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Minority in Minorities:

The Worsening Representation of Native Hawaiians and Pacific Islanders in Medical Education and Profession

words and visuals by Lexi Zhang

According to the Association of American Medical Colleges, applicants to medical school rocketed to 62,443 for the 2021-2022 school year, marking the largest applicant pool ever so far. Regardless of the increase of applicants across most races /ethnicities, diversity remains a persistent challenge for doctors and future doctors in the US.

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The COVID-19 pandemic was believed to reveal the importance of medical workers and therefore motivate young people to apply for medical schools. Another reason behind the surge may be the social injustice issues exposed by COVID-19 such as the disproportionate impact on communities of color.

With minorities being generally more vulnerable to COVID, the AAMC reported historical increases among underrepresented populations in the 2021 application cycle. American Indian or Alaska Native (AIAN) and Black or African American powered the surge, rising by 43.8% and 41.4% respectively. While almost all racial or ethnic groups made a two-digit leap last year, there was zero increase in the number of Native Hawaiian or Other Pacific Islander (NHPI) applicants, which made up only 0.065% of all applicants in 2021.

Even within the underrepresented in medicine (URM) population defined by the AAMC, NHPIs are often “the forgotten minority group that is underrepresented in multiple facets of medicine,” according to Kekoa Taparra, MD, PhD, at Stanford University. Dr. Westley S. Mori, who is an NHPI dermatologist, suggested the lack of peers and faculty role models from similar backgrounds can be discouraging and even lead to imposter syndrome.

This may not only dispirit NHPIs from applying for medical schools but affect their school performance as well. Last year, a cohort study of 33,389 medical school matriculants found that AIAN and NHPI are more likely to withdraw or be dismissed before they complete their study than students with other racial or ethnic backgrounds.

Based on 2021 physician supply data from the AAMC, the underrepresentation of NHPI doctors is prevalent across the states. Does it get better in the states with more NHPI population? Quite the contrary. In the top 5 NHPI populated states, the physicians needed to proportionately represent NHPI are at least 3.5 times the current NHPI workforce. Based on 2020 US Census data, 27.1% of Hawaii's population was NHPI (alone or combination); meanwhile, the percentage of physicians who identified as NHPI (alone or combination) was less than 3%, indicating a lack of over 1,000 more NHPI physicians.

Despite some medical school diversity pathway programs, Dr. Taparra and her colleague found that NHPI representation has only worsened during the last decade among US Allopathic medical schools, residency programs, and faculty physicians. To reverse the trend and combat the disparities, Dr. Mori urged for more investment at all educational levels to help NHPI individuals “cultivate a desire to pursue medicine and provide them with opportunities that will make their applications to medical school competitive.”

I created the visualization using Flourish based on data from AAMC and the US Census.

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