Where We Stand
Section: Workforce Issues
Policy: Equity Task Force Recommendations
Equity Task Force Recommendations
The Equity Task Force recommends:
A. That the OMA adopt the Equity Task Force Principles related to equity and inclusion in the medical profession.
- The OMA is committed to improving diversity, equity, and inclusion within the medical community and to being an antiracist organization.
- Patient care benefits when the medical workforce at all levels and in all specialties reflects the diversity of our communities.
- The OMA affirms the importance of ongoing collection of data and measurements of inequities for impacted groups to create transparency and accountability. We must respect the sensitivity of information collected but must understand the barriers to improved workforce diversity in order to overcome them.
- The OMA will work to further an inclusive and supportive environment within medicine. Recognizing the burdens to be overcome by individuals facing barriers, the OMA will offer mentorship opportunities and promote policies resulting in active recruitment and support of a more diverse workforce.
- The OMA recognizes alternate and nontraditional career pathways and supports them as to ensure the growth of and sustain diversity within the workforce and medical community.
- Those caring for children, elder family members, or others with increased needs carry burdens and assume responsibilities that should be highly valued in the profession. Taking on this responsibility demonstrates traits congruent with the calling to a life of service in medicine, and retention of these members of our professional community must be a priority. Traditional cultures and systems within the profession must change to allow all members of our professional community to continue to contribute, even when other life burdens make this challenging.
- A shift in medical traditions must allow alternate career pathways to include recognition and rewards for work done to further the goals of a diverse workforce.
- A shift in culture must also improve the retention, and hence equity, of the medical workforce by recognizing that overcoming barriers is a task to be shouldered by the whole community.
- The OMA will increase representation of diverse members of the medical community within the organization and its own leadership.
- The OMA encourages institutions that intersect any part of the pathway in medicine to actively work to increase recruitment to and retention within the medical professions of diverse members.
- The OMA affirms that physicians and physician assistants deserve equal compensation for the same work as their peers, without regard to gender, race, ethnicity, religion, sexual orientation, and gender identity; or other factors that have placed people at risk of discrimination. This will require further evaluation of salary inequities by race, gender, and other minority status, as well as development of transparent compensation strategies and advancement metrics.
- The OMA recognizes that improvements in equity in the medical profession will increase the wellbeing, safety, productivity, work satisfaction, and opportunities for medical professionals, as well as positively impact health outcomes for communities, patient access to care, and satisfaction with care.
- Equity issues in the profession and our society will always be a work in progress. Task Force members recognize that not all facets of equity are thoroughly addressed in this document, and the OMA commits to continuing to advance equity work with attention to additional areas, including but not limited to systemic racism, disability communities, international medical graduates, and religion.
B. That the OMA adopt the Equity Task Force Recommendations regarding Pathways into Medicine.
C. That the OMA adopt the Equity Task Force Recommendations regarding Workforce Culture.
- Opportunities for early exposure to medicine and specialty fields and early contact with mentors from diverse backgrounds in medical professions;
- Institutionally and state funded financial support for students interested in healthcare careers who have a demonstrated financial need to help with preparation for medical school, including support for living expenses and medical school application expenses;
- Community programs that aim to create a diverse conduit of students to enter health professions, such as underrepresented minority-directed pre-med immersive programs, youth outreach to inspire early interest by medical students and clinicians, and paid opportunities for high school students to work in medical practices with clinicians;
- Enhanced funding for quality early childhood through high school education and for parental educational and employment opportunities and benefit programs; these are foundational for economic and housing stability and food security for all at-risk families;
- Holistic admission criteria for medical schools, removing standardized testing as a requirement and prioritizing recruitment from underserved regions;
- Inclusion of sexual orientation and gender identity as standard demographic variables collected on medical school (AMCAS), residency (ERAS), fellowship, and other employment applications, as well as on licensing applications, academic appointment applications, and professional society surveys to understand whether current recruitment practices effectively achieve diversity goals;
- Routine evaluation of what demographic variables are collected on medical school, residency, fellowship, and other employment applications, as well as on licensing applications, academic appointment applications, and professional society surveys to consider additional expansion of this list over time as needed to help understand whether current recruitment practices effectively achieve diversity goals;
- Opportunities for interaction and longitudinal mentorship with faculty and clinicians in the community, including mentors whose own knowledge or experiences may help mentees navigate issues related to characteristics of diversity during medical school and training;
- Accreditation standards of training programs that require programs to promote inclusion by requiring demonstrated actions taken to improve diversity;
- Training for clinicians and healthcare administrators on critical race theory to improve awareness of potential for bias;
- Decreased weight of Step 1 board examinations and moving toward holistic evaluation in the residency application process;
- Universal and equal acceptance of COMLEX exams by all US residency programs to decrease the added financial and testing burden placed on underrepresented DO students when they are implicitly expected to take the USMLE series in addition to the COMLEX series;
- Robust test preparation resources that are integrated into a medical school’s curricula to minimize inequality of access to high-quality board prep materials;
- Change to criteria for honors societies, awards, and opportunities for public speaking and elimination of their use from consideration on applications for training positions, hiring, promotions, and tenure if honors have not been scrutinized for issues of equity; and
- Increased research in key areas in which the literature related to equity in medicine is lacking. This includes, but is not limited to: impacts of sexual gender minority status on experience of training, access to career advancement, and improvement in clinical care delivered; impacts of improved gender, racial, sexual orientation/gender identity diversity on the quality of care and costs, effective interventions that achieve improved representation, and retention of diversity in the practice of medicine; and reasons for clinicians for reducing work hours and ways to improve full engagement and retention in the profession.
- Training for leaders at all levels of organizational structure to be change agents for the development of a positive, inclusive, and respectful workforce culture for all members of a diverse healthcare team, with the goal of moving beyond a focus on reducing legal risk and focus on actively altering culture and climate;
- Funding for research on medical institutional climates to better understand the problems and needs of medical professionals and academic medical centers in Oregon;
- Requirements for tracking and reporting progress in equity through measurable data on representation by race, ethnicity, gender, sexual orientation, etc., monitoring retention in the profession and institution; and exploring the experiences people have with discrimination and/or violence at regular intervals;
- Medical school accreditation tied to evidence of active and meaningful leadership to improve representation of women, racial/ethnic minorities, and LGBTQ+ people in all arenas;
- Resources to reduce isolation within the profession and to develop systems to elevate voices and concerns of disadvantaged groups to institutional attention, with an eye toward improving culture;
- Integrated and centralized diversity within the mission of an organization and within the organization's leadership ranks;
- Transformation by medical institutions of their internal culture through enhancing the visibility of diverse populations in leadership positions and diversifying leadership positions at every institutional level, including, but not limited to, board of directors membership, executive-level organizational leadership, management positions, medical directorships, and tenured faculty roles;
- Publicly reported data on board of directors and C-suite diversity (including trends in diversity over time) from medical institutions within the state;
- Promotion and tenure policies to be better adapted to reflect and value the career trajectories and contributions of women and underrepresented groups within academic medicine and other medical organizations;
- Effective mentorship opportunities, either locally or through national organizations, targeting the specific population/demographic group’s experience of barriers and challenges;
- Strong, meaningful representation of diversity on panels involved in recruitment and promotion reviews within a medical institution, as well as ensuring diversity among candidates for hire before closing the search to fill a position;
- Recognition that racism is a system that assigns value based on how one looks and internal examination of an organization’s own policies, practices, norms, and values and how they influence decision-making in order to determine how racism is operating within the institution;
- Access to educational materials and resources to guide the construction of antiracist interventions within medical institutions, including but not limited to identifying who is missing from the decision-making table and what is “on” versus “missing from” the agenda;
- Close examination of the historical role of sexism/gender bias and racism in an institution or organization to identify how past decision-making and practice may be influencing current policy and climate; the OMA will start by modeling this work internally;
- Stricter anti-discrimination policies and protections that actively remove barriers to women clinicians and develop an antiracist culture;
- Adoption of the 2018 NASEM report recommendations for individual, institutional, and legislative changes to reduce workplace discrimination and violence, which include targeted efforts to improve safe and respectful work environments and organizational culture, addressing the most common forms of sexual and gender harassment;
- Institutional, local, state, and federal legislation that upholds and strengthens the rights and privacy of survivors of sexual harassment and violence and is survivor-centered, including but not limited to changes made to Titles VII or IX;
- Use and funding of confidential advocates within institutions to support students and professionals who experience harassment and/or violence, with the role of confidential advocates expanded, and appropriately funded, to also address microaggressions and inequities experienced within the organization, with a goal of shifting institutional culture and mitigating current inequities;
- Zero-tolerance policies for workplace harassment based on race, ethnicity, gender identity, sexual orientation, religion, parenting or caregiving status, disability, or other unique identity held by individuals in the medical workplace;
- Routine surveying by educational institutions of medical trainees about gender-based violence;
- Recognition of the value that unique contributions from women clinicians and underrepresented faculty or clinicians offer by modifying promotions processes to positively weight contributions, including but not limited to, underserved patient care advocacy, community service, and research with underserved and minority patients. increased time and commitment to mentoring of women and underrepresented clinicians and students; and time and commitment to diversity work within the organization;
- Education for academic faculty and organizational leaders about existing literature-documented challenges that women and underrepresented clinicians face and methods to overcome those challenges;
- Implementation of best practices for collecting data on representation of LGBTQ+ clinicians in the workforce and on the pathway to the workforce, including applicants to medical school, residency, and fellowship training;
- Efforts and initiatives directed at more broadly Implementing early-career debt relief;
- Performance evaluation criteria and advancement criteria that are explicit and transparent, including the standards for advancement when a clinician works part-time or has a leave of absence for caregiving responsibilities; to be reviewed annually with employees to identify areas of difficulty and ensure success;
- Targets for hiring, retention, and advancement of women and underrepresented members of clinical and academic teams and that leadership team reviews, and program accreditation be tied to success in these arenas;
- Opportunities for leadership training and mentoring in medical organizations, academic institutions, and practices, with a focus on women and other underrepresented clinicians;
- Family-friendly policies and adjustments to the promotion cycle within organizations that allow for career customization and individualized career plans which span a faculty member’s career, with options to flex up or down in research, patient care, administration, and teaching;
- Increased availability of pilot funds from academic and governmental institutions to lower barriers for research and systematically monitor startup packages for research and academic work to ensure resources are equitably distributed, regardless of demographic differences; and
- Training for decision-makers of hiring, promotions, and leadership to recognize their own biases and on the organizational imperatives around improving diversity.
D. That the OMA adopt the Equity Task Force Recommendation regarding Caregiving Responsibilities.
- Flexible course schedules within medical schools that allow for caregiving for family members, with efforts made to ensure timely graduation and progress;
- Residency application process and cycles that increase options for trainees who seek to care for family members, such as a second application cycle to minimize unused time off;
- Family leave policies that are opt-out, as opposed to opt-in, with reasonable wage replacement rates;
- Gender-neutral parental and family leave that would ensure protection for LGBTQ+ families that otherwise face unequal social and economic treatment;
- High quality publicly and institutionally supported childcare, including backup care for sick children;
- Accessible lactation resources in workplace and academic settings and standardized policies regarding scheduling accommodations to support breastfeeding;
- Opportunities for flexible work schedules;
- Resources to ensure the provision of childcare in emergency and on-call situations;
- Increased resources for in-home care for the elderly and reduced-cost high quality options for institutional care; and
- Increased research on care for older adults by “sandwiched” families.
E. That the OMA adopt the Equity Task Force Recommendations regarding Patient Relationships.
- Increased research on how to improve identity-conscious care;
- Improved education for trainees and continuing education for practicing clinicians that addresses not just issues of cultural difference, but systemic racism, sexism, homophobia, and transphobia, and provides tools to examine these issues;
- Self-assessment of institutional bias by healthcare organizations while creating a robust support system for clinicians and other healthcare members;
- Nuanced approaches to reimbursement to account for differences in patient utilization and care needs;
- Discrimination reporting systems for both clinicians and patients within healthcare organizations;
- Funding to increase access to healthcare resources and clinician training in rural settings:
- Resources for clinicians to adequately assess their appropriate amount of workload in their patient panels and support these findings with appropriate panel assignment;
- Policies within healthcare organizations that explicitly address patient bias, with a clear mechanism for reporting incidents of patient bias and procedures to inform decisions about future care of the patient and support of the medical staff; and
- Standardized responses by medical groups and healthcare institutions to be directed to patients who demand different clinicians due to patient bias against clinicians.
F. That the OMA adopt the Equity Task Force Recommendations regarding Pay.
- Routine collection of data on pay and total compensation by all large medical groups, academic institutions, and coalitions of smaller groups, carried out with attention to demographic factors and any factors that may account for differences in compensation, with special attention to groups that have not yet been well evaluated;
- Consideration for protecting privacy and confidentiality in developing methods of data collection and sharing;
- Governmental support and funding for data collection and pay disparity research;
- Standardization within medical institutions and groups of starting position salary based on specialty, rank, and region;
- Omission of questions about previous compensation during the application, interview, and hiring process;
- Routine audits of total compensation (clinical and non-clinical) for large clinician practices performed by outside consultants, with results of the analysis shared with a diverse supervisory and accountable leadership group or with the division director;
- Incorporation of equity metrics into quality targets or annual evaluations of organizational leaders;
- Transparency on how initial and subsequent salary is determined and data on current compensation levels (including information on rank, years of employment, gender, race, and other pertinent demographic data);
- Adjustments in salaries made if unexplained differences are identified;
- Compensation based on a broad range of factors that value the overall experience of the clinician beyond FTE and productivity;
- Implementation of compensation models that reduce inequities, such as: salary-only structured compensation models incorporating national benchmarks and clear standardized pay steps and increments, structured compensation models based on rank and time-in-rank in a given subspecialty, value-based compensation systems, and development of an “academic RVU” measure that can also be used to determine compensation;
- Public access to national salary data such as the AAMC salary report;
- Evaluations of compensation that include a comprehensive view of compensation including: retirement benefits, disability/malpractice insurance, health benefits, access to pay for performance or bonuses; research support; division of work between clinical, teaching, committee, and research responsibilities; access to leadership opportunities; and factors impacting clinical workload for individual clinicians;
- Avoidance of patient satisfaction metrics such as Press Ganey or HCAHPS as factors in deciding compensation, bonus, and advancement unless there are robust data demonstrating that patient bias has no statistical effect;
- Consideration for differences in risk levels of patient panels when using quality of care measures to determine compensation, to avoid penalizing clinicians for caring for more complex groups of patients;
- Precise promotion guidelines (e.g. number of papers, size of grants) for academic positions and availability of an experienced senior faculty member who can counsel faculty on readiness for promotion;
- Consideration of valuation of citizenship work (e.g. committee, mentoring, service work); rewarding activities central to medicine like teaching and committee membership;
- Specific criteria for earning add-on bonuses available and achievable by all the members of the group, with routine updates on progress toward the goal provided by leadership;
- Performance reviews coupled to routine assessments for compensation adjustment;
- Human Resources involvement in countering forces pushing toward compensation inequities, by evaluating job offers to ensure they’re based on the value the position brings to the organization and not on what the candidate earned previously, participating in routine pay equity analyses to determine if pay is based on relevant variables like market value, experience, last three performance ratings, utilizing peer group settings to discuss and defend the distribution of raises; and monitoring hiring, promotions, and raises to ensure they are bias free and explicit regarding who is responsible for equitable pay;
- Term limits for leadership positions;
- Standardization and transparency related to how decisions about part-time status and family/medical leave impact advancement, bonuses, and expectations about productivity in a given period of time;
- Research to identify the policies, procedures, leadership, and/or culture that promote equity in some specialties in order to determine best practices and target the effective remedies to disparities in all specialties; and
- Federal and state legislation to address wage gaps such as the Paycheck Fairness Act.
See also Appendix M
Adopted by the Board of Trustees, February 2021.
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