Addressing the Need for Ethnic and Racial Diversity in the Pipeline for Pharmacy Faculty

DISCUSSION

In comparison to the increases in percentages of URMs reflected in the US Census, representation of Black (5.0%) and Hispanic (3.2%) pharmacy faculty is woefully inadequate and has not changed despite 20 years of initiatives dedicated to changing this. The pipeline to a practice faculty position is traditionally viewed as a residency or fellowship-trained PharmD graduate. Pharmaceutical, social, and administrative science faculty are typically recruited from among science, technology, engineering, and math (STEM) graduates. Clearly, based on the findings from our analyses, the candidates delivered via the current pipeline will not increase the number of underrepresented faculty at a consistent enough rate to meet population demographics. Several strategies to address issues in the pipeline are presented below and in Table 4.

Residency programs tend to be the pipeline that delivers clinical pharmacy practice faculty candidates. Pharmacy residency programs accredited by ASHP do not report the race/ethnicity of applicants or individuals who match with and complete residency programs. In 2000, the Final Report of the Ad Hoc Committee on Affirmative Action and Diversity for AACP recommended to the Board of Directors that the ASHP, the American Pharmacist Association (APhA), and the National Pharmaceutical Association (NPhA) combine their efforts to recruit minority students into fellowships and residencies. They should also establish a system to track the number of minority students in such programs if one does not exist, yet 20 years later, this has not been done.¹⁴ The lack of such data hides the resulting realities but not the consequences.

Students at HBCUs, which generate the largest percentage of Black graduates, have much lower residency match rates. This troubling disparity seems indicative of a glass ceiling, which further narrows the path to obtaining a faculty position. Residency programs should examine and report racial and ethnic composition, while making intentional efforts to increase numbers of URM residents. Faculty hiring criteria should be modified to include other factors such as years of experience or demonstrated expertise in an area, particularly as competition for residency positions increases. Diversity among residency program directors (RPDs) and fellowship and pharmacy preceptors is likewise crucial.

The ACPE has no accreditation standards related to broadening diversity among students. In 2020, Campbell and colleagues reported that racial disproportionalities still exist between pharmacy students and the population of patients surrounding the pharmacy programs themselves.¹⁵ A review of pharmacy programs by accreditation status posted by ACPE echoes the Flexner Report of 1910, which closed Black medical schools.¹⁶ In 2020, one HBCU lost accreditation and one Predominantly Black Institution (PBI) was placed on probation because of issues with student progression.¹¹ The HBCUs and PBIs educate 21% of the Black pharmacy student population. Thus, failure of any of these institutions results in a major loss to the Academy as they are a major source of Black pharmacists and Black faculty.

Research outside of pharmacy provides potential solutions. When examining motivators of biomedical science PhD graduates to pursue faculty careers, researchers found that personal values played a key role.¹⁷ Motivators of non-URM biomedical scientists included academic freedom, while motivators for women and URM scientists included to research health problems facing their community. URM faculty placed a high value on impacting students through mentorship.¹⁷ In addition, diversity, equity, and inclusion initiatives are left for the URMs to do. If such aspects are not valued by promotion and tenure committees, then this type of work is marginalized, and represents a barrier for URM faculty retention.¹⁸

When federal funding and dissemination of research in peer-reviewed journals are used as benchmarks for promotion, bias is already built into the system. Reviews of NIH R01 funding found that Black applicants were less likely to receive funding.¹⁹ To address this barrier, criteria used in faculty promotion should be as free from bias as possible and should be revised to reflect this reality. Ginter and colleagues found that faculty who worked at the 30 most highly funded NIH institutions had a higher probability of receiving funding regardless of their ethnic identity.¹⁹ Given the fact that Blacks receive less NIH funding moving to institutions focused on such funding might be a barrier. This may explain the low number of URM faculty in the top-ranked research pharmacy programs. In addition, female URMs face additional barriers related to the marginalization of their scholarship, negative student interactions and evaluations, and higher service loads.²⁰ These structural biases must be acknowledged and fundamentally dismantled to see any progress in increasing the number of underrepresented faculty at these institutions.

Another strategy used to direct attention to diversity includes addressing diversity and inclusion in the mission and vision statements of schools and colleges.²¹ While this is a necessary first step, institutions must go further. A recent report on the use of strategic planning for faculty diversity in medicine found no relationship between having a strategic plan for increasing diversity and an actual increase in the proportion of full-time faculty members who were URMs from 1998-2015.²²

Our analyses suggest that there are other factors to consider if we want to expand the pipeline of URM faculty candidates. The commitment to increasing the representation of Blacks and Hispanics in pharmacy programs must be agreed upon by all faculty in a program. Leadership for this goal must come from senior faculty members and must be fully supported by them in tangible ways.²³ Recognize that the motivations for young URM scientists and health care students to pursue a faculty career may be different from those of non-URM students and even that of their mentors.¹⁷ Showing how these values can be achieved in a faculty career is important to attract URM pharmacy graduates to the Academy. Rather than trying to mold URMs to fit into a system that was not developed with them in mind, programs need to develop environments that are flexible, welcoming, and open to new ways of thinking and new ways of rewarding faculty efforts.

The competitive nature of professional training programs can be very unattractive to prospective students who want to contribute to health care by serving society. Competition is in direct opposition to this goal. The dominant culture in the United States can be categorized as a zero-sum game, one of winners and losers. Non-URM pharmacy faculty must learn new ways of thinking by valuing what URM colleagues have to offer. Medical, dental, and pharmacy academies must seriously rethink the criteria used to recruit and admit students to health care training pipeline programs and to promote and retain URM faculty. Pipeline programs such as schools and colleges of pharmacy must value a diverse faculty and student population for the purposes of integration and learning (new ideas, different ways of thinking, challenges to the status quo) rather than for marketing purposes (attracting more students) or to feel good about their policies (doing the right thing).²⁴ The Academy must examine all aspects of its organization (power differentials, implicit and explicit bias, etc) to determine whether the working environment in pharmacy pipeline programs is hostile, demotivating, and/or unattractive. Future research is needed to investigate the experiences of URM students and faculty within schools and colleges of pharmacy.

The findings of this study were limited by the availability of data. To overcome this limitation, we used data from a variety of sources that provided data on and/or insight into the current realities of pharmacy education. The effects of the COVID-19 pandemic on higher education are unclear and have the potential to make the goal of diversifying faculty even harder to achieve. It also has the potential to create incentives to address the dream of living in a just society. Finally, backlash to the implementation of any of the actions discussed here must be anticipated because any solution which threatens the current status quo is subject to charges of bias. It is the authors’ contention that framing solutions as actions that will benefit one group at the expense of another misses the point and goes nowhere in targeting the underlying problems the Academy is trying to redress.²⁵