing cultural sensitivity or cultural humility163,164 Advocate for collaborative relationships that value differing points of view in an effort to improve outcomes164 Tailor interactions to patient social, cultural, and communication preferences and needs156,158 Increase access to high-quality care services for the medically underserved165 Assess institutional readiness to address patient communication and environmental needs158 Strengthen the medical research agenda by improving diversity among both researchers and study participants165 Expand the pool of medically trained executives ready for health care system and governmental leadership roles165
	Patient-physician communication training Improve exchange of information Improve health outcomes Maintain or reduce appointment length Improve scheduling control Improve patient satisfaction Improve reimbursement outcomes	Use patient-centered, conversational communication style consisting of more individualized, reciprocal and supportive responses and notetaking122,166,167 Identify patient's preferred language, communication needs, and assistive devices158 Improve awareness of patient affective cues166,168 Use patient decision aids and navigation169 Encourage use and participation of patient companions170
	Debt reduction and compensation equity Remove debt as a disincentive to medical career and/or specialty choice, and/or practice location Remove compensation inequity as a disincentive to medical career and/or specialty choice, and/or practice location	Free or reduced medical school tuition171–173 Loan repayment, repayment delays, or loan forgiveness174,175 School-sponsored financial planning courses and/or access to personal finance experts175 State-sponsored financial incentive programs to attract qualified professionals174 Transparency in and public reporting of administrative salary information89 Accountability and initiatives to combat inequity across specialties and institutions89,176–178 Transparency in defining criteria for compensation179 Base pay structures on objective criteria179 Mitigate implicit bias in compensation decisions, including those regarding salary and bonuses179
	Diversity initiatives and workforce studies Improve patient access to care Accelerate Triple Aim154	Enhancement of diversity standards in medical and other professional training schools131,132,174 Establishment of workforce centers or clearinghouses to monitor data on the supply and demand for specific providers174 Evaluate the effectiveness of educational and workforce strategies174
Women physicians	Sexual harassment	Develop methodical approaches surveying and combating sexual harassment180 Within institutions and organizations, evaluate and address (1) perceived tolerance for sexual harassment, (2) male-dominated workforce, (3) hierarchal power structures, (4) symbolic compliance, and (5) uninformed leadership103 Create diverse and respectful environments, improve transparency and accountability, diffuse power, support the targeted individual, and promote strong and diverse leadership103
	Gender discrimination	Adoption of systematic guidelines to end gender discrimination and improve the advancement of women in medicine94,181 Support rising women physicians through sponsorship,182 equitable funding (grant and award),183 and equitable collaboration and representation among authors,97,98 award recipients,93,94,183 faculty, editorial boards,184 committee members,100 and presidents of medical specialty societies99 Improve parental support, including but not limited to “longer paid maternity leave, backup child care, lactation support, and increased schedule flexibility”79 Improve support for physicians as family caregivers19 Improve control over patient-related decision-making, including but not limited to selection of referral physicians and determination of hospital length of stay19 Improve control or influence over work environment such as space and facilities, clinic/office schedule, patient load, and patient characteristics19
URM physicians	Access to medical education	Increase public support for historically black medical schools133 Increase recruitment of URM physicians through holistic review of applications, conditional acceptance programs, outreach, scholarships, and branch campus locations185,186 Increase funding for k-12 education135
	Support for and advancement in medical ranks	Recruitment of minority physician faculty9,135 Medical specialty society support through education, pipeline programs, clinical care programs, position statements, advocacy, data management, research, and mentorship187
LGBTQ+ physicians	Recruitment and workplace culture	Applications allowing declaration of LGBTQ+ status as well as consideration of that status as strengthening applications to medical school188 Diversity hiring policies188 LGBTQ+ advocates campus-wide, LGBTQ+-friendly training, and LGBTQ+-friendly workplaces (e.g., gender inclusive restrooms)188 Partner benefits equivalent to those available to a traditional spouse (e.g., sick leave, maternity leave, and insurance coverage)188 Healthy coping strategies, social networks, professional networks, and advocacy groups189
	Patient comfort, communication, and outcomes	LGBTQ+-inclusive evidence-based educational materials188,190 LGBTQ+-inclusive forms and decision-making tools188,190
Physicians with disabilities	Recruitment and workforce culture	Include disability in discussions of diversity4,191,192 Increase recruitment193 Remove pressure on students and physicians to disclose the full nature of their disability4 Improve and standardize medical school technical standards194 addressing unclear, inconsistent, and lengthy policies and processes4 Define responsibility for accommodations4,194 Provide access to appropriate accommodations, personal and professional networks, peer support, and mentorship4 Expand study of barriers and accommodations supportive of physicians194–196
	Patient comfort, communication, and outcomes	Improve access, provider awareness, and communication, and address attitudinal barriers45–49,195,197–199