In Hawaii, McDonald’s serves spam for breakfast. It’s a menu item that would raise eyebrows anywhere else, but not in Hawaii, where state consumption of Spam is higher than anywhere else in the United States. The McDonald’s Spam breakfast meals have been so successful that competitors like Burger King have added Spam to their local menus as well.1 The net result is beneficial all around: Hawaii residents can enjoy a beloved food, and fast-food chains can enjoy the financial benefits of that love.
This mutually beneficial situation wouldn’t have happened without the knowledge and advice of Hawaii residents. Without their insight into Spam, McDonald’s would not have been able to identify this potential market. Hawaii, McDonald’s and Spam is a key example in how including differing perspectives is good for your bottom line—one of hundreds of examples proving that, when companies diversify their products and staffing, financial benefits follows.
The diversity bonus
A 2015 study by McKinsey & Company found that, when companies are gender-diverse, they are 15% more likely to outperform competitors. When a company is ethnically diverse, they are 30% to 35% more likely to outperform.2 Diverse workforces, the study’s authors hypothesize, are better at talent acquisition, customer service and flexible decision-making, factors that all lead to greater financial reward.
The impact of diversity on finances makes perfect sense when you think of the workforce like a toolbox: Every tool has a purpose and design that makes it optimal for certain jobs. If your toolbox is full of only Phillip’s head screwdrivers, you’ll never be able to work with a flat head screw.
Google has tailored its hiring practices with this impact in mind. Instead of hiring from the same top schools, Google hires from across the country, looking at different curricula to ensure a broad set of knowledge.3 Pulling staff from the same demographics, the same schools and the same programs will result in a homogeneous workforce. The same holds true in medicine: If our doctors come from the same programs, they will all have the same education. For example, a major hospital may find itself with IRs skilled at interventional oncology but with no practical knowledge of musculoskeletal interventions. Because we currently have a racially homogeneous workforce, we have one that doesn’t employ the full set of skills, experiences and perspectives needed for a full toolbox.
Benefits to the patient
A diverse workforce will result in better service. Both studies and personal experience show that patients react better to doctors of their own gender and ethnicity and go so far as to seek out doctors of their own race.4 This is a powerful metric in favor of a more diverse workforce. Patients feel more comfortable and feel more seen, perhaps because they trust physicians from similar backgrounds to better understand their concerns and to not fall into bias.
One key example to consider is the bias Black patients face regarding pain management. Despite there being no biological evidence, there is still a pervasive belief that Black patients have “thicker skin” and so are perceived to not feel pain as severely as white patients. A 2016 study at the University of Virginia found that a significant portion of the white medical student body held incorrect assumptions about the physiology of Black patients, such has having thicker skin or blood that coagulates more quickly.5 Those kinds of misconceptions can lead to patients with undercontrolled pain, or with pain not considered in their treatment plans, resulting in diminished care and a corresponding diminished trust in the system.6 A Black doctor is far less likely to hold this misconception and, in fact, is more likely to take extra consideration in pain management for their patients.
Compassion, understanding and first-hand experience are crucial to providing better patient care. You don’t need a broken arm to know how to treat a broken arm, but you do need to understand what to provide the patient to heal them and make them comfortable. It’s the same with race or gender—a doctor doesn’t have to have a uterus to effectively treat uterine fibroids, but having a uterus helps the doctor understand the degree of pain and discomfort their patient is experiencing. That doesn’t mean everyone must only treat patients who look identical to them—but physicians should have colleagues who can relate to their patients, who they can turn to for advice. These considerations result in better patient satisfaction, which leads to the patient being willing to trust and engage with the health care system again in the future.
Getting patients into the pipeline
Diversity is also a financial asset when it comes to finding patients. It’s not uncommon for physicians to go into local communities to speak about disease states such as uterine fibroids. But the doctor may not be able to relate to the community and their specific needs, and then, after their presentation, are never seen by community members again. It can create the effect of the physician as a sales rep, popping into the community temporarily to sell their wares before disappearing.
When healthcare systems employ physicians with existing ties to these communities, that dynamic changes. The physician can then visit and understand acutely the issues facing the community—be it disease states the community is vulnerable to, like fibroids or vascular disease, or systemic issues, like lack of access to care or to unbiased doctors. The physician doesn’t disappear at the end of their pitch because they are part of the community. Community members are more likely to trust them and be willing to listen to their presentations and book appointments or spread the word to friends and family. And that physician will come with their own medical community as well—a wide circle of peer specialists who they can recommend to their new patients. As a result, one physician from one community can bring multiple new patients into the healthcare pipeline.
The path to diverse hiring practices
Within IR, committing to diverse hiring practices has its own barriers. In order to have a pool of excellent, diverse candidates, we first have to ensure that there is a pathway open to underrepresented minorities. That requires reaching out on every level—not just to college students but to high school students and even younger—to show them that they have a place in medicine and teach them what an impact they can have. Most of those students probably won’t go into IR…but a rising tide lifts all ships.
We also must increase access to care—and ensure that once patients are in our pipelines, they are getting the best care possible—one free of biases and misconceptions. Any doctor of any race or culture can do this by dedicating themselves to learning their own biases, adjusting their perceptions and understanding that, especially in a clinical setting, race is not a genetically defined factor.7 It’s a culturally defined one.
Change is slow and at times scary, but the truth is that equitable hiring practices benefit everyone, from the patients to the staff and other stakeholders. It is a moral decision, but it’s also a fiscally sound one.
For additional reading on the benefits of diverse hiring practices, the authors recommend The Diversity Bonus by Scott E. Page.
References:
- Song J. Burger King fighting Spam war with McDonald’s in Hawaii. Seattle Times. June 11, 2007.
- Hunt V, Layton D, Prince S. Why diversity matters. McKinsey & Company. Jan. 1, 2015.
- 2021 Diversity annual report. Google.
- Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff (Millwood). 2000 Jul-Aug;19(4):76–
- Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment. PNAS. 2016(16);4296–4301.
- Torres N. Research: Having a Black doctor led Black men to receive more effective care. Harvard Business Review.
- Chadha N, Lim B, Kane M, Rowland B. Toward the abolition of biological race in medicine: Transforming clinical education, research, and practice. The Institute for Healing and Justin in Medicine and The Othering & Belonging Institute. May 2020.
