This study is one of few to quantitatively characterize racial/ethnic differences in faculty’s perceptions of bias, professional satisfaction, mentorship experiences, and future career plans in academic medicine.7–10
Perceptions of the Johns Hopkins diversity climate were poor for most physician faculty and worse for URM faculty. Our findings support and extend what has been shown in previous work. To our knowledge, this is the first study to illustrate an academic medical institution’s formal assessment of its diversity climate to better inform organizational change.
Our findings substantiate the urgent need for the institution to improve its structural diversity (number of diverse faculty). Study participants, regardless of their race/ethnicity, were not satisfied with the racial/ethnic diversity of the faculty, and URM faculty were less satisfied than majority faculty. Efforts to enhance recruitment of diverse faculty could improve the professional experiences and satisfaction of all faculty physicians, regardless of race/ethnicity.
We also found that there were perceptions of bias in faculty recruitment and promotion. Moreover, faculty perceived that career networking opportunities did not include ethnic minorities, women, and foreign-born faculty. URM women and URM junior faculty may be particularly vulnerable in this regard, because they were more likely than their colleagues to report experiences of bias, less likely to report professional satisfaction, and less likely to believe networking includes minorities, women, and foreign-born faculty. Yet, there was no significant difference in URM versus majority faculty perceptions of availability of networking opportunities within and outside the institution overall. These seemingly contradictory findings could relate to our wording of the questions. When faculty responses were stratified by gender, rank, department, or birth status, a lower proportion of URM faculty reported satisfaction within the institution, whereas a higher proportion of URM faculty reported satisfaction with networking opportunities outside of the institution. Our findings suggest a need for faculty recruitment and promotion policies and procedures as well as networking opportunities that are transparent, equitable, and inclusive.
Fewer than 50% of all respondents reported satisfaction with most forms of institutional support for professional development. There were no significant differences between URM and majority faculty in satisfaction with their social integration, training in grantsmanship skills, amount of protected time, amount of external funding, or recognition of clinical and scientific knowledge by their colleagues. Institutional programs structured to enhance academic productivity could improve professional satisfaction of all faculty.
The finding that fewer than half of URM faculty survey respondents expect to be at our institution in five years is particularly concerning and warrants further investigation. Adjusting for perceptions of bias in faculty recruitment, dissatisfaction with diversity of colleagues, perceptions of the lack of inclusiveness of networking, mentorship, and number of publications did not explain these findings, so it is unclear whether URM faculty might leave for better opportunities elsewhere or because of other negative experiences with regard to the diversity climate. Previous studies indicate that ethnic minority faculty at other institutions have also had negative experiences and expressed similar intentions to leave their current institution.26
Establishing a confidential mediation process for faculty who experience barriers and conducting formal exit interviews for all faculty who leave an institution would provide more insight as to which strategies will improve faculty retention.
Overall, there was a high likelihood of all respondents reporting that their mentors engage in career development and promotion activities and a low likelihood of reporting that mentors advise them on social issues or teach negotiating skills. There were no statistically significant racial/ethnic differences in mentorship experiences. Given the potential importance of mentorship for achieving professional success and the dearth of rigorous evidence to support this assertion,27
future work should examine barriers to mentorship and test successful mentorship models for faculty from diverse groups.
Our study should be interpreted in the context of its limitations. First, our sampling frame was physician faculty at one institution; therefore, our findings may have limited generalizability to other academic institutions or to nonphysician faculty. Second, with a response rate of 50%, our findings may not be representative of all faculty at our institution. For example, participants may represent faculty with salient experiences in the topic areas we explored and who were looking for venues in which to describe their experiences. Third, given the sensitive nature of the questionnaire, participants may have tried to give “socially acceptable” responses. However, we minimized the likelihood of this bias by using study numbers and removing identifiers from surveys to ensure confidentiality. Fourth, use of more personalized recruitment strategies for URM faculty may have introduced bias to our findings. Nonetheless, the Committee for Faculty Recruitment and Diversity confirmed our findings in a larger diversity climate survey in 2006 (personal communication, Drs. Janice Clements and George Dover, co-chairs, JHU Committee for Faculty Recruitment and Diversity, February 1, 2008). Fifth, we used an instrument that was tailored to our institution but not previously validated. However, we did establish content validity by using a theoretical framework, findings from a previous qualitative study of faculty, and the views of experts to develop the items. Still, we may not have covered instrumental aspects of professional development, such as mentorship and networking, in adequate depth. Sixth, because of the cross-sectional design of our study, we do not know whether faculty perceptions are predictive of professional success and/or retention. Longitudinal data collection of institution-specific rates of recruitment, promotion, and retention among diverse faculty are needed. Finally, the authors’ affiliation with the DOM Diversity Council could have influenced the interpretation and application of the results to policy and programmatic changes. Even so, our study was among a number of factors prompting institutional changes related to the diversity climate.
Notwithstanding these limitations, this study showed that a majority of respondents at our institution desire a more diverse faculty, that perceptions of bias and exclusivity are common, and that URM faculty physicians are more likely than majority faculty physicians to anticipate leaving the institution. Each institution’s diversity climate and strategies to improve it may be unique; however, our study is one example of how assessment of faculty perceptions may serve as one of many catalysts for organizational change with regard to diversity in academic medicine.
Our findings were presented to the dean of JHUSOM in March 2005 and to the Board of Visitors (a group of about 40 friends and donors that addresses academic issues such as faculty appointments and promotions in the JHUSOM) in collaboration with the Committee on Faculty Recruitment and Diversity in May 2005. Institutional changes that have occurred since then may be considered as embodying John Kotter’s28
eight steps to transforming organizations. Our survey findings established a sense of urgency for improving the diversity climate: in 2005, the university and the Board of Visitors conceived of and funded 12 scholarships as a means of attracting the most sought-after URM students to Hopkins29
(step one). JHM formed an institution-wide diversity committee, a powerful group of people within the institution, to work as a team in leading the change by formulating the vision, designing strategies to implement it, communicating the vision to the broader institution, and role modeling expected behaviors (steps two, three, and four). JHM has also sponsored leadership retreats on diversity, incorporated diversity and inclusion into the mission, vision, values and strategic plans for the institution, conducted the aforementioned baseline survey of the diversity climate for all faculty and staff, hosted retreats for all URM faculty with institutional leaders, and held town meetings that heighten expectations for change among faculty, staff, and students30
(step five). Accountability for progress toward diversity is now monitored by having all JHM entities and departments report annually to the dean/CEO and quarterly to the JHUSOM Board of Trustees (step six). JHM uses the credibility of small improvements in key departments to change systems, structures, or policies that contradict the vision for diversity (step seven). In 2007, a new professorship designed to attract exceptionally promising faculty, with an emphasis on recruiting highly qualified URMs to JHUSOM, was established with a generous gift from Baltimore-area philanthropist Robert Meyerhoff and his late wife, Jane.29
Finally, JHM has now incorporated specific diversity and inclusion goals for the institution with regard to the talent pipeline, workplace climate, community partnerships, and disparities in access and quality of patient care into its 2020 strategic plan. The last two strategies anchor changes in the diversity climate to the institution’s culture, values, and social norms to prevent loss of improvements once the pressure for change is removed (step eight). Our study also relates to other organizational change models.31–33
By addressing the initial “standing still,” “collecting data,” and “confronting the brutal facts” stages of organizational change, it has led to subsequent stages, including engagement of powerful stakeholders, an aspiration for change, focus and intentionality, and multiple actions.
Our study findings support ongoing initiatives to improve ethnic diversity among physicians in academic medicine. Faculty perceptions, although subjective, are the basis of the reality in which faculty work and can, in turn, impact overall professional satisfaction, recruitment, and retention of select groups. We employed a two-stage, rigorous, mixed-methods approach to assess the unique diversity climate at our institution and to quantify faculty perceptions of their work environment. We provide a replicable model of institutional needs assessment that could be employed at other academic medical institutions with similar missions, goals, and visions with respect to workforce ethnic diversity. More studies in this area are needed to facilitate nationwide comparisons of the diversity climate across various academic medical institutions and to determine whether standard policies and procedures will enhance recruitment, promotion, retention, and professional development of ethnically diverse physician faculty in academic medicine.