GW researchers found disparities in the representation of Asian American, Native Hawaiian and Pacific Islander ethnic groups in the United States health care workforce in a study published early this month.
Researchers from the Milken Institute School of Public Health, Fitzhugh Mullan Institute for Health Workforce Equity and the School of Medicine & Health Sciences found that Native Hawaiians and other Pacific Islanders are often underrepresented in many health care professions. Emmeline Ha, an assistant professor of family medicine and the study’s lead author, said the results highlight the need to individually study different AAPI ethnic groups and avoid grouping them together into a monolith to understand the different barriers each group faces.
“There’s so many nuances to this overall category of our race, and unfortunately, by grouping everyone together, the individual lived experiences of each community becomes eradicated,” Ha said.
Ha said researchers analyzed data between 2018 and 2022 from the American Community Survey, a demographic survey released every year by the U.S. Census Bureau, to analyze how many members of each AAPI group work in different fields of medicine.
She said the AAPI community has been advocating for individual disparities in these professions to be highlighted “for decades” to policymakers and researchers, but there is a lack of data that individually studies groups because of a tendency to group all Asian populations together in research.
For the study, researchers calculated a diversity index for each ethnic population in 15 health care occupations, including physicians, dentists and pharmacists, the index being the percentage of that group represented in the occupation divided by the percentage of the group represented in the working-age population in the United States.
A diversity index under one indicates the ethnic group is underrepresented in a given profession.
The study indicates that many South Asian and East Asian American populations are represented in positions like physicians, pharmacists and dentists, with 10 out of 12 groups having a diversity index above 1.00 for physicians, as well as 11 groups for pharmacists and nine for dentists.
Native Hawaiian and Pacific Islander populations were more likely to be underrepresented in these professions, with the diversity index for the group in physicians falling at 0.47, and in dentistry, 0.12.
Those designated “Other Southeast Asian populations,” including Malaysian, Burmese and Thai populations, were also underrepresented in positions, like nurses with a diversity index of 0.44 and physicians’ assistants with a diversity index of 0.51.
The data shows a high variance in representation across ethnic groups in certain professions. The highest diversity index score for physicians was 9.41 for Pakistanis and the lowest was 0.47 for Native Hawaiian and Pacific Islanders.
Similarly, the highest diversity index for dentists was 8.89 for Koreans and the lowest was 0.12 for Native Hawaiian and Pacific Islanders.
“Each subpopulation has such unique experiences that can define overall health inequities and contribute to social economic barriers that contribute to health disparities, and so understanding the differences and focusing on those nuances so that we could better improve the health of all these populations is why it’s so important,” Ha said.
Ha said the research found that across all AAPI populations, there was underrepresentation in the behavioral health workforce — psychologists, counselors and social workers — which reflects the fact that mental health is often “stigmatized” in these communities.
The study found that out of all studied populations, only Japanese populations in the counselor profession and the Japanese and Korean American populations who work as social workers and psychologists had a diversity index above one.
“If we don’t have ethnic concordance and language concordance to better support [AAPI populations], then we are not going to be able to address many health needs,” Ha said.
Ha said the “next big step” in this work is how to use this data to inform policy decisions that can facilitate better health care representation for AAPI populations. The data highlights the need for health provider outreach to communities underrepresented in the workforce and for the current health care workforce to implement things like better translation services to encourage more AAPI individuals to break into the field, she said.
“We now finally have the data to support all this advocacy efforts that many individuals and many organizations and groups have called for,” Ha said. “To disaggregate the data to show the difference that we can go forward. So the next big step is to use that information for policy.”
Finn Dobkin, a doctoral student at the Trachtenberg School of Public Policy & Public Administration and an analyst on the study, said he primarily worked to statistically analyze the data from the American Community Survey and calculate the diversity index for each population.
Since the survey only goes out to 1 percent of the population each year, researchers combatted issues of small population sizes by clustering together some ethnic groups into categories like “Other Southeast Asian,” which included Burmese, Indonesian, Laotian, Malaysian, Thai, Hmong and Cambodian Americans, Dobkin said.
“With very specific subpopulations, it can sometimes be difficult when you have a 1 percent sample,” Dobkin said. “So I think that’s primarily where it comes from and so when that’s the case, you normally just have to cluster together like specific regions rather than individual countries.”
Edward Salsberg, a lead research scientist for the Mullan Institute and co-author on the study, said it’s challenging to narrow the study’s specificity to individual ethnic populations within the AAPI community because the number of professionals in a specific ethnic group and discipline can be small.
He said national data, like the census, often does not get down to that level of precision, which makes it difficult to study the needs of specific populations. That challenge is why this study had to disaggregate data from the American Community Survey to figure out which individual respondents were in each ethnic group, Salsberg said.
“One of the analytical challenges is the numbers,” Salsberg said. “If you take a smaller country, and given the number of countries, there are many, many countries with fewer individuals in the United States and even fewer who may be physicians or dentists. So the numbers get quite small.”
Salsberg said increasing representation of certain ethnic groups in the workforce has gotten more difficult in the past few years with decisions like the overturning of affirmative action and race-conscious admissions programs. He said President Donald Trump’s recent attacks on diversity, equity and inclusion and higher education research may make it harder to collect data disparities among racial groups in health care professions.
Salsberg said the general data on AAPI populations from research like the survey can give the impression that these populations are overrepresented, but when the data is separated into specific ethnic groups, it shows individual disparities that DEI programs could help eliminate.
By not reflecting underlying subpopulation disparities, these data “perpetuate the ‘model minority’ myth in which all Asian Americans have high academic and economic achievement,” the study states.
“One of the messages we want to get out is that if the Asian subpopulation group or the Native Hawaiian Pacific Islanders are underrepresented, they too should be eligible for programs designed to increase representation,” Salsberg said.
