TABLE 1. Minority Enrollment in US Medical Schools, 1980_1981*
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PEDIATRICS (ISSN 0031 4005). Copyright © 1983 by the
American Academy of Pediatrics.
* From Petersen E, Crowley A, Etzel 5, et al:
Undergrad-uate medical education. JAMA 1981;246:2913-2930.
Ponce and South Dakota did not provide information.
t First-year enrollment data exclude repeaters from
count.
Women
of Ethnic
Minorities
in Pediatrics
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OVERVIEW
Minority women physicians may be defined as
those of nonwhite racial and ethnic identification.
There is a paucity of data available on these women. Until the passage of the 1964 Civil Rights Act and the impact of affirmative action programs, reliable statistics regarding minorities were scarce.
Subsequently, a data base identifying racial/ethnic
origin as well as sex of medical students and
phy-sicians has been evolving. Many sources are
cur-rently unable to provide such information because
most applications are without racial identification.
Neither the American Board of Pediatrics (ABP)
nor the American Academy of Pediatrics (AAP) maintain data regarding racial/ethnic origin of members.
In the 1970s there was a rapid increase in
admis-sions of both women and minorities in US medical
schools. First-year enrollment in 1980-1981
in-cluded 14.1% minority men and women (Table 1). The number of minority women entering medical
school increased from 266 (2.2%) in 1971-1972 to
1,066 (6.2%) in 1981-1982 (Table 2).
In departments of pediatrics in US medical
schools in 1982, minority women represented 17%
of all faculty members. Of 201 minority women,
there were 127 Asian, 37 black, 24 Puerto Rican,
three Mexican-American, nine other Hispanic, and
one American Indian. The most significant increase
in representation has occurred in the Asian ethnic
group.
Minority populations have poorer health status
and are at higher risk with respect to accessibility,
availability, and utilization of health services. The
recruitment and training of minority physicians is important in providing culturally sensitive health care acceptable to bilingual and bicultural
minori-ties.
Most minority groups have career development
problems that may be related to their ethnic and
cultural background. Three such racial/ethnic
groups of women with significant visibility in
pe-diatrics are blacks, Asian/Pacific Islanders, and
women of Hispanic origin.
BLACK WOMEN
Prior to the mid-1960s, the main struggle of blacks in medicine was against overt racial discrim-ination in hospitals, medical schools, physicians’
offices, and throughout the planning systems for
the delivery of health care. In the North and South, blacks were denied equal access to training. Blatant exclusionary practices existed in the South, whereas in the North the process was more subtle with quota systems in medical schools (usually one per class or none). Few black physicians functioned on house staffs or attending staffs. There are no data regarding black women trained in nonsegre-gated institutions during this era.
Before the impact of affirmative action, four
in-stitutions were responsible for training the majority
of blacks in pediatrics: Freedmen’s Hospital
(How-No. %
First-year enrollmentt
Black (not of Hispanic origin) 932 5.7
Ameri#{232}an Indian or Alaskan Native 59 0.4
Mexican American 229 1.4
Puerto Rican 285 1.8
Other Hispanic 213 1.3
Asian or Pacific Islander 572 3.5
Total 2,290 14.1
Graduates
Black (not of Hispanic origin) 773 5.0
American Indian or Alaskan Native 43 0.3
Mexican American 201 1.3
Puerto Rican 223 1.4
Other Hispanic 126 0.8
Asian or Pacific Islander 414 2.7
Total 1,780 11.6
Total enrollment
Black (not of Hispanic origin) 3,719 5.8
American Indian or Alaskan Native 226 0.3
Mexican American 957 1.5
Puerto Rican 1,050 1.6
Other Hispanic 664 1.0
Asian or Pacific Islander 1,953 3.0
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TABLE 2. Enrollment in US Medical Schools: Selected Academic Years*
Category 1971-1972 1975-1976 1981-1982
Men and Women Men and Women Men and Women
Women in
Category No. %
Women in
Category No. %
Women in
Category No. %
Total first-year enrollment 12,361 1,693 13.7 15,295 3,647 23.8 17,268 5,317 30.8
First-year minority enroll- 1,280 266 20.8 1,787 585 32.7 2,933 1,066 36.3
ment
Black 882 200 22.7 1,036 376 36.3 1,196 517 43.2
Mexican American 118 10 8.5 224 46 20.5 300 91 30.3
Mainland Puerto Rican 40 6 15.0 71 24 33.8 105 46 43.8
Other Hispanic t t t 41 9 22.0 497 136 27.4
American Indian 23 8 34.8 60 21 35.0 70 19 27.1
Asian 217 42 19.4 282 86 30.5 765 257 33.6
Other minority 1 73 23 31.5 j 1
Total enrollment 43,650 4,755 10.9 55,818 11,417 20.5 66,298 18,505 27.9
Total minority enrollment 3,072 583 19.0 5,928 1,739 29.3 9,724 3,522 36.2
Black 2,055 420 20.4 3,456 1,147 33.5 3,884 1,718 42.2
Mexican American 252 24 9.5 699 129 18.5 1,040 293 28.2
Mainland Puerto Rican 76 13 17.1 197 51 25.9 350 139 39.7
Other Hispanic t t t 144 35 24.3 1,703 522 30.7
American Indian 42 10 23.8 172 45 26.2 229 63 27.5
Asian 647 116 17.9 1,022 256 25.0 2,518 787 31.3
Other minority 1 238 66 27.7 1 t
* From Women Enrollment and Its Minority Componentin US Medical Schools.J Med Educ 1976;51:691-693;
1979-80 Enrollment in US Medical Schools. J Med Educ 1980;55:1042-1044 and Minorities and Women in the Health
Fields. DHEW Publication No. (HRA) 79-22. October 1978 US Medical School Enrollments for 1981-82. AAMC, Dec
1, 1981.
t This category not used in 1971 to 1972.
:1:
This category not used in 1971 to 1972 or 1979 to 1980.ard University), Hubbard Hospital (Meharry Med-ical College), Harlem Hospital (City Hospital, New York City), and Homer G. Phillips Hospital (City Hospital, St Louis).
The Pediatric Service of Freedmen’s Hospital has had an accredited residency training program since 1935. From the inception of this program until
1970, 18 black women completed the program and
seven were subsequently certified by the American Board of Pediatrics (ABP).
The pediatric residency program at Meharry has been accredited since 1948. From 1948 to 1978, 28 women were trained in this center and 22 of this number were black; eight of these 22 women have been certified by the ABP. It is noteworthy that of the early female trainees in the program, 5/6 were certified by the ABP, whereas in subsequent years, women in training either elected not to take the
examination or were unsuccessful.
By 1951, a total of 13 black pediatricians were certified by the American Board of Pediatrics, in-cluding Dr Margaret Lawerence who was the first black female pediatrician certified, after receiving her training at Babies Hospital in New York.
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In 1980 there were 3,000 black physicians on dutyas residents in the United States. Ofthese, 341 were in pediatrics and two were in pediatric cardiology.
The number of women in this group is not identified
(Table 3).
The minority professional woman’s life is further
complicated because she is viewed as a double sta-tistic, being female and belonging to a racial mi-nority. So much emphasis may be placed on race
and sex that the individual’s personal qualifications and capabilities become overshadowed. This adds additional pressure to prove competence.
There is no evidence that there has been any significant change in the black membership of the
American Academy of Pediatrics for the past 10
years, which is estimated at approximately one tenth of one percent of the total membership. (No specific effort has been made to ascertain the
per-centage of black [or white] women who hold the fellowship.) During the past decade, black women have become more visible in the AAP at the chapter and national levels. In 1969, the first black woman was appointed to a national committee, the Com-mittee on Adolescence. Subsequently, eight black
women have been appointed to national
commit-tees: Adolescence (three), Community Health Serv-ices (two), Adoption (two), Infant and Preschool
Child (one). One black woman served on the Task
Force on Pediatric Education, two have been
1978 4 65 2 24 2 317 631 32 21 8 390 66 88 44 56 0 1 2 274 3 3 7
cannot be understood without historical reference to their immigration. According to Lott and Pian,4
1979 1980 the most notable aspect of this history is the dearth
4 4 of these women in the United States until the
79 97 middle of this century, due to restrictive US
immi-0 2 gration policies.
3g
4 Concomitant with the civil rights movement, the283 280 amendment of the 1952 Immigration and
Nation-772 752 ality Act abolished the national origin quota
sys-26 39 tern, which had restricted immigration from Asia
21 27 and the Pacific Islands.5 The first wave of
immi-363 385 grants in the United States was uniquely
handi-54 48 capped because the majority had no American
par-81 94 ents, having entered this country in the last 15
44 38 years. As new arrivals, they had to overcome
lan-95 74 guage and cultural barriers in addition to coping
?
with the differential treatment related to minority0 4 status. Coming from a cultural heritage in which
386 341 the concept of civil rights is foreign and female
3 0 assertiveness unheard of, these women are severely
8 2 hampered as they compete for equality. Moreover,
14 13 the majority of these women physicians are
gradu-10 13 11 ates of foreign medical schools (FMGs).5’6
Although Asian and Pacific Americans are
rela-tively well represented in medical school admissions
and applicant poois (Tables 1 and 2), they have fared less well than others in medical school ad-ceptance rates. If so, this may imply that a higher
proportion of this population group prepares for and applies for graduate training. It is also possible
that Asian and Pacific applicants to US medical schools may have faced more stringent and even unfair selection.
As of September 1981, there were 827 Asian and
Pacific Islanders in US pediatric residency training
programs; 524 (60%) were women. Women of this minority group comprised 19% of all women pedia-tric residents, of whom 90% were FMGs. These data indicate the extent to which Asian and Pacific women physicians favor pediatrics as a specialty.
Data suggest that Asian and Pacific women have made strides toward the achievement of equal op-portunities in medical academia (Tables 4 and 5). Although they are well represented numerically,
they need better education to qualify for the same job, and comparatively fewer find opportunities in
the higher ranks of medical academia.7
In summary, Asian and Pacific women in the
United States face many unique problems that limit
their opportunities for equality. These include their disproportionate representation by recent
immi-grants and FMGs, their need to overcome the
ster-eotypes, extreme heterogeneity, and their percep-tion by some as being forever foreign. In exploring the opportunities for these women in pediatrics,
these obstacles should be kept in mind. The
signif-icant number of Asian and Pacific women among
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Asian and Pacific women in the United Statesshare with other women and minorities many corn-mon barriers to full participation in American
so-ciety. Sometimes labeled the “model minority,” this
group is erroneously presumed by some to have succeeded in the majority society through hard work and self-reliance, to have fewer problems and
therefore little need for inclusion in affirmative action programs and other special considerations accorded to minorities.’’
The status of Asian and Pacific women in the
United States and their opportunities in pediatrics
TABLE 3. Number of Black Residents on Duty Sept 1, 1978, 1979, and 1980, by Specialty
Allergy and immunology Anesthesiology
Colon and rectal surgery Dermatology Dermatopathology Family practice Internal medicine Neurological surgery Neurology Nuclear medicine Obstetrics-gynecology Ophthalmology Orthopedic surgery Otolaryngology Pathology Blood banking Forensic pathology Neuropathology Pediatrics Pediatric allergy Pediatric cardiology
Physical medicine and rehabili-tation
Plastic surgery Preventive medicine
General 6 5 11
Aerospace medicine 1 1 1
Occupational medicine 4 4 7
Public health 1 3 5
Psychiatry 169 161 197
Childpsychiatry 19 20 12
Radiology, diagnostic 87 61 90
Radiology, diagnostic (nuclear) 1 1 2
Radiology, therapeutic 12 9 4
Surgery 385 342 333
Pediatric surgery 2 2 1
Thoracic surgery 13 10 10
Urology 43 42 60
Total 2,793 2,944 3,000
* From Crowley AE: Graduate medical education in the
United States. JAMA 1981;246:2938-2944.
or are Alternate District Chairmen. A number of these same individuals have been or are active in chapter and specialty sections, serving as officers and on executive committees.
Sex Racial/Ethnic Origin Total Minority Total Faculty .
Amen- Black Asian. Mexican. Puerto Other White.
can Amen- Rican Hispanic
Indian can
Male 0 36 171 7 28 49 2,470 291 (9.7%) 2,987
Female 1 37 127 3 24 9 920 201 (17%) 1,175
Total 1 73 298 10 52 58 3,390 492 (11.8%) 4,162
* From Higgins EJ, Jolly HP: Participation of Women and Minorities on US Medical School Faculties. Washington
DC, Association of American Medical Colleges, July 1982.
TABLE 5. Distribution of Minority Females on US Medical School Faculties, by Year of First Appointment, All
Schools, All Faculties*
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1951-1960 1961-1965 1966-1970 1971-1975 1976-1981
Female minority
American Indian 1 0 0 0 6
Asian 23 36 71 219 364
Black 11 20 38 69 96
Mexican American 0 3 2 3 7
Puerto Rican 11 12 11 19 37
Other Hispanic 0 9 16 38 34
Female white 449 486 895 1,529 2,350
Unknown 8 8 28 92 224
Total female 503 574 1,061 1,969 3,118
Total faculty (male and female) 4,881 4,727 7,304 11,122 15,233
Female faculty 10.3% 12.1% 14.5% 17.7% 20.4%
Minority female faculty 0.9% 1.6% 1.8% 3.4% 3.5%
Minority female in female faculty 9.1% 13.9% 13.0% 19.6% 17.4%
* From Higgins EJ, Jolly HP: Participation of Women and Minorities on US Medical School Faculties. Washington,
DC, Association of American Medical Colleges, July 1982.
WOMEN OF HISPANIC ORIGIN
TABLE 4. Distribution of US Medical School Faculty in Pediatrics Departments, 1982*
recent US medical school applicants should be viewed against their poor acceptance rate relative to numbers of admissions and the possibility of a policy of unequal admission selection practices. In medical academia, this minority is well represented numerically, but poorly distributed in the higher echelons of faculty. Although there are no statistics on the status of these women in leadership and policy-making positions in medicine or pediatrics, there is some evidence that they are
under-repre-sented in such highly selective positions.’3
There is a paucity of data regarding the role of women pediatricians of Hispanic origin in this country. In developing a data base it is important to have a uniform definition of Hispanics. The definition of Hispanics used here will be that of the Bureau of Census: Hispanic, a person of Mexican, Puerto Rican, Central, South American, or other Spanish origin regardless of race.8
Women of Hispanic origin, representing approx-imately 6% of US women, tend to be younger, poorer, and less educated than nonHispanic
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women. Therefore, it is not surprising that thesewomen are under-represented in medicine.
The total medical school enrollment for all
mi-norities in the United States has increased to 13.3%
of the first year class, 1980-1981 (Table 1). The percentage of enrollment of Hispanic students in the first year in US medical schools has increased to 4.1% in 1980 (Table 1). At the same time the total enrollment of women in medical school in-creased from 9.6% in 1970-1971 to 26.5% in
1980-1981. In 1971-1972 women of Hispanic origin
corn-prised 0.77% of US women medical students; but
by 1977-1978 they comprised 5.02% of all women accepted in first year classes in US medical
schools.’#{176}
On Sept 1, 1979, ofa total 56,055 residents in the
United States, 4.1% were ofHispanic origin.” How-ever, the number of women in this group is not known.
The distribution by sex and ethnicity of all med-ical school faculty members showed that all persons of Hispanic origin made up 2.2% of the total in
1975 and 1.9% of the total in 1978. Women of
Hispanic origin made up 2.3% of the female faculty in 1975 and 2.3% in 1978. In the clinical depart-ments women faculty members are primarily in physical medicine (19.9%), pediatrics (27.2%), and
psychiatry (19.9%).12
In 1981, eight women physicians were chairing
departments of pediatrics in US medical schools.
from Puerto Rico.’3 Of 59 faculty members in the Department of Pediatrics of the University of Puerto Rico School of Medicine, 44.7% are women (personal communication, 1981).
As the Hispanic population increases in the
United States, there is a need to increase the
num-bers of women of Hispanic origin in medicine so
that they can provide culturally sensitive health care to this population. A program should be de-signed for the active orientation of high school and college students to the opportunities available in the field of medicine. This would assist in the recruitment of more medical students of Hispanic
origin, both male and female. The orientation
should be done by professionals of Hispanic origin who are practicing their profession.
In summary, few data are available on the role of women of Hispanic origin in the field of medicine in the United States. Despite the fact that US women of Hispanic origin are younger, poorer, and
less educated than non-Hispanic women, there has
been an increase in the percentage of women of Hispanic origin enrolled in US medical schools. In
1977-1978, they made up 5.02% of all women
ad-cepted in the first year classes. In 1978, women of Hispanic origin represented 2.3% of female faculty in medical schools.
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REFERENCES
1. Success of Asian Americans: Fact or Fiction. Washington, DC, US Commission on Civil Rights. Clearinghouse Publi-cation No. 64, September 1980
2. Chun KT: The Myth of Asian American Success and Its
Educational Ramifications. IRCD Bulletin, Vol XV, Nos. 1 and 2, Winter/Spring 1980, Teachers College, Columbia University, New York
3. Civil Rights Issues of Asian and Pacific Americans: Myths
and Realities. Consultation sponsored by the United States
Commission on Civil Rights, May 8-9, 1979. Washington, DC, Government Printing Office, 1980, pp 624-856 4. Lott JT, Pian C: Beyond Stereotypes and Statistics:
Ernerg-ence of Asian and Pacific American Women. Washington, DC, Organization of Pan Asian American Women, 1979 5. Crowley AE: Graduate medical education in the United
States. JAMA 1980;246:2938-2944
6. Goldblatt A, Goldblatt PB: The status of women physicians:
A comparison of USMG women, USMG men and FMGs.
JAMA 1976;31:325-328
7. Higgins EJ: Comparison of Characteristics of US Medical School Salaried Faculty in the Past Decade 1968-1978.
Washington, DC, Association of American Medical Colleges, October 1979.
8. Bureau of Census: Circular NOA-46, revision of circular No. A-26 exhibit F: Race and Ethnic Standards for Federal Statistics and Administrative Reporting. Washington, DC, Office of Management and Budget, Executive Office of the President, May 12, 1977
9. Petersen E, Crowley A, Etzel 5, et al: Undergraduate medical
education. JAMA 1981;246:2913-2930
10. Gordon TL: Study of US Medical School Applicants 1977-78 (Table 8: Self Description and Sex of Applicants and Acceptees to US Medical School, 1977-78, First Year Class) J Med Educ 1979;9:677-702
11. US DHHS: Type ofEnrollment and Graduates for Specified Minority Groups in US Medical Schools: Academic Years 1974-75 through 1977-78 (Table 88) in Health of the
Dis-advantaged, DHHS Publication No. (HRA) 80-633. Public Health Service: Health Resources Administration: Office of Health Resources Opportunities, September 1980
12. Philport P: Number of Employed Physicians (MD and DO) in the US by State and Racial Ethnic Category, April 1, 1970: Minorities and Women in the Health Fields (Table
15). US DHHS PHSRA, August 1979, p 24
