The U.S. is becoming increasingly diverse, and minority populations are predicted to become a majority in 2040. However, numbers of medical school graduates from ethnic and racial minority groups remain disproportionately low, and the numbers of medical students from specific groups (particularly black male applicants and matriculants) have declined since 1978.

There are clear benefits for having an ethnically diverse medical workforce, including increased patient satisfaction, perceived quality of care, adherence to medication regimens, and more. The benefits also exist in the medical research field, including greater improvements in problem-solving and publications with greater impact on the scientific community. However, despite these clear benefits, significant disparities still exist.

Physicians from Underrepresented in Medicine (URiM) groups remain underrepresented at all levels of academic medicine, are promoted at lower rates, receive less funding for research and both faculty and trainees report feelings of isolation and lower career satisfaction.

Mentorship is one proposed mechanism to address disparities for URiM physicians and trainees and has been associated with increased career satisfaction, research productivity, and preparedness for junior faculty. Unfortunately, URiM physicians are less likely to have mentors both as trainees and as faculty. Institutional focus on improving diversity by supporting mentoring programs is vital to increase representation and retention of a diverse mentor population.

Identifying and Creating Opportunities for Mentorship for URiM

Institutions have tried to increase diversity in mentoring for several decades. The dyadic model of mentorship, used almost exclusively prior to 2000, is limited because of the limited availability of URiM mentors. To overcome this limitation, different and creative models of mentorship have started to emerge since:

• Peer or horizontal mentorship model, in which individuals of the same rank or experience mentor each other.
• Group model of mentorship, which includes groups of multiple senior mentors and multiple junior mentees.
• Mixed models: dyadic model in combination with a peer model.
• Peer-Onsite-Distance model: which featured peer mentors who were close to the mentee in rank; senior faculty as on-site mentors to serve as advocates, liaisons, or coaches; and distance mentors who are leaders in healthcare, business, academia, or political settings.
• Cascading mentorship model: multiple senior faculty members were each paired with multiple medical students, who in turn, mentored two or three undergraduate university students, who then mentored a group of five high school students.
• Mosaic model: aimed to increase the sex and racial/ethnic diversity of researchers in aging (a “community of mentors” scheme, operationalized through a three-tier system that gave faculty basic logistical information, and skills appropriate to their developmental needs, and conducted institutional initiatives to enable committed professional relationships).

Goals and Benefits

Mentoring URiM programs can serve multiple purposes, from the usual development of specific career goals to URiM-specific goals:

• Improvement and retention of minority trainees/faculty, leading to increased representation.
• Develop leadership skills and opportunities.
• Develop specific skills: teaching, clinical skills, cultural competence, research skills.
• Train mentors.
• Emotional support by enhancing socialization and networking.
• Orientation of junior faculty to institutional and departmental culture.

Barriers to Finding Mentorship for Ethnically Diverse and URiM Psychiatrists

• Limited number of ethnically diverse URiM mentors: This results in disparities across career span (see Minority Tax below) and highlights the need to address mentoring throughout the career span. Allies and non-URiM mentors can help by becoming culturally competent mentors.
• Minority Tax: The inequities faced by URiM faculty (responsibility for achieving diversity efforts, racism, isolation, mentorship, clinical, and promotion inequities) make it very difficult for them to remain and advance in academic medicine. It is also a regressive disparity—URMM faculty that have “extra” responsibilities are more likely to be found in the lowest paying ranks.
• Intrinsic logistical issues: mentor matching, including pairing mentors or role models from similar gender and cultural or racial backgrounds whenever possible, mentors skills and communication.

Facilitators of Mentoring URiM

• Support from senior members of the department and institutional leadership. Having institutional support, including a greater mission for diversity, is essential for mentoring program success.
• Financial resources for salary parity for URiM faculty.
• Assistance in mentoring and sponsoring URiM faculty to assume leadership.
• Training of mentors through workshops or written materials.
• Optimizing the relationship with Majority Group mentors by fostering cultural competency and humility and developing a shared narrative about mentorship.

How to Mentor for Culturally Diverse and URiM Psychiatrists

• Institutions should value diversity effort fairly:
  • Recognize that the URiM responsibility disparity exists and adjust assignment of responsibilities accordingly.
  • Work to ensure that clinical and community endeavors are counted toward promotion.
  • Assign promotion value to work in the area of diversity.
  • Fund stated institutional diversity commitments.
  • Establish formal mentoring programs.
• Develop positive curiosity when encountering “otherness” and recognize differences in faculty and trainees as benefitting all in the community.
• Seek training in unconscious bias to help recognize its role in discrimination.
• Ensure clear, frank, honest communication, especially when recognizing mentee effort and goal-achievement to avoid mentee discouragement.
• Develop opportunities for explicit conversations about personal values to amplify the meaning mentors find in the practice of medicine and in their careers.
• Understand the prevalence and acceptance of unconscious bias. Mentors need to use their visibility as non-URiM faculty to educate peers and teach acceptable institution specific behaviors to address silent racism.
• Practice cultural humility: ask about micro-aggressions and stereotype threat and find acceptable institution specific behaviors to deal with those (reporting, encouraging training).
• Help develop and implement organizational culture-change activities in medical schools involving broad participation to provide the experience (for faculty and leadership) of learning and collaborating in an inclusive and humanistic culture.^25,26

Organizations for Culturally and Ethnically Diverse, URiM, and LGBTQ+ Physicians

• Building the Next Generation of Academic Physicians (BNGAP): Our mission is to help diverse medical students and residents become aware of academic medicine as a career option and to provide them with the resources to further explore and potentially embark on an academic medicine career.
• Asian Pacific American Medical Student Association (APAMSA): The Asian Pacific American Medical Students Association (APAMSA) is a national organization of medical and pre-medical students committed to addressing the unique health challenges of Asian and Pacific Islander American (APIA) communities. APAMSA serves as a forum for student leaders to engage these health issues and develop initiatives and projects addressing those needs. APAMSA provides an important venue for medical students to meeting, exchange experiences, and develop personally and professionally through leadership and service.
• National Council of Asian Pacific Islander Physicians (NCAPIP): NCAPIP is a national organization of Asian American, Native Hawaiian and Pacific Islander (AANHPI) physicians that advocate for the health and well-being of our patients and communities. NCAPIP board members are comprised of leaders in national, state and local physician organizations and medical groups.
• Association of Native American Medical Students (ANAMS): The Association of Native American Medical Students (ANAMS) is a student organization representing Native American graduate health professions students throughout the U.S. and Canada. The goals of ANAMS include providing support and a resource network for all Native Americans currently enrolled in various allied health professions schools.
• Association of American Indian Physicians (AAIP): The Association of American Indian Physicians (AAIP) was founded in 1971 as an educational, scientific, and charitable non-profit corporation. A group of 14 American Indian and Alaska Native physicians sought to d services to.
• AAMC Group on Diversity and Inclusion (GDI): The Group on Diversity and Inclusion (GDI) supports the efforts of AAMC-member institutions and academic medicine to realize the benefits of diversity and inclusion in medicine and biomedical sciences. It offers various webinars.
• Latino Medical Student Association (LMSA): The Latino Medical Student Association unites and empowers medical students through service, mentorship, and education to advocate for the health of the Latino community.
• National Hispanic Medical Association (NHMA): The mission of the organization is to empower Hispanic physicians to lead efforts to improve the health of Hispanic and other underserved populations in collaboration with Hispanic state medical societies, residents, and medical students, and other public and private sector partners.
• Student National Medical Association (SNMA): Student National Medical Association (SNMA) is committed to supporting current and future underrepresented minority medical students, addressing the needs of underserved communities, and increasing the number of clinically excellent, culturally competent and socially conscious physicians.
• National Medical Association (NMA): The NMA promotes the collective interests of physicians and patients of African descent. We carry out this mission by serving as the collective voice of physicians of African descent and a leading force for parity in medicine, elimination of health disparities and promotion of optimal health.
• Medical Student Pride Alliance: The Medical Student Pride Alliance (MSPA) is an activist and social organization committed to empowering sexual and gender minority medical students.
• GLMA Health Professionals Advancing LGBTQ Equality: GLMA is a national organization committed to ensuring health equity for lesbian, gay, bisexual, transgender, queer (LGBTQ) and all sexual and gender minority (SGM) individuals, and equality for LGBTQ/SGM health professionals in their work and learning environments. To achieve this mission, GLMA utilizes the scientific expertise of its diverse multidisciplinary membership to inform and drive advocacy, education, and research.
• American Medical Women’s Association (AMWA): The American Medical Women’s Association is an organization which functions at the local, national, and international level to advance women in medicine and improve women’s health. We achieve this by providing and developing leadership, advocacy, education, expertise, mentoring, and.
• Black Psychiatrists of America, Inc.: The Black Psychiatrists of America (BPA) was created in 1969. The struggles, social conditions of Black Americans, professional experiences, and the barriers faced by Black psychiatrists provided the thrust for its creation. Today, we serve as expert clinicians, supporters, and educators for mental health. Join us to network with other psychiatrists across the diaspora. We work together to eliminate racial, ethnic, religious, and gender bias and discrimination as well as prejudicial practices. We must go back to our roots in order to move forward and fight stigma. The BPA embraces all of this and more.

References

• Bonifacino E, Ufomata EO, Farkas AH, Turner R, Corbelli JA. Mentorship of Underrepresented Physicians and Trainees in Academic Medicine: a Systematic Review. J Gen Intern Med. 2021 Apr;36(4):1023-1034. doi: 10.1007/s11606-020-06478-7. Epub 2021 Feb 2. PMID: 33532959; PMCID: PMC7852467.
• Rodríguez, José E, Kendall M Campbell, and Linda H Pololi. “Addressing Disparities in Academic Medicine: What of the Minority Tax?” BMC medical education 15.1 (2015): 6–6. Web.