Diversified clinical workforce needed to effectively serve a growing Hispanic population in underserved areas: Study

A new study examining the impact of the 2009 National Health Service Corps (NHSC) expansion on clinical diversity has found the number of Hispanic NHSC clinicians lacking relative to the Hispanic population.

The study, Racial and Ethnic Concordance Between National Health Service Corps Clinicians and the Underserved Populations," was led by investigators at the Harvard Pilgrim Health Care Institute and appears in the March 20, 2024 edition of JAMA Network Open.

Health workforce shortages pose a challenge for underserved areas within the U.S. health care system. An additional challenge is providing racially and ethnically concordant care, which has been shown to improve patient care and health outcomes, in addition to reducing health expenditures. The National Health Service Corps (NHSC) program aims to address health professional shortages by providing loan repayment and scholarships to clinicians who commit to working in Health Professional Shortage Areas.

"The importance of racial and ethnic concordance between patients and clinicians has been widely recognized," said Olesya Baker, a research scientist at the Harvard Pilgrim Health Care Institute, and lead author of the study. "We wanted to get a better idea of how—or even whether—this program, which has the potential to greatly diversify the health care workforce, has been able to meet the needs of a changing patient population."

The study team found that the average annual number of NHSC clinicians increased from 3,357 in 2003–2008 to 9,592 in 2009–2019. Prior to the program's expansion, 41.6% of clinicians identified as white, 5.3% as Black, 4.5% as other and 48.6% as Hispanic. Concordance was low among non-Hispanic white and Black individuals due to clinician underrepresentation relative to the population, yet Hispanic clinicians were overrepresented.

After the expansion, the proportion of Hispanic clinicians declined to 13%, while concordance was achieved for non-Hispanic white and Black individuals. This was the case across three specialties—Primary Care, Mental Health Care, and Dental Care.

"Given the projected growth of the Hispanic population in the U.S., we suggest the NHSC consider recruitment efforts targeted at improving concordance for Hispanic individuals in underserved areas," says Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute, and senior author of the study.

"Future research into deeper dimensions of ethnic concordance, such as language proficiency, cultural competence, and shared experiences could help enhance recruitment efforts and maximize patient health outcomes."