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Achieving faculty diversity at University of California medical schools while maintaining compliance with proposition 209
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Achieving faculty diversity at University of California medical schools while maintaining compliance with proposition 209
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ACHIEVING FACULTY DIVERSITY AT UNIVERSITY OF CALIFORNIA
MEDICAL SCHOOLS WHILE MAINTAINING COMPLIANCE WITH
PROPOSITION 209
by
Jody C. Schnabl
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
August 2012
Copyright 2012 Jody C. Schnabl
ii
DEDICATION
This dissertation is dedicated to those in my life who have given me purpose:
My wife, Laura - You bore the burden of our numerous life changes (two moves, my new
job and a new baby) while I groaned under the pressure of the doctoral program and dissertation,
all while remaining a loving and supportive partner of more than half of my life. I love you more
than you could ever know and look forward to spending the rest of my life with you. I assure you
– it will all be worth it.
Jake, my son – You maintained your studies throughout the challenges of college while
also discovering your independence. I missed you these past many years but I am so proud of
you. You are the smartest young man I know. I can’t wait to see what changes you will bring to
the world in the years to come.
Jordyn, my daughter – You are the most dedicated student-athlete I have met in my life.
You overcame countless challenges, stemming mostly from changing high schools twice and
enduring the worst treatment that one’s peers could offer. On the most competitive national stage
imaginable, you became one of the most celebrated and recognizable athletes in your sport due
entirely to your hard-work, dedication and indomitable spirit.
Evey, my baby – I will try not to fail you. You are perfect to me in every way. It makes it
hard for your mother and me to push you to excel and reach for your dreams because we watch
in amazement at everything you do and say. You captivate a crowd and random strangers tell us
how extraordinary you are. This is all the more reason for our entire family, Mommy, Jake,
Jordyn and me, to teach you how to live up to such a lofty pedestal. We owe you that.
I also dedicate this dissertation to my mother and father, Sue and Jim, and to my brothers,
Jim and Jay. You taught me that family comes first. We support each other. We challenge each
iii
other. We revel in each other’s successes and lament each other’s losses. Above all – you taught
me that we’re in this together.
I miss you, Jay.
iv
ACKNOWLEDGEMENTS
I am confident that many doctoral students at Rossier have acknowledged Professor Mark
Power-Robison for guiding and assisting them in the completion of their studies. I am also
confident than few (if any) have meant it more than I. My dissertation was built on a foundation
of “I couldn’t get it done in time; I took a new job; I just had a baby; I just moved; I need more
time.” Despite each of these delays, and despite the numerous other students he was guiding at
the same time, Professor Robison kept track of my progress and patiently checked in with me to
ensure I was still moving forward. It is for this reason alone that I sit here today and write my
acknowledgements. Thank you, Sir.
I must also acknowledge the other two members of my committee, Professor Leslie
Bernstein and Professor Michael Diamond. They provided shape and purpose to my final product
and ensured that it was “scholarly” – a feat I wasn’t always sure I would achieve.
v
TABLE OF CONTENTS
Dedication ................................................................................................................................. ii
Acknowledgements ................................................................................................................. iv
List of Tables .......................................................................................................................... vii
List of Figures........................................................................................................................ viii
Abstract .................................................................................................................................... ix
Chapter 1: Overview ................................................................................................................ 1
Statement of the Problem ............................................................................................ 5
Purpose of the Study .................................................................................................... 7
Research questions ....................................................................................................... 7
Significance of the Study ............................................................................................. 8
Limitations of the Study ............................................................................................ 11
Delimitations of the Study ......................................................................................... 12
Definitions .................................................................................................................. 12
Chapter 2: Literature Review ................................................................................................. 15
Diversity, Populations Studies and Underrepresentation. ........................................ 16
Legal and Social Constructs of Diversity ..................................................... 16
Social Constructs of Discrimination ............................................................. 22
Institutionalized Discrimination and Other Barriers to Faculty Diversity ............... 28
Other Barriers to Faculty Diversity: Realities and Myths ............................ 28
The Affirmative Action Plan ........................................................................ 29
Anti-Affirmative Action Movement and Proposition 209 ....................................... 30
Proposition 209 .............................................................................................. 34
Accreditation .............................................................................................................. 35
Conclusion ................................................................................................................. 38
Chapter 3: Methodology ........................................................................................................ 39
Design Overview ....................................................................................................... 39
Primary Question ........................................................................................................ 39
Secondary Questions ..................................................................................... 39
Analytical Framework ............................................................................................... 40
Study Population ........................................................................................................ 41
Quantitative Analyses ................................................................................................ 42
Demographics ................................................................................................ 42
Qualitative Analyses .................................................................................................. 43
Records Research .......................................................................................... 44
Document Analysis ....................................................................................... 44
Interviews ...................................................................................................... 45
Data Analysis ............................................................................................................. 47
Quantitative Data Analysis ........................................................................... 47
vi
Qualitative Data Analysis ............................................................................. 47
Conclusion ................................................................................................................. 47
Chapter 4: Results .................................................................................................................. 49
Introduction ................................................................................................................ 49
Demographic Statistics .............................................................................................. 50
Recent Historical and Current Demographics .............................................. 50
Projected Demographics ............................................................................... 52
Records Research .......................................................................................... 57
Document Analysis ....................................................................................... 69
Interviews ................................................................................................................... 73
Interview Discussion ..................................................................................... 76
Interview Themes .......................................................................................... 79
Summary .................................................................................................................... 83
Chapter 5: Discussion ............................................................................................................ 85
Summary .................................................................................................................... 85
Summary of Findings ................................................................................................ 86
Recommendations...................................................................................................... 90
Implications of the Study .............................................................................. 90
Best Practices: Recommendations for UC Medical Schools ....................... 91
Recommendations for Further Research ...................................................... 98
Conclusion ............................................................................................................... 100
References ............................................................................................................................ 102
Appendices:
Appendix A: University of California Diversity Statement ................................... 112
Appendix B: Employment Numbers for the UC Medical School Faculty ........... 113
Appendix C: Employment Percentage for the UC Medical School Faculty ......... 114
Appendix D-1: UCLA Faculty Diversity Statistics 2008 ...................................... 116
Appendix D-2: UCLA Faculty Diversity Statistics 2011 ...................................... 117
Appendix E: Interview Questions ........................................................................... 119
vii
LIST OF TABLES
Table 1: David Geffen School of Medicine Faculty
Diversity Statistics 2010 and 2010 ......................................................... 68
Table 2: Interview Participant Statistics ................................................................. 75
viii
LIST OF FIGURES
Figure 1: Race/ethnicity of active patient care physicians
in California vs. population .................................................................... 50
Figure 2: Projections of the total population for the United States:
2010 to 2050 (in millions) ....................................................................... 53
Figure 3: Projections of the percent minority for the United States:
2010 to 2050 (percent) ........................................................................... 54
Figure 4: Racial breakdown in 5 California counties with
UC medical schools, 2000 and 2050 ...................................................... 56
Figure 5: UC Davis School of Medicine faculty demographics,
2004–2010. ............................................................................................. 63
ix
ABSTRACT
The Liaison Committee on Medical Education (LCME), the accrediting body for schools of
medicine in the United States and Canada, has accreditation standards that require faculty gender
and ethnic diversity to reflect that of the general population and contend that medical students of
different races and backgrounds benefit from a multi-racial, multicultural teaching force whose
members may serve as role models and mentors. In the State of California, Proposition 209
prohibits state institutions such as the University of California (UC) schools of medicine from
using racial, gender or similar factors when hiring faculty. This study examined how these schools
have worked to address the contradiction between LCME accreditation standards and Proposition
209 directives. It also sought the best practices that have been developed by UC medical schools to
achieve faculty diversity as required by LCME accreditation standards while maintaining
compliance with Proposition 209.
Through demographic analysis, records research and interviews, it was discovered that UC
medical schools lacked a comprehensive awareness campaign to inform faculty with hiring
responsibilities of both the diversity-related requirements in the LCME accreditation standards and
the true benefits to medical care of hiring a more diverse faculty. As a result, slowness in achieving
greater faculty diversity may be more attributable to psychological barriers related to beliefs and
attitudes rather than to legal or statistical challenges. Identifying and developing ways to address
attitudinal barriers formed the foundation of several of the best practices recommendations outlined
in the study, as well as implementing a regimen for accountability in achieving success in diversity
hiring.
1
CHAPTER 1: OVERVIEW
Introduction
In the United States, medical schools must abide by a set of standards devised by the
Liaison Committee on Medical Education (LCME) in order for their students to be eligible to
receive federal funding for attendance as well as licensure in the medical profession. An
important aspect of these accreditation standards is the need for schools to achieve a level of
racial and ethnic diversity amongst their faculty in accordance with the general population, in
both a local and national context. Achieving such diversity requires a concerted effort to
overcome a variety of societal dynamics that have resulted in its limitations. In addition,
University of California medical schools were constrained in their approaches to achieving such
diversity with the passage of Proposition 209, now Article 1, Section 31 of the state constitution,
which prohibits public institutions from considering factors such as race or ethnicity when
making hiring decisions. The study examines this contradiction, the requirement by the
accrediting body for medical schools to increase the level of racial and ethnic diversity amongst
their faculty and the opposing prohibition by the California State Constitution from considering
such factors in faculty hiring decisions, and how the UC medical schools have worked to address
this contradiction.
The notion of equality, or more specifically equal access to opportunities for the diverse
population of the United States, is widely accepted as an American ideal. Valued for its
contributions to democracy, diversity also provides measurable benefits throughout society and
within the system of higher education. This may be especially true in medical education.
Diversity provides “opportunities for the exchange of ideas about the practice of medicine…and
these exchanges may be the most effective means of exposing everyone involved to the issues
that frame the effort to develop a culturally competent physician workforce” (Bates & Chapman,
2
2008, p. 1). Effective healthcare requires that patients place a certain amount of trust in their
physicians: Nelson (2003) concludes that higher levels of trust between patients and their
physicians are shown to be correlated with a more positive health outcome, yet this trust is often
compromised across racial and ethnic lines. Experts have argued that a racially and ethnically
diverse physician workforce is essential for ameliorating inequities in healthcare relating to race,
ethnicity and socioeconomic status (Smedley, Stith, & Nelson, 2003; Sullivan Commission,
2004; Smedley, Butler, & Bristow, 2004). Medical students of different races and backgrounds
would benefit from a multi-racial, multicultural teaching force whose members may serve as role
models and as mentors (Owens, Reis, & Hall, 1994, p. 58). Colleges and universities, including
medical schools, have long recognized the importance of attracting and training a diverse student
body—and, by extension, future faculty. For without diversity among medical school graduates,
there is little chance of achieving diversity among medical school faculty since most members
would be drawn from that pool.
As of 2007, the percentage of medical students from underrepresented minority groups
continues to drop even though their percentage among the general U.S. population continues to
rise (Nelson, 2003). Across the country, an estimated 25% of the patient population comes from
underrepresented racial and ethnic minority groups, compared with just 7% of practicing U.S.
physicians (Nelson, 2003). Studies suggest that the post-secondary institutions committed to
faculty and staff diversity will be best positioned to mentor and educate the physicians who will
treat the nation’s increasingly multicultural population (Doka, 1996; Johnson, 2004). Efforts for
achieving such diversity, however, were seriously restricted in the state of California with the
passage of Proposition 209—now Article 1, Section 31, of the California State Constitution – as
it prohibits the University of California from discriminating against any individual or group or
3
from granting preferential hiring based on race, gender, or national origin. The effect on faculty
diversity has been significant. “In the four years following the passage of Proposition 209, many
UC campuses experienced a drop in the rates of hiring underrepresented minority faculty”
(Clark, N. D.).
Relevant major professional and student associations have embraced the importance of
gender, racial, and ethnic diversity among medical school faculty, including the American
Medical Society, Council on Graduate Medical Education, American College of Physicians,
American Medical Student Association, and Association of American Medical Colleges (Bates &
Chapman, 2008). The challenge arises in the need to balance the desire to achieve diversity with
the legal necessity of avoiding policies or practices that suggest preferential treatment in regards
to recruiting or hiring.
Diversity and the Proposition 209 Tightrope
As of 2007, census data estimated the makeup of the U.S. population as 79.96% White,
12.85% Black, 4.43% Asian, 0.97% American Indian and Alaska Native, 0.18% native Hawaiian
and other Pacific Islander, and 1.61% two or more races. The Hispanic population, by which the
U.S. Census Bureau means a person of Latin American descent (including persons of Cuban,
Mexican, or Puerto Rican origin) living in the United States who may be of any race or ethnic
group (White, Black, Asian, etc.), represents about 15.1% of the total U.S. population (CIA,
2009).
While gender ratios in the U.S. have remained roughly equal, racial and ethnic makeup
has shifted rapidly. By 2050, the combined minority groups will comprise half the U.S.
population (Association of American Medical Colleges, 2003). California’s racial and ethnic
minority population, while already significantly greater proportionately than in many other
4
states, is expected to rise. As Bates and Chapman (2008) reported, California is now one of the
most racially and ethnically diverse states in the country and the trend will continue: Population
projections indicate that over the next 25 years, California’s population will grow by roughly 12
million people, and over 90% of this population growth will be Latino (75%) and Asian (17%).
In 2000, Latinos and Asians represented roughly 43% of California’s general population; in 2030
they are projected to represent approximately 58% of the state’s population (Bates & Chapman,
2008).
Translating the state’s overall diversity into a more representative makeup among
University of California medical school faculties, however, will require a conscious and
concerted effort on the part of the schools. Some universities and other educational institutions
had high hopes that the various school accreditation processes would help them walk the fine
line between addressing the under-representation of minorities and the notion of reverse
discrimination.
In the United States, medical education programs that lead to the degree of Medical
Doctor (M.D.) are accredited by the Liaison Committee on Medical Education (LCME). The
latest additions to LCME accreditation standards include New Standard IS-16, which became
effective as of July 1, 2009. This new standard requires that each medical school must have
policies and practices in place to achieve diversity among its students, faculty, staff, and other
members of its academic community reflective of the local and national populations (LCME,
2008, IS-16). Further, each school must engage in ongoing, systematic, and focused efforts to
attract and retain students, faculty, staff, and others from demographically diverse backgrounds
(LCME, 2008, IS-16). Before this new standard took effect in 2009, the LCME directed that
medical schools “should” engage in such diversity recruiting efforts (LCME, 2008, IS-16).
5
According to LCME standards (2008), the term “should” refers to a requirement that must be
met unless the accrediting board agrees to waive that requirement for a “compelling reason.” The
term “must” denotes a requirement that cannot be waived (LCME, 2008). Therefore, the LCME
made this change in their accreditation standards with the intention of holding all medical
schools equally accountable for promoting diversity in faculty recruiting.
In 2006 the University of California Regent’s Study Group on University Diversity
published a Faculty Work Team Report that summarized the progress—or lack of progress to
date—of diversity efforts across the system, and found that despite efforts to the contrary, women
and minorities were significantly underrepresented in the faculty and that the numbers of
underrepresented minorities had not improved since the late 1980s (UC, 2006). More women had
joined the faculty, but not in numbers representative of the served population. Furthermore,
women and underrepresented minorities were concentrated in only a few academic fields, with
almost 25% of underrepresented minority faculty (compared with less than 8% of all faculty)
were in one of three departmental areas—education, languages, and ethnic studies—leaving
them substantially underrepresented in the physical sciences, math, and engineering (UC, 2006).
All of this is despite the publication of University of California Guidelines for Recruitment and
Retention of Faculty in 2002. As recently as 2009, lack of faculty diversity in the UC system was
widely recognized, with little mention of progress (Rescola, 2009).
Statement of the Problem
In 1995, the University of California Board of Regents passed resolution SP-2, which
prohibited the university system from using racial, gender or similar factors when hiring faculty
and staff. The regents rescinded SP-2 in 2001 after Proposition 209 was passed by the voters in
California and incorporated into the California Constitution as Article 1, Section 31, which
6
enunciated those same hiring restrictions. The Board of Regents is also guided by the September
20, 2007, Policy on University of California Diversity statement, which included the declaration
that the University “particularly acknowledges the acute need to remove barriers to the
recruitment, retention, and advancement of talented students, faculty, and staff from historically
excluded populations who are currently underrepresented” (Regents, 2007). Yet the initial
adoption of SP-2, and subsequent compliance towards Proposition 209, led to a significant drop
in the numbers of faculty, staff and student candidates from underrepresented populations
(Nelson, 2003; Clark, N. D.), suggesting that it was in fact adding a barrier, either real or
perceived.
A report prepared by the Greenlining Institute for the Office of the President of the
University of California focused on the racial and ethnic diversity of tenure-track faculty at each
of the five medical school campuses—UC Davis, Irvine, Los Angeles, San Diego, and San
Francisco—published some disturbing findings (a sixth medical school, UC Riverside, did not
exist at the time of the research period of this analysis and will therefore not be included in the
study). According to Echiverri, Joy, & Kanu (2007), there are significant disparities in minority
representation among UC medical school faculty as compared to their representation in the
state’s population, with the level of disparity increasing with each successively higher faculty
rank position. The University of California must, therefore, identify and implement strategies to
align its faculty demographics more closely with those of the state’s population in order to meet
the new accreditation standards of the LCME, while simultaneously staying within the guidelines
Proposition 209 (Article 1, Section 31 of the state’s constitution).
7
Purpose of the Study
The purpose of the study was to examine recruitment and retention practices, programs,
and policies that University of California medical schools have used in an effort to identify those
that (a) successfully enhance faculty diversity, as measured by significant demographic changes,
and (b) comply with both government regulations and the LCME Accreditation Standard IS-16
on diversity. Many schools have made significant strides in this endeavor. The study examined
the overall strategies and specific recruitment and retention efforts of the schools, successful and
otherwise, with the intention of identifying general guidelines for similar institutions of higher
education facing these same conflicting standards. The study was guided by the following
question:
Research Question
What best practices have been developed by University of California medical schools to
achieve faculty diversity as required by LCME accreditation standards while maintaining
compliance with Proposition 209?
In order to elicit information pertinent to this research question, other subordinate
questions were asked:
To what extent do leaders at the University of California medical schools see LCME
accreditation standards and Proposition 209 compliance requirements as being in
conflict with one another?
What modifications have the leaders of University of California medical schools
made to earlier recruiting practices in an effort to improve faculty diversity while
maintaining compliance with Proposition 209?
8
What recruiting practices currently in place at the various University of California
medical schools have shown promise in achieving faculty diversity while remaining
in compliance with Proposition 209?
Significance of the Study
Demographics across the country are changing, and California’s are changing especially
fast. Just one generation from now, in less than 25 years, California will be home to an additional
12 million people. The “White majority” will likely become a thing of the past considering that
estimates project that by 2030, Latinos and Asians will make up about 58% of the population
(Bates & Chapman, 2008). The study will gather data on those hiring practices utilized by
University of California medical schools to address the issue of alignment between faculty
demographics and the local and national academic context in which the respective schools reside.
The researcher utilized this data to develop a proposal for the best practices in achieving such
alignment.
The study has significance for colleges and universities in California and across the
nation, as well as governing bodies and interest groups that seek to support the goals of these
institutions to provide both equity in teaching opportunities and the academic excellence that
comes from serving the population in a culturally competent and diverse manner. It has specific
significance to professional schools in California and throughout the United States due to the
highly specialized nature of the course curricula in such schools and the appreciably smaller pool
of potential faculty candidates from which to draw.
University of California Board of Regents
The people involved with recruiting, hiring, and retaining faculty in the UC system can
benefit from insights that will allow them to better diversify that faculty while still remaining in
9
compliance with the strictures of Proposition 209 and the state constitution. The results of a
study that identified and proposed ways to do just that can assist them in their short-term efforts
and inform their long-range plans for recruitment and retention. Chief among these organizations
that could benefit directly from the results of the study is the University of California Board of
Regents. Another group that would benefit from the information contained in the study is the
University of California President’s Task Force on Diversity. The Task Force’s website stated
that the system-wide, in-depth analysis of faculty demographics would be provided in a
preliminary report to the chancellors in spring 2006. Having access to the findings of the study
would help the Task Force continue its efforts. The Chancellors’ Statement on Faculty Diversity
stated the following:
A diverse faculty reflects inclusiveness and opportunity that are essential if UC is to
maintain excellence and legitimacy in its role as a land-grant university. UC will remain
competitive as a leading institution of higher education only if it fully utilizes the
available talent pool. UC will retain its leadership as the premier public research
institution in the world only if it is inclusive, so that all members of our heterogeneous
society can participate in the educational and research programs necessary for our future.
(Chancellors’ Statement, N.D.)
This statement indicates that the U.C. Chancellors, the chief executive officers of the
individual campuses, have internalized the mission of fulfilling the role of the land-grant
universities by involving everyone in our society in meeting the challenges and realizing the
opportunities of our nation’s future. Other senior-level University of California faculty and staff,
particularly at the medical schools, can benefit from the findings of the study. While the overall
diversity policy comes from the Board of Regents, many people play a role in faculty recruitment
10
and retention, from the high-level administrators (chancellors, provosts, academic deans) to the
department heads and senior faculty themselves.
Government Policymakers
Local, state, or federal agencies concerned with diversity in general and faculty diversity
in particular can benefit from reading the findings of the study, as it aimed to be a comprehensive
guide to the current “promising practices” and as-yet untested innovations in faculty diversity
programs. Achieving faculty and workforce diversity will continue to be a challenge in the years
to come. The lessons learned by this important institution and detailed herein may prove to be
applicable in a variety of contexts.
Researchers and Academicians
Other researchers interested in diversity-related studies can benefit from this work, as it
touched on a wide range of topics and fields of interest: history, critical race theory,
demographics, accreditation, discrimination, civil rights legislation, California’s Proposition 209,
and faculty recruitment and retention.
Other Groups That Can Benefit from the Study
Other colleges, universities, and educational institutions interested in advancing their
own faculty diversity, especially those facing similar legal constraints to diversity
hiring practices
Diversity and multicultural awareness groups, including nonprofits and university-
based groups (e.g., DiversityWeb.org, “An Interactive Resource Hub for Higher
Education”)
Women and minorities who wish to promote diversity recruiting within their own
institutions
11
Limitations of the Study
The study was conducted with the understanding that the research would likely be limited
by several factors. First, since the primary methodology involved personal interviews, the study
was limited by the degree and depth to which interviewees responded to the researcher’s
questions. The responses may have been affected by the comfort level of the interviewees;
interchanges where a natural rapport is established between the parties may lead to more candid
responses and willingness to volunteer information than those where the interchanges remain
strictly formal. Since the topic of interest is diversity, the researcher’s race may have made some
respondents more comfortable and others less comfortable.
Second, the researcher could only incorporate data from interview respondents who
agreed to participate and who were thus self-selected. There will be no way of knowing whether
or why those willing to participate were particularly motivated to participate, or whether the non-
respondents were unwilling to participate for substantive reasons or are simply unavailable. Nor
can it be determined whether the responses of non-participants would have yielded different
results from the data gathered from those who chose to participate in the study.
Finally, the study was limited by the existence of and cooperative access to appropriate
and reliable archival and individual sources from the various University of California institutions
and personnel. While the records kept by the University are extensive, not all pertinent
information has been archived nor was it all available for reasons of confidentiality. As the study
included the review of documents, it was also presumed that documents have been revised or
updated over time to reflect changes in policy, procedures or practices with regards to diversity
or employment issues.
12
Delimitations of the Study
The study consulted sources outside of the University of California system when
searching out successful strategies for faculty recruitment and retention, but in terms of making
recommendations for implementing those strategies, the only schools considered were the
medical schools within the University of California system. While the study dealt with diversity
as a whole, it did not focus on any single underrepresented minority such as particular ethnic or
racial groups, women, or people with disabilities.
Definitions
Accreditation. This is an external third-party certification that a particular organization—
in this case, a college, university, and other education institution—meets a set of criteria and all
applicable standards. Accreditation agencies are private bodies, not government run.
Accreditation is not required for an educational institution to operate; that license is granted by
the individual states. Rather it is an attempt at quality control, peer review, and, to some extent,
standardization that allows the transfer of educational credits from one school to another. Its
importance increased in the United States in the 1950s when returning Korean War veterans
began taking advantage of the scholarship money available through the GI Bill; an earlier wave
of GI Bill activity led to the creation of a rash of new so-called schools, many of which were of
questionable value and quality. Accreditation is still required for student access to federal and
state grants and loans as well as institutional and program access to federal funds for research
and programs and state funds for operating (CHEA, 2009).
Medical education programs in the United States (and Canada) that lead to the degree of
M.D. are accredited solely by the Liaison Committee on Medical Education (LCME), which
13
determines whether an institution continues to meet the national standards as described in
Functions and Structure of a Medical School (LCME, 2008).
Affirmative action. These are policies that consider gender, race, ethnicity, religion, and
national origin, to the extent that it is allowed by law, in a wide range of arenas such as
recruitment, hiring, contracting, educational outreach, and admissions standards for the purpose
of promoting diversity, redressing the effects of past discrimination, and encouraging
organizations to reflect the demographics of the people they serve. One study defined
Affirmative Action as government-fostered and voluntary action by public and private
organizations going beyond the cessation of formal discriminatory practices. It is the notion of
acting positively and aggressively to remove all barriers, regardless of how informal or subtle,
that prevents minorities and women from accessing their rightful places in the employment and
educational institutions of the United States (Washington & Harvey, 1989).
Minority. This is a relative term used to describe any group that is not considered part of
the majority. With respect to racial and/or ethnic minorities in the context of the United States,
“minority” refers to anyone who is not part of the current majority of the population (variously
labeled as White, Anglo, or Caucasian). The terminology changes over time, as can the identity
of which group is the majority. Women are not technically considered a minority in the United
States, but their gross under-representation in many fields and organization levels—including
faculty at the University of California medical schools—generally leads to women being paired
with minorities with respect to programs and policies aimed at promoting diversity.
Under-representation. In the context of the study, this refers to the condition in which the
percentage of women or of a given minority on the faculty of a higher-education institution is
14
lower than the percentage of women or of a given minority in the general population, the study
body, and/or the healthcare consumer population.
15
CHAPTER 2: LITERATURE REVIEW
Introduction
California’s racially and culturally diverse population is not reflected in the makeup of
University of California medical schools’ faculty demographics, despite decades of efforts to
expand diversity and inclusion. The recent trend away from embracing the legislative strategy
known as “affirmative action” led to the passage of Proposition 209, which prohibits efforts to
attract and retain minority faculty that were deemed to “discriminate against, or grant preferential
treatment to” (Proposition 209) any person or group of people. Given that the schools must not
only maintain but increase their efforts to achieve a more diverse faculty to remain in compliance
with the new LCME accreditation standards, they must now tread carefully to find a path that is
both effective and in compliance with Proposition 209.
To fully comprehend the scope of the challenge required a solid understanding of the
historical context of Proposition 209, the meaning and importance of diversity, past legal actions,
current and projected demographics of the country and California in particular, and an overview
of faculty recruitment and retention programs nationwide. The first goal was to assess current
practices and policies that promote faculty diversity. It then aimed to identify among those
successful strategies any practices and policies that could be implemented to improve the
diversity of the faculty of University of California medical schools, while remaining in
compliance with Proposition 209. Contextual research fell into five categories:
• Diversity, Population Studies, and Under-Representation
• Institutionalized Discrimination and Other Barriers to Faculty Diversity
• Anti-Affirmative Action Movement and Proposition 209
• Accreditation
• Faculty Diversity Nationwide
16
These five categories provided a broad understanding of the multi-faceted issues involved
in improving diversity by illuminating the breadth and depth of the problem while addressing the
forces at work affecting its resolution or resistance thereto.
Diversity, Population Studies, and Underrepresentation
As was explained in Chapter 1, achieving diversity among University of California
faculty is an admirable goal. Before implementation strategies can be assessed and developed,
however, it is necessary to explore what is meant by ‘diversity’ as both a legal construct and as a
social construct. While the main focus of the study is developing successful diversity strategies
that fit within the legal construct, specifically, those that do not violate Proposition 209, the
social construct cannot be ignored. It is society’s perception of diversity—and, by association, of
such related concepts as discrimination, preferential treatment, and even racism—that drive the
changes in the legal constructs.
Legal and Social Constructs of Diversity
The easiest way to understand the legal construct of diversity is to examine the specific
bases of discrimination prohibited by the relevant governing body. An historical perspective is
necessary to frame the slow evolution of the anti-discrimination legislation and provide some
insight into why laws are not sufficient to change behaviors or people’s perceptions of behaviors.
President Kennedy’s Executive Order 10925, issued in March of 1961, established the
President’s Committee on Equal Employment Opportunity. It began: “WHEREAS discrimination
because of race, creed, color, or national origin is contrary to the Constitutional principles and
policies of the United States…” (Executive Order 10925, 1961). This introduction sets the stage
for President Kennedy’s desire to address discrimination as being contrary to the spirit of the
U.S. Constitution. Interestingly, he must use the phrase “constitutional principles” as the actual
17
letter of the U.S. Constitution, with its reference to “three fifths of all other Persons” is, in itself,
discriminatory. Section 200e-2 [Section 703] of Title VII of the Civil Rights Act of 1964
identified gender as another distinct segment of the population that had historically experienced
discrimination and added it to the groups previously enumerated, in the form —“race, color,
religion, sex, or national origin” (Title VII, 1964). The State of California’s legal construct of
diversity and discrimination is spelled out in Proposition 209, now Article 1, Section 31 of the
state’s constitution. Proposition 209 prohibits discrimination against any individual or group or
from granting preferential hiring based on race, gender, or national origin. This indicates that the
state had become less interested in spelling out which groups had been historically discriminated
against and chose instead to prohibit compensatory treatment towards such groups in an effort to
counteract the negative effects of prior negative treatment.
At the time the U.S. Equal Employment Opportunity Commission (EEOC) was formed,
the federal government’s efforts were focused almost exclusively on lowering unemployment
rates. This is where understanding the social construct of diversity and discrimination becomes
important. Although women were entering the workforce in growing numbers, the pervasive
social attitude was that men were the breadwinners, and women the support system for their
husbands and families. Thus, the addition of the word “sex” in the 1961 document was
controversial. That fact is important here because the contentious debate over whether sex should
be included speaks to the tenor of the times in terms of both racial and gender equality, and helps
explain some lingering effects today. Howard Smith, a congressman from Virginia and chair of
the House Rules Committee, introduced the amendment to add “sex” to Title VII. Since he was a
staunch segregationist, it is widely believed that he did so in an effort to defeat the entire bill
since he had already tried several other means of derailing the legislation (Freeman, 1991;
18
Gittinger & Fisher, 2004). Two prominent women’s groups in existence at the time held views
that were diametrically opposed: The National Women’s Party supported the inclusion of “sex”
on the grounds that without it Title VII would deny “to white women [the] protection it would
afford to Negroes.” Edith Green, the congresswoman from Oregon and usually one of the most
determined defenders of women’s rights, opposed including “sex” because she feared it would
cause the bill to fail altogether. Lawyer Pauli Murray argued that the word “sex” had to be
included to be fair since without it, the bill would help only men and thus offer equal opportunity
employment to half the “Negro” workforce (Gueron, 1995; Becker, 1998; Mayeri, 2001). To the
astonishment of most, Title VII passed. (It was later amended to prohibit discrimination against
pregnant women.) All this would be simply an interesting but only tangentially related issue were
it not for lessons it holds for diversity in the workforce today. The various underrepresented
groups still must compete for jobs not only with the established White male majority, but with
each other, rather than using their numbers in combination to effect social change.
Title VII of the Civil Rights Act of 1964 protected people from employment
discrimination based on race and color. Today the EEOC elaborates on what those words mean to
address perceptions and misperceptions:
Equal employment opportunity cannot be denied any person because of his/her racial
group or perceived racial group, his/her race-linked characteristics (e.g., hair texture,
color, facial features), or because of his/her marriage to or association with someone of a
particular race or color. Title VII also prohibits employment decisions based on
stereotypes and assumptions about abilities, traits, or the performance of individuals of
certain racial groups. Title VII’s prohibitions apply regardless of whether the
discrimination is directed at Whites, Blacks, Asians, Latinos, Arabs, Native Americans,
19
Native Hawaiians and Pacific Islanders, multi-racial individuals, or persons of any other
race, color, or ethnicity. (EEOC, 2009)
This was an attempt by the EEOC to enumerate the characteristics of individuals from the
various groups and to elaborate on subgroups of those who had been historically discriminated
against in an effort to eliminate any question of who was covered by these protections.
Interestingly, the EEOC included Whites as the first protected racial group in the list as a
demonstration that these prohibitions were intended to protect everyone in American society,
even the majority group. Although the language used is similar to that used in Proposition 209,
the inclusion of prohibitions against positively redressing the historical practices of
discrimination effectively changes the tenor of the law from that of a doctrine seeking to
establish a “level playing field” to that of a doctrine seeking to maintain the status quo.
Chapter 1 discussed the reality that the United States is not a “melting pot” in which all
the differences among all the people of diverse backgrounds disappear. Some edges may be
softened, and some cultural, physical, or other elements may be allayed, but there is no inevitable
reduction of individuality. “This is especially relevant for the state of California, where 25% of
the population is foreign-born, and two out of five Californians speak a language other than
English at home” (Field Research Corporation, 2006, as cited in Echiverri, Joy, & Kanu, 2007,
p. 9). Though Americans share many characteristics, they also comprise a diverse group of
people, among whom race and ethnicity are but a few of the various categorizations. As they did
in the Sixties, minority workers compete for jobs with the White male majority and among
themselves.
In another legal construct of diversity, in 1990, people with disabilities were added to
anti-discrimination laws. The Americans with Disabilities Act of 1990 was signed into law on
20
July 26, 1990, by President George H. W. Bush, and later amended and broadened by changes
effective January 1, 2009. The ADA prohibits discrimination based on disability, defined as “a
physical or mental impairment that substantially limits a major life activity,” and covers
employment, among other things (ADA, 1990, 2009). The ADA affects employers with 15 or
more employees, including state and local governments, and certainly applies to the University
of California system. It is of relevance here because of the inevitable debates over how to
distinguish between accommodation and preferential treatment.
There are other human and cultural characteristics that are variously included in both
definitions of diversity and protections against discrimination. The Age Discrimination Act of
1967 protects those over 40 from discrimination based solely on age (EEOC, 2009). “National
origin” has been covered since the Civil Rights Act of 1964, but that does not mean that
discrimination on its basis has disappeared, as evidenced by the ongoing debate with respect to
non-English speakers. Technically, discriminating on such a basis is unlawful under many
circumstances:
National origin discrimination means treating someone less favorably because he or she
comes from a particular place, because of his or her ethnicity or accent, or because it is
believed that he or she has a particular ethnic background. National origin discrimination
also means treating someone less favorably at work because of marriage or other
association with someone of a particular nationality. (EEOC, 2009)
The law clearly states that discriminating by national origin—discrimination commonly
manifested as a reaction to a foreign accent—is illegal. The language of the law is written
carefully to include a wide range of discrimination, and of what it would mean to discriminate on
the basis of national origin. However, despite the intention to protect those with a foreign
21
national origin from being discriminated against, despite the careful language, neither the letter
of the law nor the spirit of the law have been enough to enforce the principles behind the law.
Covered under Title VII are any employment decision, including recruitment, hiring, and
firing or layoffs; harassment; language, including accent, English fluency, and when English-
only rules can be adopted. Given the large number of immigrants to California, and to the
country as a whole, this can also be applied to faculty hiring. Still reflecting the nation’s post-
9/11 attitudes based on stereotypes, intolerance, and a lack of understanding of people of non-
Eurocentric cultures, the EEOC includes on its website pages discussing discrimination based on
religion or national original links to special “frequently asked questions (FAQs) concerning the
rights of employees and employers with respect to Muslims, Arabs, South Asians, and Sikhs
(EEOC, 2009)”. This is especially important in addressing spikes in the instances of
discrimination that are driven by relevant newsworthy events.
The University of California Board of Regents has its own constructs of diversity, as
stated in its official Policy on University of California Diversity Statement:
Diversity—a defining feature of California’s past, present, and future—refers to the
variety of personal experiences, values, and worldviews that arise from differences of
culture and circumstance. Such differences include race, ethnicity, gender, age, religion,
language, abilities/disabilities, sexual orientation, socioeconomic status, and geographic
region, and more. (Regents, 2007)
This addresses the notion that California is a state built by a diverse population and its
future will continue to be defined by the value of such diversity. Therefore, it is imperative that
the policies of the university continue to promote access to its campuses and provide the
population with the knowledge necessary to contribute to the future success of the state.
22
The Board of Regents acknowledged that to achieve its mission of serving the interests of
the State of California, it needed to ensure that it exemplified diversity not just among the
student body, but among the faculty:
[T]he University of California renews its commitment to the full realization of its historic
promise to recognize and nurture merit, talent, and achievement by supporting diversity
and equal opportunity in its education, services, and administration, as well as research
and creative activity. The University particularly acknowledges the acute need to remove
barriers to the recruitment, retention, and advancement of talented students, faculty, and
staff from historically excluded populations who are currently underrepresented.
(Regents, 2007)
By twice alluding to the UC system’s history with respect to diversity, the Board
of Regents tacitly acknowledged that its strategies for recruitment and retention of
underrepresented groups have not been successful: if the strategies had been successful, the
“historically excluded” groups would not be “currently underrepresented.” This recognition is a
significant first step in the direction of correcting the way minority groups are recruited and
retained at UC; the challenge now becomes fulfilling that potential.
Social Constructs of Discrimination
People’s perceptions, beliefs, prejudices, traditions, misinformed ideas, and other actions
and reactions play an enormous role in society’s views on inclusion, diversity, and
multiculturalism. Race is a prime example. Ian F. Haney López (1998) analyzed court cases of
the 19
th
and early 20
th
centuries that addressed civil rights, race, and citizenship. He found that
the courts’ main concern was not how the law governed the ways in which people were treated,
but how people were treated “in relation to the social order of the day” (Stovall, 2001, p. 42).
23
The distinction highlights the difference between a legal construct and a social construct. The
social framework, and not the legal one, became the paradigm in which race-related cases were
judged. This may seem inappropriate from an intellectual perspective and with the benefit of
distance in time, but this was the reality during this period; social, societal, often emotional
reactions to race issues were heavily weighted even at the expense of enforcing the law. For
convenience, López (1998) used “the law” as an umbrella term, but he pointed out that it referred
to “a complex, incoherent system of practices, rather than to a monolith.” He argued that the law
reinforces the nation’s preference for “Whiteness” by maintaining racial classifications in the
language of the law. Regardless of whether the distinction between White and non-White is made
in order to bestow advantages on the non-Whites, the persistent classification inherently creates a
hierarchy that has never benefited non-Whites.
Vindicating the rights of minorities has required maintaining a legal system that
distinguishes between Whites and Non-Whites, even though those classifications arose from
efforts to subordinate those constructed as Non-White. The necessary persistence of racial
categories in law lends legitimacy to the notion that races exist in fact, leading people to think
not only of others but of themselves in racial terms (López, 1998).
He and others, such as constitutional law professor and critical race theorist Derrick Bell,
have argued that encouraging diversity is often a euphemism for employing or tolerating anyone
who is not an able-bodied, heterosexual, White male with mainstream Christian or Jewish beliefs
(Bell, 2000a, 2004b). To diversify is to make changes to the default, or the status quo, and so the
movement to encourage diversity was one that recognized the able-bodied, heterosexual,
Christian and Jewish White male profile is the majority and that the goal of diversification was to
address specifically those who did not fit that profile; to set those people apart, to distinguish
24
them and target them as the aim of the effort. Essentially, in this effort to unify people, labels and
categorizations were placed on people, or emphasized if already in place, further exacerbating
the problem. Engineers did not seek out collaborations with engineers from diverse educational
backgrounds; rather, Whites targeted blacks, and men targeted women, and heterosexuals
targeted homosexuals. Minorities were further alienated in efforts to diversify because
underlying those efforts was the belief that the majority profile was ideal, and that different was
worse, making diversity a word for tolerance of others who were not tolerated before. The lens
through which legislators, administrators, and other decision makers view diversity focuses on
the issue as one of “us” and “everyone else”—not always intentional, but as a result of centuries
of being the majority and ruling class. The result, as it relates to increasing diversity among
faculty members for example, is that the issue is often viewed as a simple matter of adding
members of underrepresented groups rather than as a more complex equation that may involve
not just adding minority members but subtracting majority members. Every relevant scenario has
limitations, and in this example, there are a maximum number of faculty positions available. A
true balancing of the faculty across groups would not be possible simply by adding a few “token”
minorities. The most obvious alternative is making room for underrepresented groups by
replacing overrepresented groups. Although executing this would be a complex and sensitive
process, navigating around not only balancing, and therefore having to define, minority groups,
but also weighing seniority and other elements of choosing faculty members, it serves as a novel
basis for developing a comprehensive solution. A detailed plan for such a “reshuffling” of the
faculty demographics is outside the scope of this discussion, but this general approach is another
angle that could be considered in efforts to diversify faculty and other systems.
25
López speaks of “White privilege” as freedom from having to be constantly aware of
race: “Never forced to experience or reflect upon the petty indignities and intentional slights of
racism, most Whites are free to act in the world with energies undiminished by the anger and
self-doubt engendered among racism’s victims” (López, 1998). Whites are not reminded that
they are White nearly as often as minorities are reminded that they are not White. López and Bell
believe that it is far easier for a majority group to support the idea of “colorblind” legislation
because they do not worry that their group will be underrepresented. Though faculty selection
committees may be legally bound to making “colorblind” decisions, the fact remains that there
are more White faculty members than non-White across the country. The intention of
“colorblind” is to prevent an underrepresentation of non-Whites by prohibiting their race from
being considered, thus reducing the likelihood of discrimination. Unfortunately, this tool is not
working in the manner in which it was intended.
A long-time civil rights advocate and attorney, Bell (2004a) has argued that colorblind
legislation has perpetuated the de facto ruling-class mentality of the White majority that has
thwarted significant university faculty diversity. Bell claimed that Harvard Law School hired him
and granted him tenure to “make themselves look good” (Pyatt, 1998) as affirmative action
efforts swept across campuses nationwide. When, 20 years later there were still no women of
color on the law faculty, Bell told the university he would take a leave of absence until one was
hired, to which dean Robert Clark responded, “This is Harvard Law School not some lunch
counter in the South” (Pyatt, 1998). It was neither the first nor the last time Bell took a hardline
stance on principle over the issue of faculty diversity: named the first-ever dean of a non-
historically Black law school in 1980, he resigned 5 years later after he was “directed not to
appoint an Asian-American faculty candidate” (Pyatt, 1998). The shift toward “colorblind”
26
policies hasn’t worked in accomplishing diversity, according to Bell, because it has simply
driven prejudices into the unconscious mind. “Nestled deep in the unconscious racial motivations
are typically repressed, frequently lied about, and often disguised by after-the-fact
rationalization. Thus, by requiring proof of intent, anti-discrimination law renders the multitude
of manifestations of unconscious racism beyond legal redress” (Bell, 2004b). Those in charge of
hiring, therefore, may search out reasons not to hire minorities, without even knowing they are
doing so, based on prejudices they do not recognize or admit to having.
However, as mentioned briefly above, race and faculty selection do not exist in a
vacuum; faculty is not selected for being White or non-White, but primarily for the candidates’
academic achievements and potential. It is nearly impossible to look at statistics of White versus
non-White faculties and determine in which cases non-White candidates were not hired because
of their race, and in which cases they simply were not the most qualified candidate. There is no
data on how many non-White faculty members hold positions that were applied for by White
candidates.
Additionally, non-White candidates who are not hired because of insufficient
qualifications may not have had the same opportunities to accumulate resume-worthy experience
due to racial discrimination earlier in life. In other words, a hiring committee might not hire a
non-White candidate only indirectly due to discrimination—not because the committee was
racist, but because the candidate under consideration was a product of societal racism that
prevented him or her from ever competing with Whites. Bell does not explore these two quality-
related nuances of unequal treatment of Whites and non-Whites. By failing to do so, he allows
the focus on discrimination to remain on present-day hiring decisions, overshadowing the
discriminatory historical circumstances that have led to such decisions.
27
The importance of the concept of the social construct of racial diversity and
discrimination to the issue of faculty representation cannot be overstated. It can cause even those
who are well meaning to be blinded to the obvious. Understanding the influence of social
constructs means looking at the unsuccessful efforts to integrate schools through bussing after
Swann v. Charlotte-Mecklenburh Board of Education in 1971, and recognizing that black and
white children are not pawns who can be shuffled around until everything is “fair;” they are
people embedded in a context, in neighborhoods, and until those environments change, where
culture and opinion is deeply rooted, superficial efforts to mix people up will never succeed. The
bussing was instituted with the best intentions to integrate, but without a grasp of what
integrating requires. This lack of understanding of social constructs of diversity and
discrimination and the influence they have on faculty representation is not only a racial issue, but
a gender issue as well.
From a nationwide population standpoint, women are not a minority, but they still face
discrimination in hiring and salary today. Consider system-wide demographics for University of
California faculty in 2007: 62.7% of the full professors were men, and 48.8% of the full
professors were White men; 13.8% of the full professors were women, and 11.6% of the full
professors were White women (UC, 2009). These numbers are not drastically different from the
numbers in 1989: 63.3% of the full professors were men, and 57.5% of the full professors were
White men; 5.8% of the full professors were women, and 5.1% of the full professors were White
women (UC, 2009). In considering how to approach recruiting and retention policies that
encourage diversity, therefore, attitudes towards not just female professors but female doctors as
well must be taken into account.
28
Overall, readings in the area of diversity, population studies, and underrepresentation
suggest that the main reason that faculty diversity does not correlate with demographics is that
the issue has generally been considered from the White majority paradoxical perspective of how
to achieve diversity without changing the status quo.
Institutionalized Discrimination and Other Barriers to Faculty Diversity
America’s history and laws track a slow climb toward equality mandates. Fortunately,
while there is ample room for improvement, the trend has been away from subjugation and
toward equality. In order to get a sense of the rate of progression towards equality for all, it is
important to look back to the start of the recognition of inequality as a) an existing phenomenon,
and b) one that should be changed. The current unequal representation of minorities on university
faculties is not an isolated situation and it did not arise in a vacuum of academia or any other
faculty-specific arena. This narrow yet vital microcosm of inequality is embedded in a larger
historical narrative, and a discussion of faculty inequality would be remiss if it did not address
the genesis of the entire construct. A logical starting point is the famous Dred Scott v. Sanford
Supreme Court case.
Other Barriers to Faculty Diversity: Realities and Myths
One barrier to faculty diversity in University of California medical schools is the
differential retention rates. A report on the University of California system overall indicated that
“retaining [women and minority scholars] is a significant challenge…. The higher rates of
turnover also may be influenced by a lack of ‘critical mass’ in many departments and perceptions
of a hostile climate in California” (UC, 2000). Faculty turnover is an issue unto itself, as women
and minority scholars cannot be hired into positions that are not available. “Because faculty
careers can last up to 40 years, the rate of demographic change is necessarily slow” (UC, 2006).
29
Another barrier to diversity recruitment and retention of minorities and women is the
sense or fear of being the “token” hire. One study showed show that when a department has only
one minority or woman, that person is not only suspected of being less than 100% qualified
(Turner et al., 1999), but also soon finds the workload nearly unbearable. “All too often, minority
faculty members are expected to handle a full teaching load, produce a large number of
published articles on their individual research, and then serve as the minority representative on
every panel, committee, or community service project” (Murray, 1996, as cited in Stovall, 2004).
The Affirmative Action Plan
In order to assist federal employers, federal contractors and other employers that receive
federal funding, in addressing the issue of ensuring equal employment opportunities, the Code of
Federal Regulations (C.F.R.) included a guideline for allowable Affirmative Action Plans (AAP).
The C.F.R. acknowledges that, absent discrimination in the hiring process, an employer’s
workforce would reflect the gender, racial and ethnic makeup of the labor pool from which it
draws (C.F.R., 2011). It is the intent of the C.F.R., therefore, to utilize the Affirmative Action
Plan as a tool to institutionalize the commitment of federal employers to equality in employment
practices through a process of regular evaluation and monitoring of employment and
compensation decisions and the impact of those decisions on women and minorities (C.F.R.,
2011).
As a recipient of federal funds, the University of California was required to abide by the
Affirmative Action Plan guidelines provided by the C.F.R. and develop its own plan for
improving equality in its employment practices. The UC, however, saw the pursuit of such
practices as an academic imperative (UC, 2002). In its study Affirmative Action Guidelines for
Recruitment and Retention of Faculty, the university found that the diversity of worldviews, life
30
experiences and interests that would come from such efforts would greatly enhance its ability to
achieve its academic mission (UC, 2002). In addition, the needs of the diverse population of the
state could be better served by promoting equal employment opportunities and better utilizing
the intellectual resources that could come from the improved diversity (UC, 2002). As a result,
the UC set out to create an AAP that would incorporate the guidelines established in the C.F.R.
while accommodating for the idiosyncrasies of employment practices within higher education.
The resultant framework will be utilized in the analysis of this research and is addressed in detail
below.
Anti-Affirmative Action Movement and Proposition 209
University faculty equality efforts can learn a lot from student equality efforts, which
have made great gains through the affirmative action movement. Case law in higher education
has historically focused on student rights, but being embedded in the same academic context has
a lot to offer faculty equality activism. Analyzing both how the affirmative action movement has
succeeded and where it met its greatest challenges will provide the faculty equality movement
with great tools for success.
There are still challenges, including legal ones, to inclusion in general and to affirmative
action in particular. The first serious effort to dismantle its policies in the educational sector did
not appear until 1978 when a White man twice rejected by the University of California at Davis
Medical School sued, openly challenging the school’s affirmative action admission standards.
Allan Bakke claimed he was denied not because he was less qualified than other applicants but
because the school had reserved 16 out of 100 admission slots for minority applicants (Bell,
2004a; Sander, 2004). The school had both regular admissions and “special admissions” in which
certain candidates could be exempted from the regular candidates’ grade-point cutoff. The views
31
from the bench in the Supreme Court’s 1978 decision in Regents of the University of California
v. Bakke were mixed. Four of the justices felt that the school had used an illegal quota system;
four of the justice felt that the school’s admissions policy was acceptable. Justice Powell argued
that quotas were illegal but that some consideration of race as one of many criteria ought to be
allowed. Ultimately the Court ruled along the lines of Justice Powell’s argument (Regents of the
University of California v. Bakke, 438 U.S. 265 (1978)).
The ruling did not end the controversy but instead seemed to fuel the fervor of those who
argued that any consideration of race was unfair preferential treatment spurring a number of
similar so-called reverse discrimination cases (Rubio, 2001; Bell, 2004b; Sander, 2004). In 1996,
a White woman sued the University of Texas Law School, claiming that her Texas Index (TI)
score (a composite undergraduate GPA and LSAT scores) was higher than those of some black
and Mexican-American applicants who had been accepted (Rubio, 2001; Moody, 2004). As
Moody pointed out, Cheryl Hopwood had also outscored over 100 other White applicants who
were accepted, although neither she nor the Courts considered that relevant. She had more than
likely been rejected, as is common among graduate schools, because her application was based
on attendance at several community colleges and a state school rather than an elite undergraduate
college or university, the primary feeder schools for postgraduate and professional institutions
(Anderson, 2004; Bell, 2004). In the US Court of Appeals for the Fifth Circuit case Hopwood v.
Texas, 78 F.3d 932 (5th Cir. 1996) ruled in her favor—the first successful challenge to
affirmative action since the Bakke case but not the last (Rubio, 2001; Anderson, 2004). The
Hopwood case reversed the Bakke decision and “tossed professional, graduate school and
undergraduate admission standards up in the air” (Anderson, 2004, p. 254). The U.S. Supreme
Court refused to take up the Hopwood appeal since the school had changed its admission policies
32
and rendered the case moot - leaving admissions and human resources personnel bewildered for
seven years until the University of Michigan cases (Anderson, 2004).
In 2003 affirmative action opponents mounted an offensive with two cases, one against
the University of Michigan Law School and one against the undergraduate admissions policies of
the University of Michigan. The White plaintiffs all argued that only “reverse discrimination”
could explain their rejections. Affirmative action proponents changed their past strategy of
arguing for the programs as remedial action for past discrimination and concentrated instead on
extolling the virtues of diversity to the schools and society in general.
They bolstered their case with 64 amici briefs representing more than 3,000 organizations
supporting the university, including academics, labor unions, at least 110 members of Congress,
70 different Fortune 500 companies, and nearly 30 retired military and civilian defense officials,
including U.S. Army General Norman Schwarzkopf, who argued that without affirmative action
military academies would have an impossible job of recruiting minority officer candidates
(Anderson, 2004; Schemo, 2004). The amici briefs all said that their institutions required a
racially diverse, well-educated work force for their continued success (ibid). The essential
debate—was considering race as a factor preferential treatment or just a temporary adjustment to
address past injustices—is the same one that led to California’s Proposition 209.
The results from the two Michigan cases were mixed. In the case against the
undergraduate admissions policies, Gratz v. Bollinger, the Court majority declared that the
policy, “which automatically grants 20 points, or one-fifth of the points needed to guarantee
admission to every single underrepresented minority applicant solely because of race, is not
narrowly tailored to achieve the interest in educational diversity that respondents claim justifies
their program,” (Gratz v. Bollinger, 539 U.S. 244 (2003)), which was a victory of sorts for
33
opponents of affirmative action. However, in the other case, Grutter v. Bollinger, there appeared
to be a sea change on the bench. In earlier cases, Justice O’Connor had voted with the four
conservative justices against affirmative action policies. In this case, she voted in favor of the
school, and her swing vote gave supporters of affirmative action a victory, too. Justice O’Connor
argued that the University of Michigan Law School’s admission process involved a “highly
individualized, holistic review of each applicant’s file, giving serious consideration to all the
ways an applicant might contribute to a diverse educational environment,” and that while race
was considered as a factor, it was not used in a “mechanical way” (Grutter v. Bollinger, 539 U.S.
306 (2003)).
While these cases were concerned with college admissions rather than faculty recruitment
and retention, their rulings rippled through the federal policies toward affirmative action and
diversity and affected all employers of a certain size. Following the rulings in these cases, set-
asides—federal programs requiring a certain percentage of government funds to be reserved for
businesses owned by women and minorities—were largely abandoned, as was the use of
assigning admissions policies that included race as part of a point system. Substituting class-
based affirmative action was discontinued as well after studies showed that because too few poor
minorities were graduating from high school such as policy would ultimately result in fewer
minorities in college and more poor Whites (Anderson, 2004). Additionally, the administrative
bodies charged with defining admissions policies are generally part of the same boards and
departments that consider faculty hiring and diversity policies.
Proposition 209
Opponents of affirmative action loudly denounce the effort to influence admissions and
hiring to enhance diversity as nothing more than conferring special privileges. The effort to ban
34
anything that suggested racial preferences or quotas rose to a groundswell in California with a
series of legislative changes culminating with Proposition 209; the state’s anti-affirmative action
momentum carried the movement across the country, and provided much of the momentum for
the University of Michigan and other suits.
It began in July 1995 with two resolutions adopted by the California Board of Regents,
SP-1 and SP-2. The former removed race and gender from consideration in the student admission
policies; the latter removed race and gender from consideration in the University of California’s
hiring and contracting polices, except in cases where doing so might cause the loss of federal or
state funding (UC, 2001). According to Bates & Chapman (2008), SP-1 and Proposition 209
precipitated a decline in Latino and African-American enrollments in California medical schools.
Detractors were wise enough not to attack directly the goals of affirmative action, only the
methods. The common public perception was that belonging to an underrepresented minority
was enough in and of itself to guarantee admissions or employment, and that race was not being
considered merely as a “plus factor” but as free pass for non-Whites. Had the people of
California been more confident that race was just one of many considerations they might not
have pushed to ban racial preferences in higher education altogether (Ali Raza, 1999).
Proposition 209 bans preferential hiring based on race, gender, or national origin. In
summary, readings on the anti-affirmative action movement and Proposition 209 suggest that for
diversity-conscious faculty recruitment and retention policies and programs to be successful and
accepted, they must not have even the appearance of providing preferential treatment, special
considerations or advantages, or quotas. In addition, any policies to attract or retain
underrepresented faculty must be backed by statistical evidence that they are applied fairly and
do not discriminate against majority members.
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Accreditation
Accrediting agencies for institutions of higher learning emerged in the United States
more than a century ago. Their original purpose was to help prospective students determine
which schools were high-quality institutions committed to maintaining high standards of
learning, and which were not. Until 1952, accreditation was strictly voluntary, although most
colleges and universities chose to pursue it to add to their credibility. The 1952 Higher Education
Act, however, changed the voluntary nature of accreditation by requiring that any student
receiving federal funds to attend a college or university could only do so if the school in question
was accredited. At this point, accreditation took on an unprecedented significance as a
precondition for receiving increasing amounts of federal funds (Leef & Burris, 2003, p. 49).
Some universities and other educational institutions believed that the accreditation
process could help them in their efforts to attract and retain diverse faculty and ameliorate the
under-representation of minorities while still avoiding “reverse discrimination” and
homogeneity. Congress later amended the Higher Education Act to strengthen requirements that
had to be met by the Department of Education and requiring accreditation organizations to
develop standards regarding, among other things, faculty (Leef & Burris, 2003). A recent study
of the accreditation organizations, however, suggests that far from helping they may in fact be
harming the efforts to achieve diversity. “Accrediting standards can actually undermine colleges’
institutional missions and subordinate academic goals to non-academic considerations” (Leef &
Burris, 2003, p. 26). For example, one North Carolina university was put on probation because
its teachers were expected to teach 15 hours per week and the accrediting institution claimed that
12 should be the maximum. As a result, many classes were combined so that the small classes
that attracted so many students to the school grew to 60 or more students. Accreditors often
36
demand that all teachers meet a specific set of criteria and list of credentials rather than allowing
instructors with professional experience that can be just as or even more valuable.
Critiques of accreditation have argued that accreditation is not effective, in part, due to
not being rigorous or transparent enough to really raise the level of accountability in higher
education. Other critiques include that accreditation is inflexible and therefore stifles creativity
which would be beneficial in educating students. The compliance process is also so burdensome
that institutions expend all their energy in the paperwork and actually gain little from the self-
improvement element of the process. Partial solutions include a greater emphasis on research
involving quantitative social science techniques to determine the relationship between
accreditation and performance; the question is being asked by many, “Does accreditation really
work?” (Floden, 1980; Lederman, 2009).
Accreditation is not a transparent process: member lists and lists of any sanctions are
made public, but without detail. It is not a guarantee of a school’s quality, or that of individual
programs or departments (Leef & Burris, 2003; ACTA, 2007). “Accreditation is a conflicted,
closed, and clubby system” (ACTA, 2007, p. 14) in that when member schools are “evaluated”
by the very same organizations to which they pay annual dues and fees. In addition, the teams of
evaluators are generally drawn from other schools in the region, so rather than seeing each other
as though they are competing to be the best, they tend to view themselves as equal, dues-paying
members of an exclusive club (ACTA, 2007).
In the United States and Canada, the accrediting body for medical education programs
leading to the degree of M.D. is the Liaison Committee on Medical Education or LCME (LCME,
2008). Most medical licensing boards require that a medical school be accredited by the LCME
in order for graduates to be eligible for licensure to practice in the field of medicine (LCME,
37
2008). LCME accreditation is also required for students to receive federal loans to attend
medical school, as well as for many federal research and program grants (LCME, 2008).
The LCME accreditation standards do not detail the specific qualifications required of
medical school faculty, but rather leave such qualifications open to the interpretation of the
individual schools, merely stating that faculty members “must have demonstrated achievements
commensurate with their academic rank” (LCME, 2008). Rather than citing specific
requirements, the brief section on faculty names certain requirements that a medical school
“must have,” and then describes those requirements in generalities: “a sufficient number of
faculty…the full faculty should meet often enough…appropriate instructional facilities” (LCME,
2008). This demonstrates the superficiality of accreditation, and how it is possible that schools
may be accredited without being held to higher standards. Recognizing this superficiality is
important when analyzing the inherent value of accreditation, or lack thereof.
Medical schools wishing to achieve accreditation must also follow the LCME’s new
diversity requirement detailed in New Standard IS-16. While the new standard is not impossible
to follow while remaining in compliance with Proposition 209, doing so requires extra vigilance,
creativity, resourcefulness, effort, and careful legal review. Unfortunately, the LCME added its
requirement for diversity without suggesting how it should be achieved or even how it should be
measured. As a result, it remains unclear as to whether the LCME will accomplish the
improvements in faculty diversity it had intended with this new requirement.
Conclusion
Demographics in the state of California are changing. As the percentage of healthcare
consumers shifts to comprise more minorities, the percentage of practicing physicians in the state
should keep pace. Minority medical school students should have the benefit of learning from
38
minority faculty, mentors, and role models, providing culturally competent healthcare to
underserved populations. This means that minority faculty diversity must also keep pace with the
shifting demographics of the state. Thus far, they have failed in this.
The literature suggests that although historical, traditional, and legal hurdles still exist,
the need for diversity among University of California medical school faculty is greater than ever.
Readings further suggested that despite restrictions imposed by SP-2 and Proposition 209,
achieving faculty diversity will be a challenging but far from impossible task.
39
CHAPTER 3: METHODOLOGY
Design Overview
The primary purpose of the study was to examine past and current recruitment and
retention policies, programs, and practices at University of California medical schools and to
identify strategies that both (a) successfully enhance faculty diversity, as measured by significant
demographic changes, and (b) comply with both the LCME Accreditation Standard IS-16 on
diversity and Proposition 209. Both quantitative and qualitative research methods, described in
detail below, were needed to address specific components of the research questions:
Primary Question:
• What best practices have been developed by University of California medical schools
to achieve faculty diversity as required by LCME accreditation standards while
maintaining compliance with Proposition 209?
Secondary Questions:
• To what extent do leaders at the University of California medical schools see LCME
accreditation standards and Proposition 209 compliance requirements as being in
conflict with one another?
• What modifications have the leaders of University of California medical schools
made to earlier recruiting practices in an effort to improve faculty diversity while
maintaining compliance with Proposition 209?
• What recruiting practices currently in place at the various University of California
medical schools have shown promise in achieving faculty diversity while remaining
in compliance with Proposition 209?
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Analytical Framework
As an analytical framework, the researcher drew from the University of California’s
“Affirmative Action Guidelines for Recruitment and Retention of Faculty” (2002). In its
document, the University of California refers to the Code of Federal Regulations for the elements
of an allowable Affirmative Action Plan (AAP). According to the C.F.R., such an action plan
must employ the following six quantitative analyses: (1) organizational profile; (2) job group
analysis; (3) placement of incumbents in job group; (4) determining availability; 5) comparing
incumbency to availability; and (6) placement goals (UC, 2002). Of these elements, the UC
determined that only the final three were valuable to hiring practices within an academic
environment.
The AAP was the best framework for the study for several reasons. First, it took into
account the federal guidelines for pursuing any proposed Affirmative Action program that an
institution may consider. It itemized those guidelines that had already been evaluated as being
allowable or expected when working to address diversity issues within an institution’s
workforce. Second, the University of California’s AAP only utilized those aspects of the federal
guidelines that were most pertinent to the realm of faculty diversity and hiring. Finally, data had
already been collected by the University of California in such a manner that would greatly aid in
the answering of the research questions posed in the study.
The framework enabled the researcher to ascertain how the hiring practices of the
respective medical schools were implemented with respect to achieving faculty diversity. Data
derived from records and document analysis and interviews demonstrated how the schools
defined the terms “availability” and “incumbency” and how they measured each. Additionally,
the analysis revealed the extent to which schools delineated their placement goals and what
41
efforts were undertaken to achieve those goals. Changes in these definitions, measurements and
goals in response to the implementation of Proposition 209 or the new LCME accreditation
standards illuminated how these directives affected the institutions and the extent to which the
respective schools endeavored to adapt to them. The application of this framework will be
discussed below.
Study Population
The focus of the study was the faculties of five of the six medical schools that were part
of the University of California System during the period of the study: UC San Francisco, UC
Davis, UC San Diego, UC Irvine, and UC Los Angeles (the sixth medical school, UC Riverside,
did not exist at the time of the research period of this analysis and was therefore not included in
the study). The populations examined included both basic sciences and clinical faculty members.
The study also focused on the current deans, associate deans and chairs of the five medical
schools. The study included only those faculty members who hold or held the rank of professor,
associate professor or assistant professor as these were the three levels for which relevant
diversity data had been collected consistently by the UC system for the years preceding the
study. Including faculty levels below the lowest level of assistant professor might have affected
the findings; using the same classifications to dictate which data should be collected added
validity to the comparisons of pre- and post-Proposition 209 diversity statistics. The study used
data sets from one year prior to the passage of Proposition 209, five years after the passage of
Proposition 209, ten years after the passage of Proposition 209, and the 2010–2011 academic
year.
The researcher also conducted a case study of one of the five medical schools—
University of California, Los Angeles (UCLA). The use of a case study was intended to reveal a
42
deeper understanding of how school administrators perceived the school to have been affected by
the application of Proposition 209 and the new LCME accreditation standards. UCLA was
chosen as the subject for this case study due to the increased likelihood of access to research
subjects and data as the researcher was an employee of UCLA.
Quantitative Analyses
Demographics
Faculty demographics. The foundation of the study was statistics detailing faculty
diversity at UC medical. These statistics were gathered from various sources within the
University of California records database. The university system has compiled many years’
worth of demographic information on not just students but faculty, administration, and support
staff as well. It has also issued numerous reports and updates on the state of faculty diversity. The
periods of evaluation included one year prior to the implementation of Proposition 209, then five
and ten years after the implementation. It was intended that the data collected before the
implementation of Proposition 209 would demonstrate the demographic make-up of the faculty
prior to the time of implementation. Data collected five years after implementation would
demonstrate any changes to the demographic make-up of faculty once Proposition 209 was fully
implemented, and data collected ten years after would illustrate any relevant trends that
developed over time. It was important to review data from these years in order to discern
relevant patterns in hiring and retention policies and procedures related to enhancing faculty
diversity.
State population demographics. The study required that minority representation among
the various University of California medical school faculties be examined in relation to the
racial, ethnic, and gender makeup of the local and national populations. Data were collected from
43
federal census records as well as from relevant reports and peer-reviewed articles from the time
periods listed above and used to evaluate the extent to which faculty demographics reflected
these broader groups.
Qualitative Analyses
Qualitative research methods in general and interviews in particular are well suited to
data collection where nuance and perception are as important as numbers and statistics to the
findings and analyses. According to Hernandez (2000), qualitative information can help fill in
the gaps left by quantitative data collection, capturing the complexities that cannot be portrayed
through numbers alone. Records research, document analysis and interviews helped to provide a
fuller understanding of how well the diversity programs worked in the past, were still working,
and could work in the future by offering the kind of subjective insights and richness that could
only come from personal narratives and the documentation efforts of those who worked to codify
their organization’s response to complex issues. As the medical schools worked to adjust their
hiring practices to account for Proposition 209 regulations, and then the LCME accreditation
standards, documents such as policy and procedure manuals, departmental hiring memoranda
and the accreditation documents themselves underwent significant revisions. Such revisions were
designed in a manner to achieve necessary compliance while clearly articulating their intended
outcome and illustrating the vision of the institution to achieve academic excellence. Through
analysis of such documents, and the interview responses of those responsible for adhering to
them, this approach revealed a richer understanding of the conflicts that arose as a result of the
introduction of these regulations.
Key components of the research questions for the study included information about past
and present recruitment and retention programs and policies, as well as suggestions by informed
44
University of California personnel about how these might be still further enhanced through
expansion or other modifications and refinements to be most effective under the Proposition 209
guidelines. Three methods were used to accomplish this: records research, document analysis,
and in-depth interviews.
Records Research
The President’s Task Force on Faculty Diversity of the University of California System
maintains records tabulating the results of various programs for faculty recruitment and
retention. Additionally, the various universities within the system keep similar records, many in
direct response to the President’s Task Force on Faculty Diversity’s Campus Data Requests.
Reports were available from 1995 through the present and covered a variety of topics. UC Davis,
for example, published UC Davis Response to President’ s Task Force on Faculty Diversity,
Campus Data Request: Assessment of 2001–02 Hiring of Women Faculty (University of
California Davis, 2003). University of California Los Angeles published Diversity Statistics:
Excellence in Medicine (David Geffen School of Medicine, 2008). While most lacked any
content describing the specifics of the program, they did provide more detailed breakdowns of
the demographics within the medical schools and even within individual departments. These
results were used to further track trends in diversity, and were correlated by time frame with any
descriptive information found to be available.
Document Analysis
The researcher conducted an analysis of the policy-related documents created by the UC
medical schools both pre- and post-Proposition 209 that pertained to the diversity efforts of the
respective schools. This analysis identified trends toward the acceptance or rejection of such
diversity efforts or their perceived efficacy. The researcher also obtained and analyzed
45
accreditation-related documents to identify changes or planned changes related to hiring
practices or the promotion of faculty diversity taking place in conjunction with the introduction
of LCME New Standard IS-16.
Interviews
For the case study of the UCLA school of medicine, the researcher conducted interviews
with the dean, associate dean and department chairs, as well as with those school officials
charged with achieving and maintaining compliance with LCME accreditation standards, to the
extent that members of these populations agreed to participate in the study. The researcher also
gathered demographic information on the interview participants, as they were members of one of
the data sets in the study. The goal of the interviews was threefold: (a) to gather data about the
perception of the degree to which LCME standards are in conflict with Proposition 209 and the
extent to which accommodations had been made to reconcile any such conflict, (b) to discover
the respondents’ perceptions of which practices, either past or present, had shown promise in
achieving faculty diversity while remaining in compliance with Proposition 209, and (c) to elicit
suggestions for modifications to current recruiting and retention practices to improve faculty
diversity at the school while remaining in compliance with Proposition 209.
The interviews used the following open-ended questions regarding experiences with the
development and implementation of recruitment and retention programs and policies, both
successes and failures, in an attempt to gather data about perceived “best practices” in the
endeavor of increasing faculty diversity both pre- and post-Proposition 209:
• To your knowledge, did your school make changes to its hiring practices after the
passage of Proposition 209 in order to (1) improve compliance with the proposition,
46
(2) improve faculty diversity opportunities following the initial implementation
efforts, or (3) both. If so, what were those changes?
• In order to meet the LCME accreditation standards for faculty diversity, has your
school made, or will your school need to make, modifications to its faculty recruiting
practices? If so, how are these practices likely to change?
• Given the changes in LCME accreditation standards that now require medical schools
to achieve faculty diversity in the context of their respective local and national
responsibilities, do you believe this creates a contradiction with the tenets of
Proposition 209?
• What is your perception of how Proposition 209 applies to hiring practices at state
institutions such as UC medical schools?
• What recruiting practices currently in place at your school have shown promise in
achieving faculty diversity while remaining in compliance with Proposition 209?
Data from these interviews enabled the researcher to better understand how the
implementation of practices, such as faculty hiring, took place in response to external changes
such as new legal requirements or accreditation standards. Responses from the dean, associate
dean, department chairs and accreditation administrators helped to illustrate how responses to
such changes were prioritized, as well as how the changes were communicated to, and
implemented at, the respective UC medical schools.
47
Data Analysis
Quantitative Data Analysis
The Affirmative Action Plan framework was used to evaluate the extent to which the
University of California medical schools worked to adjust their policies and procedures to
achieve faculty diversity while following the implementation of Proposition 209. Data was
analyzed to determine both how the schools defined the terms “availability” and “incumbency”
and how they measured them. These measurements were compared against any placement goals
that were developed by the schools. The data was recorded, tabulated, developed into tables and
graphs, and evaluated within the AAP framework. This enabled the researcher to measure the
success of the UC medical schools in achieving effective diversity hiring.
Qualitative Data Analysis
The researcher developed a coding process utilizing the Affirmative Action Plan
framework and will code the data according to the key concepts of (1) availability;
(2) incumbency; and (3) placement goals. The frequency with which these themes were reported
was calculated and analyzed manually for patterns, with an attempt made to correlate the themes
with pre- or post-Proposition 209 implementation timeframes. Additionally, the researcher
sought to elicit deeper meanings within the documents and interviews. This included such
nuanced findings as how the treatment of the subject has changed over the course of time, the
meanings embedded within the various texts, and the extent to which documents demonstrated
the value upon which the respective medical schools placed the issue of faculty diversity.
Conclusion
By analyzing both the quantitative and qualitative data according to the AAP framework,
patterns emerged and demonstrate the extent to which the medical schools were able to achieve
48
faculty diversity both before and after the implementation of Proposition 209. The researcher
further utilized the AAP framework data to answer the subordinate research questions regarding
what changes were made in recruiting practices following the implementation of Proposition 209
and whether new, potentially conflicting changes were needed to accommodate the
implementation of LCME accreditation standards. Finally, analyzing the success of the various
medical schools in relation to one another in achieving faculty diversity despite changes in the
regulatory environment allowed the researcher to identify a set of best practices.
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CHAPTER 4: RESULTS
Introduction
This study was designed to identify any “best practices” that may have been developed
by University of California medical schools to achieve faculty diversity as required by LCME
accreditation standards while maintaining compliance with Proposition 209. Additionally, it
endeavored to discover the extent to which the schools saw LCME accreditation standards and
Proposition 209 compliance requirements as being in conflict with one another, what
modifications were made to their recruiting practices to accommodate such a conflict, and which
practices showed the greatest promise to achieve faculty diversity given these constraints. The
study used the two-prong approach discussed in Chapter 3: (a) quantitative analysis involving a
review of demographic statistics; and (b) qualitative analysis involving records research,
document analysis, and interviews. The findings are presented below, organized first by research
approach (i.e., Demographic Statistics, Records Research, Document Analysis, and Interviews)
and then combined in a summary section.
Nationwide, medical school faculty demographics do not reflect the diversity of the
country as a whole, nor do they reflect the diversity of the student body (Andriole et al., 2010).
In California, just 7% of physicians come from communities of color (UCDHS, 2011).
According to Marc Nivet, chief diversity officer for the Association of American Medical
Colleges, African Americans and Hispanics make up only about 7% of all applicants nationwide
to medical colleges, and American Indians, Alaska Natives, and Hawaiians/Pacific Islanders
make up just 1% (UCDHS, 2011, p/ xvi). Similarly, the demographics of California’s medical
professionals do not reflect the diversity of the state’s population (Health Sciences Committee,
2004). This is clearly demonstrated in Figure 1. Most California physicians are white (66%); the
next largest group is Asian/Pacific Islanders (22%), followed by Hispanic/Latinos (4.4%), and
50
African Americans (3%); Native Americans/Alaskan Natives and other races combined represent
3.9% (Health Sciences Committee, 2004, p. 3). Furthermore, fully 75% of the active California
physicians involved in patient care attended medical schools outside the state (Salsberg, 2004).
Figure 1. Race/ethnicity of active patient care physicians in California vs. population.
Source: AMA Masterfile, California Department of Finance, Salsberg, 2004.
Demographic Statistics
Recent Historical and Current Demographics
For the purpose of this study, “recent historical and current demographics” is the period
since 1990, using the following reasoning. First, the United States conducts its national census
every 10 years. Second, the University of California Board of Regents passed resolution SP-2 in
1995, which prohibited the university system from using racial, gender or similar factors when
hiring faculty and staff. Using the 1990 census data would thus include information from before
the first regulatory milestone in this study, 1995. Subsequent census data would cover the
51
additional regulatory milestones: (a) 2001, the rescinding of SP-2 and the passage of Proposition
209; and (b) September 20, 2007, the date of the Policy on University of California Diversity
statement. That statement included the declaration that the University “particularly acknowledges
the acute need to remove barriers to the recruitment, retention, and advancement of talented
students, faculty, and staff from historically excluded populations who are currently
underrepresented” (Regents, 2007). This study focused primarily on data sets from one year prior
to the passage of Proposition 209, five years after the passage of Proposition 209, ten years after
the passage of Proposition 209, and the 2010–2011 academic year.
The United States. The U.S. population more than tripled during the 20
th
century, rising
from 76 million in 1900 to 281 million in 2000, with the largest single-decade surge coming in
the 1990s (Hobbs & Stoops, 2002). The population in the western states grew faster than that of
any other region, although the northeast remained the most densely populated area. Between
1980 and 2000, the Hispanic population in the country more than doubled. In 1900, the state with
the highest population was New York at 7.3 million; by 2000, the state with the highest
population was California, at 33.9 million. In 1900, only 1 in 8 Americans was of a race other
than White; by 2000, that number was 1 in 4 (Hobbs & Stoops, 2002). “The minority population
grew 11 times as rapidly as the White non-Hispanic population between 1980 and 2000” (Hobbs
& Stoop, 2002, p. 80). The percentage of all people classified as among a “minority” population
combined (i.e. of races other than White or of Hispanic origin) increased by 88% between 1980
and 2000; the White non-Hispanic population grew by just 7.9% in the same period (Hobbs &
Stoops, 2002).
California. While the U.S. population increased by more than 200 million from 1900 to
2000, California’s growth alone accounted for nearly one-sixth of that increase (Hobbs & Stoops,
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2002): “In 1900, California’s population was about the same as the population of Kansas (1.5
million) but, over the next 10 decades, California increased by 32.4 million while Kansas grew
by an additional 1.2 million people” (p. 24). By the year 2000, the combined percentages of
minority populations in California was greater than 50% (Hobbs & Stoops, 2002).
Projected Demographics
The United States. The 2009 National Population Projections used four alternative net
international migration assumptions to arrive at the range of estimates: high net international
migration, low net international migration, constant net international migration, and zero net
international migration (Ortman & Guarnari, 2009). As shown in Figure 2, all four projections
indicate that in 2050 the U.S. population will increase significantly, with totals between
323 million (zero net international migration) and 458 million (high level net international
migration).
53
Figure 2. Projections of the total population for the United States: 2010 to 2050 (in millions).
As shown in Figure 3, the overall effect will be not just more people in the United States,
but a more racially and ethnically diverse nation:
The highest levels of net international migration correspond to the largest amount of
growth for the Asian and Hispanic populations, which are the primary immigrant groups
to the United States. For both the Low and High Net International Migration series, these
populations are projected to more than double in size between 2000 and 2050. Even if net
international migration is maintained at a constant level of nearly one million, the
Hispanic population is still projected to more than double between 2000 and 2050, while
54
the size of the Asian population is projected to increase by 79 percent. (Ortman &
Guarneri, 2009, p. 3)
Figure 3. Projections of the percent minority for the United States: 2010 to 2050 (percent).
By the year 2030, all members of the “Baby Boomer” cohort will have moved into the
older population (65+), resulting in a slight rise in the median age between 2010 and 2050.
Depending on which of the four models is used to determine the projections, the “crossover”
point at which the number of individuals in the “majority” (defined by the U.S. Census as those
who are White alone or Hispanic) will be surpassed by the combined number of individuals of all
those classified as “minority” (defined by the U.S Census as races other than White alone or
Hispanic) will occur sometime between 2040 and 2050 (Ortman & Guarnari, 2009).
55
California. The State of California produces its own demographic projections. Those
released in July 2007 by the California Department of Finance indicated that the state expected
to add an additional 25 million people to the totals found in the 2000 decennial census
(34 million), projecting a total state population in 2050 of almost 60 million people (Heim &
Martindale, 2007). The racial makeup of the state is expected to reflect current trends, resulting
in the percentage of Hispanics topping 50% by 2042; the projections for 2050 show the
population will be approximately 52% Hispanic, 26% White, 13% Asian, 5% Black, and
2% multi-race, with American Indian and Hawaiian/Pacific Islander groups each making up less
than 1% (Heim & Martindale, 2007, p. 1).
The California Department of Finance further broke those population projections down
by county. Los Angeles is expected to remain the state’s largest county, with 13 million people
by 2050. Second-, third-, and fourth-largest will be Riverside (4.7 million), San Diego
(4.5 million), and Orange (4 million) respectively (Heim & Martindale, 2007, p. 1). This study
was concerned with five of the six medical schools that are part of the University of California
System: UC San Francisco (San Francisco County), UC Davis (Yolo County), UC San Diego
(San Diego County), UC Irvine (Orange County), and UC Los Angeles (Los Angeles County)
(the sixth, UC Riverside, did not exist at the time of the research period of this analysis and was
therefore not included). The racial diversity for the years 2000 and 2050 in counties containing
the five UC medical schools in this study is shown in Figure 4 below.
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Figure 4. Racial breakdown in 5 California counties with UC medical schools, 2000 and 2050.
As Figure 4 shows, all five of the counties relevant to this study will experience a
significant shift in demographics. In each of the counties, except San Francisco County, the
percentage of White Californians will shrink relative to the percentages of all other demographic
groups between 2000 and 2050, with the most dramatic shifts taking place in Los Angeles and
Orange Counties. These changing demographics will heighten the need for hiring a faculty
population that more closely represents the population from which the medical schools draw.
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Records Research
The University of California system has kept electronic records for decades, and paper
records since its inception. Ideally, for the purpose of the study, it would be possible to locate or
create a single, searchable database that would provide access to information on faculty
demographics for the entire University of California system, for all the medical and non-medical
schools, and for each UC medical school. This information would ideally include the following
details about each faculty member: dates of hire, promotions and tenure appointments, changes
in status; dates and reasons for leaving position(s), school, UC system; descriptive data at each
data point (e.g., age, race, gender, etc.); and detailed records of all degrees, achievements,
publications, awards, etc., from before, during, and after leaving their last post at the UC. The
data for this hypothetical, ideal single database probably exist in some form in the various
University of California archives, department offices, libraries, and other storage locations.
However, it does not appear that such a database currently exists in electronic form, nor is the
disparate data accessible through an electronic search process available to this researcher.
Therefore, much of the data below must be offered with the caveat that much of the information
could be applied only as broad-brush indicators that suggested trends and patterns. Nevertheless,
those patterns do provide some insight into faculty diversity.
University of California —System. The University of California Office of the President
published data showing figures for tenured faculty as of October 2009 (UC, 2010a). The data did
not distinguish between faculty members for the medical schools and the rest of the UC system.
While the lack of specificity to medical school faculty made it impossible to draw definitive
conclusions about diversity progress, some inferences could be drawn based on the assumption
that trends among the science faculty correlate roughly with the medical school faculty.
58
Therefore, the most appropriate categories broken out: biological sciences (developmental and
cell biology, ecology and evolutionary biology, molecular biology and biochemistry, and
neurobiology and behavior) and “other life sciences” (nursing, public health, pharmacy, and
veterinary medicine) (UC, 2010a). There was no category for biomedical sciences, but that
program is available only through UC Riverside, which was not included in this study because it
was not in existence throughout the entire pertinent time period. The data showed figures for
tenured faculty in three categories: underrepresented minorities, all minorities, and White. A
footnote identified the categories used: underrepresented minorities are “American Indians,
African Americans, and Chicanos/Latinos”; and “ ‘All Minorities’ also includes Asians” (UC,
2010a, p. 1).
The data showed that in October 2009, Whites made up 85.2% of the tenured faculty in
biological sciences at the University of California statewide; Underrepresented Minorities made
up 4.1%, and All Minorities made up 14.4% (UC, 2010a, p. 1). The 2009 numbers for the “other
life sciences” were similar with respect to the percentage of White tenured faculty statewide
(85.2%) and the All Minorities tenured faculty statewide (14.8%); although the percentage of
tenured faculty statewide categorized as Underrepresented Minorities was 7%, markedly higher
than in biological sciences, that figure was still lower than the overall figure for
Underrepresented Minorities among all tenured faculty (7.9%), and far lower than the highest
percentage of Underrepresented Minorities faculty (15.2%, in social sciences) (UC, 2010a, p. 1).
It is reasonable to infer that Underrepresented Minorities were even less well represented among
the science faculties, and thus in those areas most closely linked to the medical curricula, than
among the faculties systemwide.
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Ideally, the above numbers could be compared with identical tables from as many years
as possible since 1990. However, records research failed to yield such one-to-one documentation.
There are a number of illustrative documents, however, that provide information on trends and
changes in lieu of exact comparisons. For example, the 2010 UC Accountability Sub-Report on
Diversity reported that the overall figures for ladder-rank faculty in 2008 were 76% White, 15%
Asian, and 8% Underrepresented Minorities (UC, 2010b). That comparison would show that
there was no significant change in representation of URMs from 2008 (8%) to 2009 (7.9%).
The 2011 Annual Accountability Sub-Report on Diversity reported some small
improvement in hiring minority faculty during the previous decade. “UC hiring of new assistant
professors from underrepresented race/ethnic groups has grown in each discipline. However, it
remains slightly lower in the aggregate than the national availabilities” (UC, 2011, section 8.5.1).
The 2003–04 National Study of Postsecondary Faculty (NSOPF) data revealed that systemwide
the University of California employed a slightly higher percentage of new assistant professors in
Underrepresented Minorities (10.3%) than did other research and doctoral institutions in the
United States (7.7%) (UC, 2011, section 8.5.1). This disparity is significant in light of the
relative difference in demographic trends between California, with its higher proportion of
URMs in the population, and most other states.
As corroborated by other University of California reports (UC, 2010a, 2010b), however,
the trend varied across disciplines. The UC system hired proportionally more Underrepresented
Minorities into faculty positions in education, arts and humanities, social sciences, and life
sciences, and slightly fewer Underrepresented Minorities in physical sciences and engineering
(UC, 2011). The report also confirmed that, as with racial and ethnic diversity, gender diversity is
greater among students and staff than among ladder-rank faculty. Less than 40% of the ladder-
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rank faculty systemwide is made up of women, while 53% of the undergraduate students are
women (UC, 2011, section 8.1.1).
Again, only inferences may be drawn, and not definitive statements. However, the data
appear to suggest that the medical school faculty lags behind other areas of study with respect to
diversity. There could be many reasons for this however, including differences in faculty
turnover rate. As the report itself admits, “the number and proportion of underrepresented
minority and women doctoral degree recipients has grown dramatically over the past 25 years,
but the demographic profile of UC faculty does not fully reflect these changes” (UC, 2010b,
p. 10). At least part of this disparity may be attributed to the fact that faculty careers last many
decades, with tenured faculty remaining for 30 or 40 years, whereas students come and go much
more frequently and can therefore more quickly reflect changes in demographic trends. “UC
employs nearly 10,000 tenured, tenure-eligible, and equivalent rank faculty. Many of these
faculty have long careers—three-quarters of the faculty who retire have more than 30 years of
service. This means the rate of demographic change is gradual” (UC, 2012, p. 8).
Recognizing that progress toward achieving faculty diversity more representative of the
student demographics (and, in the case of the medical schools, the patient population), the
University of California system has committed to improving its data collection on faculty and the
search process, beginning with two collaborative programs:
• UC Recruit. Campuses have agreed to adopt the web-based faculty search program
developed at UC Irvine. The common system will facilitate data collection and
analysis. The Faculty Diversity Workgroup convened by the President’s Council on
Campus Climate and Inclusion has affirmed this project and will assist in analyzing
data.
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• UCADV ANCE PAID. An award from the National Science Foundation ADV ANCE
PAID program (2011–2014) will support both the analysis of systemwide data and a
series of roundtable meetings for faculty and administrators from all campuses to
discuss issues involved in recruiting a more diverse faculty in science, technology,
engineering and mathematics (STEM) disciplines. (UC, 2012, p. 9)
Both of these programs should have a positive effect on diversity by expanding access to
information about the existing pool of potential faculty members both within the UC system (i.e.,
prospects among the current students and faculty) and outside the system. This assumes,
however, that both programs will be gathering data from outside the UC system, outside the
state, and even internationally. Roundtable discussions about recruitment will only be of
significant use if the applicant pool is widened to include the maximum number of qualified
applicants and not limited by artificial constraints (e.g., referrals only, or alumni preferred, etc.)
University of California —Medical Schools Other than UCLA. The diversity data for
the individual medical schools must also be considered with the caveat that much of the
information could be applied only as broad-brush indicators that suggested trends and patterns.
Again, some patterns provided insights into faculty diversity. Since the medical school at UCLA
was the subject of further research for this study through interviews, the results of its records
research are discussed separately.
UC Davis. In 2011, the Office of Diversity at UC Davis included the following in its
stated goals: “Increase the numbers of women and other underrepresented candidates receiving
faculty appointments in UCDHS Schools of Health” (UCDHS, 2011, p. vii). The accompanying
action plan included no specific programs, but addressed the major issues with broad strategies:
(a) improve the search processes that identify and assess women and other underrepresented
62
faculty candidates; (b) strengthen and use diverse interview panels; (c) expand promotion and
retention programs; (d) introduce more family-friendly policies and programs; (e) expand reward
and incentive systems; and (f) expand career development programs for junior and prospective
faculty (UCDHS, 2011). The Office of Diversity anticipated that beginning in July 2011, it
would increase the numbers of non-replacement underrepresented and female faculty candidates
by an average of 0.5% per year over the 2010 baseline numbers (782), and continue that rate
through 2013–2014 (UCDHS, 2011, p. vii).
A snapshot view of UC Davis suggests that the campus lags behind the University of
California system averages. In October 2009, Whites made up 85.2% of the tenured faculty in
biological sciences at the University of California statewide; Underrepresented Minorities made
up 4.1%, and All Minorities made up 14.4% (UC, 2010a, p. 1). At UC Davis, Whites made up
90.2% of the tenured faculty in biological sciences; Underrepresented Minorities made up 1.1%,
and All Minorities made up 9.8% (UC, 2010a, p. 3). Although the increase in the number of
women faculty continued at UC Davis through 2010, increases in the number of other
underrepresented minorities appears to have plateaued, as is shown in following table (Figure 5).
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Figure 5. UC Davis School of Medicine faculty demographics, 2004–2010. UC Davis School of
Medicine Office of Diversity.
UC Irvine. Although departments and offices dedicated to diversity were common to all the
campuses, UC Irvine appeared to have placed the greatest emphasis in the past decade on
increasing diversity not only among the student body but among faculty. This was in response to
the observed changes in the state’s and nation’s changing demographics. For instance, UC Irvine
developed a lecture series and course called Diversity in Medicine: Addressing Disparities in
Healthcare. Its goal was to educate health care professionals and enable them to better provide
culturally competent patient care and to stimulate and promote interest among the students in
cross-cultural medicine.
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It is unclear whether UC Irvine’s greater awareness increased its diversity or whether its
greater diversity increased its awareness, or whether the two rose in tandem. In any case,
although the figures still do not accurately mirror the state population, the University of
California Irvine Medical School has the highest average percentage of minority representation
among its medical school faculty (Echiverri et al., 2007). Minority representation among faculty
at the UC Irvine medical school rose from 26.3% in 1996 to 35.6% in 2004 (Echiverri et al.,
2007, p. 28). Nor have the numbers kept pace with the demographic trends of the city itself.
According to the U.S. Census Bureau, between 2000 and 2010 the population of Irvine rose by
nearly 50%, with the following demographic shifts occurring: from 61.1% to 50.5% White; from
1.5% to 1.8% Black or African American; no change in Native American population of .2%;
from 29.8% to 39.2% Asian; from 1.1% to 2.8% Pacific Islander; from 2.5% to 2.8% other races;
from 4.8% to 5.5% mixed race; and from 7.4% to 9.2% Hispanic or Latino of any race (USCB,
2010).
UC San Diego. As of 2007, the medical school at UCSD had the lowest average
percentage of minority representation among its ladder rank faculty (Echiverri et al., 2007).
However, as Echiverri et al. (2007) pointed out, it is difficult to obtain a clear view of the big
picture from just raw employment data. As an example, they cited UCSD medical school figures
that reported an increase of 1 African American at the assistant professor level from 1997 (2) to
1998 (3). What the raw numbers do not reveal, however, is that 11 African Americans were hired
into the assistant professor level during that period, but 10 African American assistant professors
concurrently left the faculty. It seems clear that the net increase of one African American
assistant professor does not provide a meaningful perspective on the state of faculty diversity
during that period. Retention and turnover are also critical elements in understanding faculty
65
diversity. Nevertheless, the raw numbers do suggest that UCSD lags behind the other medical
schools in the UC system in its diversity efforts.
UC San Francisco. The University of California San Francisco (UCSF) School of
Medicine has in place the Program of Medical Education for the Urban Underserved (PRIME-
US), a five-year effort that focuses on providing skills and support to medical students intending
to work with underserved populations, whether in direct patient care or in research. It also has an
Office of Outreach and Academic Advancement that directs the recruitment resources of the
medical school toward interested minority students. What it lacked as of 2010 was a campus-
wide Office of Diversity, which a special subcommittee on Outreach and Diversity recommended
be established as soon as possible, to be directed by a senior-level leader reporting directly to the
Chancellor (UCSF, 2010). The subcommittee noted that while there were excellent diversity
programs and policies in place, they lacked effective coordination and support.
Summary of UC medical schools other than UCLA. The trend at UC Davis has been
toward greater diversity, but progress has been slow relative to the changes in student and state-
population demographics, and relative to most of the other schools. The UCSF medical school
has made only mediocre progress toward faculty diversity, as it ranks only slightly higher than
the worst-ranked school (UCSD) in average percentage of non-white representation in faculty
(16.60% vs. 15.79%) and is almost a full 5% (4.92%) below the next-highest-ranking medical
school, UC Davis (21.53%) (Echiverri et al., 2007, p. 29). In a ranking of UC medical school
campuses by average percentage of non-white representation in faculty, UCSD came in last: UC
Irvine 32.63%; UCLA 23.74%; UC Davis 21.53%; UC San Francisco 16.60%; and UC San
Diego 15.79% (Echiverri et al., 2007, p. 29). Overall, UC Irvine’s diversity numbers were the
most inclusive at the time of this study, and were rising at the highest rates: (a) in 2001, women
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represented just 24.1% of all UCI faculty, which rose to 30.6% in 2011; and (b) in 2001,
Underrepresented Minorities represented just 7% of all UCI faculty, which rose to 8.2% in 2011
(UCI, 2011).
The David Geffen School of Medicine at UC Los Angeles. The medical school at
UCLA was singled out for further research for this study. Therefore, its records research
information was of key importance to the analyses.
The UCLA Office of Faculty Diversity & Development published two monographs on
faculty diversity for 2011. The first included figures for the school as a whole, and the second
covered only the David Geffen School of Medicine. A similar monograph for the school of
medicine existed for the previous year.
Several facts can be deduced from the data presented in Table 1. First, although there
were 9 or 10 more ladder-rank faculty members total in 2011 (the monographs failed to explain
the meaning behind the decimal in 184.3 White men), the changes in overall diversity were
insignificant. For example, although there were three African American women in ladder-rank
positions in 2011 compared with just one in 2010, the total number of African Americans in
ladder-rank positions remained the same: one woman and six men in 2010, and three women and
four men in 2011. It appears that two African American men left their Associate Professor
positions, but not by becoming full professors, as that number remained steady at three.
The number of Hispanic ladder-rank faculty members rose by 1/2 overall, while the
number of Asian ladder-rank faculty members rose by 2 1/2, suggesting that some of the faculty
members were of mixed race (again, the numbers were not explained in the monographs).
Among the female Asian faculty, the number of Assistant Professors rose by one while the
Associate Professors dropped by one, suggesting that the former were probably not promoted to
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the latter; the overall number of female Asian faculty members remained steady at 13, with no
change in the number of full Professors. Among male Asian ladder-rank faculty, the overall rise
by two and one-half people may have included one promotion, as the number of Associate
Professors dropped from nine to eight.
The most significant increases, however, were among White faculty, with women gaining
four full Professors and two Associate Professors, and men gaining 6.7 full Professors and two
Associate Professors. The number of White Assistant Professors remained the same for the
women, but dropped by four among the men, suggesting the possibility that some of the men
may have been promoted and their positions not filled.
Without supporting information explaining the shifts, it is impossible to state with any
certainty what took place in that single year, but the initial impression it gives is that men are
more likely to be hired and promoted, whereas women and minorities are more likely to leave. If
this is in fact what occurred, and if this is typical of the faculty demographic pattern shifts, then
the results of diversity efforts at the David Geffen School of Medicine are proving to be less than
optimal.
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Table 1. David Geffen School of Medicine Faculty Diversity Statistics 2010 and 2010
African
American
Asian Hispanic Native
American
White
____________ ____________ ____________ ____________ ____________
F M F M F M F M F M
2010
Professor 0 3 8 24.5 3 13.5 0 0 36 184.3
Associate
Professor
1 3 4 9 1 2 0 0 10 20
Assistant
Professor
0 0 1 7 1 2 0 1 5 17
Total
Ladder
1 6 13 40.5 5 17.5 0 1 51 221.3
2011
Professor 1 3 8 27 4 14 0 0 40 191
Associate
Professor
2 1 3 8 1 2 0 0 12 22
Assistant
Professor
0 0 2 8 1 2 0 0 5 13
Total
Ladder
3 4 13 43 6 18 0 0 57 226
Source: UCLA Faculty Diversity & Development, 2010 and 2011
A comparison of the school’s diversity monographs from 2008 and 2011 (See Appendix
D-1 and D-2 respectively) show a similar trend. Overall, in that span, the trend in faculty
diversity only roughly mirrored the statewide population trend toward greater diversity:
• Of the 2543 total ladder and non-ladder professorships school-wide in 2008, 322
(13%) were held by minority women, 515 (20%) were held by minority men, 848
(33%) were held by non-minority women, and 1,695 (67%) were held by non-
minority men (UCLA Faculty Diversity & Development, 2011).
• Of the 2520 total ladder and non-ladder professorships school-wide in 2011, 342
(14%) were held by minority women, 522 (21%) were held by minority men, 868
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(34%) were held by non-minority women, and 1,652 (66%) were held by non-
minority men (UCLA Faculty Diversity & Development, 2011).
It appears that the changes were very minor, with each category adjusted by a single
percentage point. Given that the overall total of available positions was somewhat lower (2,543
in 2008 vs. 2,520 in 2011), however, the numbers could be seen as somewhat encouraging; in
those two years, despite a reduction in faculty overall, the number of minority women in
professorships did rise by 20 between 2008 and 2011.
Document Analysis
Research on faculty diversity within the UC medical schools. The University of
California San Diego School of Medicine was selected in 1998 to be one of four National
Centers of Leadership in Academic Medicine (NCLAM) tasked with developing a structured
mentoring program for junior faculty. Hiring is only one part of the equation in achieving faculty
diversity. Retention is also key. A number of studies on faculty retention at the UC medical
schools have been published since the establishment of the NCLAM.
Wingard, Garman, and Reznik (2004) surveyed participants at the beginning and end of
the seven-month mentoring program and again four years later to tabulate one of three outcomes
for participants (i.e., stayed at UCSD, stayed in academic medicine, gained confidence in skills)
and to gauge cost-effectiveness. The results indicated that the program improved retention rates.
Of the 67 participants, 85% stayed at UCSD and 93% of those who remained stayed in academic
medicine. The participants reported increased confidence in relevant skills: 53% personal
leadership, 19% research, 33% teaching, and 76% administration. Noting that the savings in
recruitment was greater than the cost of the mentoring program, Wingard et al. (2004) concluded
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that structured mentoring can be a cost-effective way to improve retention in academic medicine
and boost the skills required of medical school faculty.
Daley, Wingard, and Reznik (2006) identified junior faculty who had enrolled in the
NCLAM program, and surveyed those who had completed the program between 1999 and 2005.
Of the 112 out of 114 junior faculty who completed the program, 13.4% were underrepresented
minorities (URM) and 86.6% were non-URM. Two junior faculty members did not complete the
program: one URM and one non-URM). The researchers found that the four-year retention rate
of URM junior faculty who had participated increased from 58% to 80%. The rate of those junior
faculty entering academic medicine increased 75%. Daley et al. (2006) concluded that a junior
faculty development program that combined professional skills development and focused
academic career counseling with instrumental mentoring significantly improved retention of
URM faculty in a school of medicine. Several of the UC medical schools have expanded their
junior faculty and membership programs, notably UC Irvine.
In another study done at UCSD School of Medicine, Ries et al. (2009) found that of the
839 new assistant professors hired between July 1988 and December 2005, those who had
participated in a faculty development program were reportedly 67% more likely than non-
participants to indicate that they intended to stay with the school after their probationary period.
The junior faculty development program was established at the UCSD School of Medicine in
1998. After adjusting for gender, ethnicity, and hire date, Ries et al. (2009) concluded that faculty
development programs aimed at junior faculty in academic medicine can positively affect
retention. That is, the development programs can lead more junior members to desire to stay on
and move up the ladder; however, their desire to do so may not be met by a corresponding desire
by the university to retain and promote those same junior faculty members. The relatively
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stagnant changes in the medical school diversity numbers overall suggest that without some
major change, diversity representation will not improve at a significant pace.
Echiverri, Joy, and Kanu (2007) attempted to assess the diversity of tenure-track faculty
at the UC medical schools. For their study they drew on employment data from 1996 to 2004
provided by the University of California Office of the President (UCOP) (See Appendices B and
C). In addition to examining representation parity across the system, Echiverri et al. (2007)
analyzed the UC medical schools individually to determine rankings for the respective schools’
status of faculty diversity. The Status Report on the Diversity of the University of California
Medical School Faculty reported these key findings:
1. “…While racial and ethnic minority groups comprise the majority of the state’s
population, they are significantly underrepresented within the faculty of the UC
medical school system and lag far behind their representation in California’s
population.
2. Latinos constitute the fastest growing racial and ethnic group in the state of
California. However [the] disparity in Latino representation continues to widen
dramatically, with no likelihood of parity ever being achieved.
3. African Americans are extremely under-represented within the faculty of UC
medical schools compared to their representation in California’s population, and
have sadly seen no gains in representation over the course of 9 years from 1996 to
2004. In fact, African American representation has actually decreased within the
UC medical school faculty.
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4. Asian/Pacific Islander representation at the faculty level within the UC medical
school system exceeds that for the state’s population. However, the data on
Asian/Pacific Islanders are misleading and need to be disaggregated….
5. Native Americans are under-represented within the faculty of UC medical schools
compared to their representation in California’s population, and have seen no
gains in representation over a 9-year period.
6. Disparities in minority representation at the UC medical school faculty level
increase with each successively higher faculty rank position….
7. Substantial gains have been made in recent years…. Nonetheless, non-whites
continue to be significantly underrepresented in the UC medical school faculty.
8. Some UC medical schools fare better than others with regard to the overall
representation of minorities within their faculty.” (Echiverri et al., 2007, p. 5)
The report concluded that only small improvements had been achieved during the nine-
year period. In light of that, Echiverri et al. (2007) included eight recommendations for ways that
University of California medical schools might increase faculty diversity. This report, and thus
these recommendations, came after the institution of Prop 209. Therefore, the eight
recommendations could serve as a framework to be further explored in the recommendations
section of this study. As noted earlier, the changes in diversity representation have been minor
and slow, both before and after the introduction of Proposition 209, suggesting that the gating
factor is not a legislative hurdle but a social or attitudinal one. This is discussed at greater length
in the section on Best Practices.
University diversity policies and documents. Appendix A shows the University of
California Diversity Statement as adopted by the Assembly of the Academic Senate May 10,
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2006, endorsed by the President of the University of California June 30, 2006, and adopted as
policy by the Regents of the University of California September 20, 2007.
Interviews
Part of this research involved a case study of the UCLA David Geffen School of
Medicine (UCLA-DGSOM). For this case study, the researcher conducted interviews with the
office of the dean, associate dean and department chairs, as well as with school officials whose
responsibilities included achieving and maintaining compliance with LCME accreditation
standards. The researcher also gathered demographic information on the interview participants
(See Table 2 below).
The interviews consisted of five open-ended questions designed to elicit responses about
experiences with the development and implementation of recruitment and retention programs
and policies, both successes and failures, in an attempt to gather data about perceived “best
practices” in the endeavor of increasing faculty diversity both pre- and post-Proposition 209. The
interview responses were analyzed and coded using the Affirmative Action Plan framework
according to three key concepts: (1) availability; (2) incumbency; and (3) placement goals.
Availability, according to the Affirmative Action Guidelines, is “an estimate of the number of
qualified minorities or women available for employment in a given job group, expressed as a
percentage of all qualified persons available for employment in that job group” (UC, 2002, p. 2).
Though the guidelines place great emphasis on “placement of incumbents in job group” and
“comparing incumbency to availability” (UC, 2002, p. 12), both the guidelines and the Code of
Federal Regulations from which the original language was drawn are unclear in their definitions.
The language of the current e-Code of Federal Regulations (2012) suggests that comparing
incumbency with availability means comparing the number of minorities and women within the
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organization who could be promoted, transferred, or trained to fill a position with the total
number of qualified minorities and women in the pool of available people. That is, the guidelines
seem to be suggesting a preference for hiring from within to achieve diversity, but allow that the
pool must be drawn from a “reasonable recruitment area” (e-CFR, 2012, §60-2.13). According to
the Affirmative Action Guidelines, deriving availability figures requires that the school “consider
the percentage of minorities and women with the requisite skills in the geographic area from
which the employer usually recruits, and to use the most current and discrete statistical
information available” (UC, 2002, p. 2). As was clearly stated by the Affirmative Action
guidelines, “placement goals are not quotas…” (p. 3):
[Placement goals] should not be considered either a ceiling or a floor for the employment
of particular groups. Placement goals do not provide a justification to extend a preference
to any individual on the basis of gender, race, or ethnicity. Placement goals do not create
set-asides for specific groups, nor are they intended to achieve proportional
representation or equal results. Placement goals may not be used to supersede merit
selection principles or as a justification for hiring a less qualified person in preference to
a more qualified person. (UC, 2002, p. 3)
Rather, placement goals are “reasonably attainable objectives” or steps toward achieving
equal employment opportunity and diversity. For example, if UC Medical School A might
identify “Assistant Professors” as a job group. They might determine that the current percentage
of women in that job group (incumbents) is 2%, but that the total percentage of women qualified
for that position is 12% (availability). They would therefore state the objective (placement goal)
of hiring women into that job group at the rate of 12%.
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The frequency with which these themes of availability, incumbency, and placement goals
were reported was noted and analyzed for patterns, with an attempt made to correlate the themes
with pre- or post-Proposition 209 implementation timeframes. Additionally, the researcher
sought to identify deeper meanings within the documents and interviews. This included such
nuanced findings as how the treatment of the subject has changed over the course of time, the
meanings embedded within the various texts, and the extent to which documents demonstrated
the value upon which the respective medical schools placed the issue of faculty diversity.
In total, there were 13 people interviewed. They cannot be identified using titles, roles,
levels of authority, or other specifics that would compromise privacy agreements. For statistical
purposes, however, they can be identified by the following self-described “diversity”
characteristics:
Table 2. Interview Participant Statistics
Characteristics Respondents
Men 11
Women 2
Age 20 –30 0
Age 30 –50 1
Age 50+ 12
White 12
Non-White 1
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The interview questions are listed in Appendix E. Overall they were designed to elicit the
respondents’ various levels of understanding of hiring and retention processes and practices for
medical school faculty at UCLA with respect to diversity, both before and after Proposition 209
and changes in the LCME accreditation standards. As is common in discussion of provocative
and even potentially actionable matters, the answers given were often indirect, tempered with
conditional language, or couched in official language. A summary of interview themes follows
this brief discussion of the interviews.
Interview Discussion
With the exception of the people directly involved with ensuring compliance, most of the
respondents were not clear on what was allowed or disallowed by either the LCME accreditation
standards or Proposition 209. Many of the interviewees were only passingly familiar with the
UCLA-DGSOM’s diversity goals and guidelines, its recruitment and hiring personnel and
practices, or both. Thus, when asked whether practices and processes had changed in order to
remain in compliance, the range of answers was as broad as it could possibly be. One respondent
spoke glowingly of the school’s conscious efforts to improve diversity despite the changes:
We have made tremendous strides in putting the framework in place that will enable us to
achieve better diversity in our faculty. It can be a long and difficult process to achieve
these changes, but we have worked to respond positively to the requirements of both
Proposition 209 and the new guidelines from the LCME.
Yet the same question elicited an answer from the other end of the spectrum. “I have been
in my position for over a decade. To my knowledge, we have made no changes in our hiring
practices because of the passage of Proposition 209 or because of rule changes made by the
LCME.”
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While most of the respondents were aware that Proposition 209 had altered the legal
workings of affirmative action programs in general, few of the respondents understood the
connection with the LCME accreditation process, or even knew what that process was. One
interviewed admitted, “I don’t know what the LCME is…,” while another said “I’m unaware of
any changes in the accreditation requirements.”
Most of the answers addressed the efforts without discussing Proposition 209 or the
LCME standards, or what role they might have played in past, present, or future diversity efforts:
“We have always taken diversity into consideration as a factor in hiring”; “[diversity] must be
considered”; and “The recruitment process hasn’t changed—qualified candidates are encouraged
to apply and hiring is based solely on the CV and the interview, not on diversity.” In fact, the
overriding theme was that diversity was important, but not at the cost of compromising quality.
As one respondent answered, “Changes? We’ve made none. I have hired five faculty in my time
here and finding the best candidate is always the key.” Another interviewee echoed that, saying
that “if there are two equal people then we are conscious of diversity.” It may be reasonable to
conclude that an overriding theme implicit in these discussions was that achieving greater faculty
diversity as well as the highest degree of quality were perceived to be mutually exclusive
outcomes.
Some of the commentary, as previously detailed, suggested that the majority of the
respondents held two beliefs that together might, either consciously or subconsciously, prevent
significant strides in achieving greater faculty diversity: (a) there are simply not enough women
and minorities available who are qualified to be part of the UCLA medical school faculty; and
(b) the only way to maintain high standards is to continue following the same tried-and-true
methods of recruiting and hiring. The idea that there might be some built-in biases involved in
78
those methods was anathema, and some comments indirectly raised this perspective: “It does
seem as though there is a very small number of ‘Blacks and Hispanics’ in the hiring pool”; “if we
have weak candidates, there is extra work available for them to make themselves better
candidates before they apply to become faculty at a medical school”; and “a quota system would
not work in this environment.”
Most respondents appeared to be no more than vaguely unaware that there was a potential
conflict between the LCME accreditation and Proposition 209 directives, or did not believe these
directives were applicable (or enforced) with respect to faculty recruiting and hiring practices.
When pressed, several indicated that such decisions were ultimately someone else’s
responsibility: “We have to follow the state law in this regard. They provide the funding and they
set the rules”; “the LCME cannot create rules that supersede the laws of the state”; “they can
create an ‘illegality’ if the directives of the LCME are not done within the requirements of state
laws like Prop 209”; and “if standards go down or qualified candidates are not selected, the state
will not like that change.”
Several of those interviewed were hopeful that programs already in place or being talked
about at UCLA had potential for expanding diversity. Several mentioned that expanding efforts
to increase diversity in the residency program would be helpful, and that already it was “a great
source for diversity.” These respondents were optimistic about the growing role of the Office of
Faculty Diversity and Development, as well as the potential growth through Faculty Partners for
Diversity and Community Partners for Diversity. They suggested that diversity was not
something that could be simply legislated into existence. “You need to be aware of biases that
can affect your hiring decisions. You must avoid ‘unwitting discrimination’— hiring ‘someone
like you’ subconsciously,” said one. Another made a similar observation, saying that “we all have
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an innate tendency to select someone like ourselves. We need to have an active attitude toward
avoiding bias because good intentions, by themselves, just don’t work.”
Interview Themes
As people involved in faculty recruitment and hiring, all the subjects interviewed for this
case study should have been at least familiar with the LCME and with Proposition 209, although
the depth and breadth of their knowledge would understandably vary within the group, which
included the office of the dean, associate dean, department chairs, and other school officials.
However, a large number of responses to the survey questions suggest that respondents were
either unaware of, or unconcerned with, the potential conflict between the LCME accreditation
guidelines and those set forth by Proposition 209.
Overall, the interviews yielded little information that directly answered the parts of the
primary research question concerned with achieving faculty diversity as required by LCME
accreditation standards while maintaining compliance with Proposition 209. However, the
interviews did yield significant insight regarding the consistency of awareness and application of
these directives. Additional insight was gained as to the best practices of improving faculty
diversity, although many of these practices must be inferred from the context of the responses.
Those responses can be grouped into a number of interview themes.
Quality of faculty outweighs diversity of faculty. Nearly every respondent included
some version of this statement. Everyone was willing to agree that diversity was an admirable
objective, but most expressed the opinion that the primary consideration for whether or not to
hire someone should be that person’s qualifications. There was, however, no consensus on what
that meant from a practical standpoint: some respondents seemed to imply that the two were
mutually exclusive.
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Not enough minority candidates. This was a common refrain: “There are not that many
minority applicants”; “it does seem as though there is a very small number of ‘Blacks and
Hispanics’ in the hiring pool”; and “there are no Blacks or Hispanics in most applicant pools.”
However, it was not widely suggested that the problem might be with the definition of the pool.
The Affirmative Action guidelines based on the Code of Federal Regulations calls upon searches
to “consider the percentage of minorities and women with the requisite skills in the geographic
area from which the employer usually recruits, and to use the most current and discrete statistical
information available” (UC, 2002, p. 3). However, in this electronic age, “geographic area” could
realistically be widened to include the entire globe, particularly since tenure and tradition suggest
that the job posts to be filled are very often lifetime appointments.
Numbers do suggest that there are far fewer minority candidates available to be
considered for faculty positions. However, the questions did not separate recruitment from
hiring, and these are two distinct phases of the process with different sized pools. The size of the
pool of people qualified to be on the faculty of the medical schools (i.e., the recruitment pool)
would be far larger than the pool of people who express interest in applying, who are sought out
for consideration, who make it through successive tiers of qualifying requirements, or who
otherwise enter into the formal job application process, (i.e., the candidate pool). It may be that
many of the respondents were referring primarily to the “short list” of candidates they see or
know of first-hand, and that the percentage of qualified minority candidates is greater before that
point.
Technical or legal comments, defenses, or rationalizations. Another theme among
respondents was the tendency to disengage from personal responsibility for achieving diversity,
or to quibble over technicalities rather than view the issue from a broad perspective. “At the
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student level, it’s different,” said one respondent. “You can accommodate for student candidates
who had less access to educational opportunities. You can look for ‘potential’ in a more diverse
candidate. For faculty, they must prove they are outstanding in order to ‘survive’ in this
environment.”
Tendency to see faculty as more diverse than it really is. Of the survey respondents,
77% were White men. This may account for the respondents’ tendency to overestimate the
school’s success at achieving faculty diversity (“we appear to have 100% gender equality” and
“no, we have a diverse faculty”) or underestimate the need to place a higher priority on achieving
such diversity. A contributing factor may have been that as part of the majority, those respondents
were more aware of any faculty members who were not part of the majority and subconsciously
weighted them more heavily. “We have Blacks, Koreans. They have to be good [to be here].”
Belief that UCLA-DGSOM (or all schools) is, or perhaps should be, held to a
different standard than other organizations in the state. This may or may not have been
related to the seeming lack of unawareness of, or concern with, the potential conflict between the
LCME accreditation guidelines and those set forth by Proposition 209. Common answers
included these: “in practice, [Proposition 209] doesn’t seem to be a factor”; “[Proposition 209]
doesn’t seem to apply here”; and “I was unaware of Proposition 209. Race doesn’t factor in, just
the quality of the CV and the interview.”
It is also possible that there exists some attitude of elitism that caused some of the
respondents to feel that they, either as educators or medical professionals or both, were somehow
held to (or should be held to) different standards from other Californians, other professionals, or
members of other organizations. “The diversity of candidates is important, but we are looking for
the most qualified candidates first,” said one respondent. Another asserted that “we take the best
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candidates regardless of diversity factors.” Peer-level interviewers were more likely to regard
such things as demographics and diversity as mere busywork that interfered with the real
business of education: “Diversity efforts seem to have more impact on the administrative side of
a university.”
Unspoken (mostly) equation of diversity efforts with quota system. Quotas are not
legal, yet the misperception persists that “affirmative action” and “diversity” are somehow
synonymous with quotas. Despite the school’s guidelines including language that clearly states
that placement goals are not quotas, set-asides, or preferential treatment, many of the respondents
regard the whole idea of affirmative action as a system designed to fill a specific number of jobs
with women and minorities regardless of their qualifications: “I’m against the principle of taking
under-qualified candidates and putting them in a position to fail” and “a quota system would not
work in this environment.”
Discomfort in speaking about or expressing strong support for diversity. This may
have been attributable to respondents’ fear of appearing racist, sexist, or elitist. This was
sometimes evidenced by several of the respondents minimizing the importance of diversity in the
recruitment and hiring process altogether. “The ability to earn grants is important in the selection
process,” said on interviewee. Another respondent also shifted the discussion in that direction,
saying that “money comes back to the school through research. Schools want good researchers
because researchers can make them more money. This means there should be more emphasis
placed on the sciences in early school years.” Discomfort was also evidenced by some
respondents embracing the concept of diversity while implying that it was idealistic and perhaps
not achievable.
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Summary
This study set out to examine three questions. The primary question was, “What best
practices have been developed by University of California medical schools to achieve faculty
diversity as required by LCME accreditation standards while maintaining compliance with
Proposition 209?” Both the quantitative and qualitative information gleaned through records,
documents, and interviews indicate that there has been no official awareness campaign or
restatement of best practices since the diversity-related changes in LCME accreditation
standards. Incremental changes have occurred systemwide, but at the UCLA medical school
there was no significant difference in procedures or policies in light of the implied contradiction
between the two guidelines.
The secondary questions were these: (a) to what extent do leaders at the University of
California medical schools see LCME accreditation standards and Proposition 209 compliance
requirements as being in conflict with one another?; (b) what modifications have the leaders of
University of California medical schools made to earlier recruiting practices in an effort to
improve faculty diversity while maintaining compliance with Proposition 209?; and (c) what
recruiting practices currently in place at the various University of California medical schools
have shown promise in achieving faculty diversity while remaining in compliance with
Proposition 209?
Overall, the efforts of the University of California system to increase faculty diversity
among its medical schools appear to have been only minimally successful. The schools have seen
more improvements in gender diversity than in increasing the numbers of underrepresented
minorities. This is also mirrored in the medical student diversity demographics, which has
troubling implications for future diversity efforts. Andriole et al. (2010) reported that efforts to
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improve the representation of female medical school graduates have achieved slightly better
results than efforts to increase representation of underrepresented minorities. They suggested that
“greater participation of underrepresented minority students in MD/PhD programs and in
interventions during medical school that promote interest in academic-medicine careers may
increase URM graduates’ representation in academic medicine” (Andriole et al., 2010, p. 1250).
As interviews reflect, however, significant slowness in achieving greater faculty diversity among
the UC medical schools may be attributable to barriers related to beliefs and attitudes rather than
to statistical challenges. Identifying and developing ways to address these attitudinal barriers
formed the foundation of most of the best practices recommendations that appear in Chapter 5 of
this research study.
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CHAPTER 5: DISCUSSION
Summary
In the United States, medical schools must adhere to standards devised by the Liaison
Committee on Medical Education (LCME) for their students to be eligible to receive federal
funding for attendance as well as licensure in the medical profession. An important component of
these accreditation standards is the requirement that the racial, gender, and ethnic diversity
among the faculty correlate with that of the general population. Increasing faculty diversity over
the past few decades has been only marginally successful. This is due in part to a variety of
societal dynamics, and in part to legislative constraints imposed in an effort to encourage
diversity without compromising fairness, civil rights, or quality standards. Medical schools in
California, for example, must work within the bounds of Proposition 209 (now Article 1, Section
31 of the state constitution), which prohibits the university system from using racial, gender or
similar factors when hiring faculty and staff. Compliance with Proposition 209 has led to a
significant drop in the numbers of faculty, staff and student candidates from underrepresented
populations (Nelson, 2003), suggesting that it was a barrier to, rather than an enhancement of,
diversity efforts.
This study examined recruitment and retention practices, programs, and policies used by
University of California medical schools to identify ways to (a) successfully enhance faculty
diversity, as measured by significant demographic changes, and (b) comply with both
government regulations and the LCME Accreditation Standard IS-16 on diversity.
Specifically the study attempted to address the following question:
• What best practices have been developed by University of California medical schools
to achieve faculty diversity as required by LCME accreditation standards while
maintaining compliance with Proposition 209?
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Answering that question required asking other subordinate questions:
To what extent do leaders at the University of California medical schools see LCME
accreditation standards and Proposition 209 compliance requirements as being in
conflict with one another?
What modifications have the leaders of University of California medical schools
made to earlier recruiting practices in an effort to improve faculty diversity while
maintaining compliance with Proposition 209?
What recruiting practices currently in place at the various University of California
medical schools have shown promise in achieving faculty diversity while remaining
in compliance with Proposition 209?
Summary of Findings
While the gender ratio has remained roughly equal, racial demographic figures in the
United States are changing, and in California they are changing especially fast. By 2030,
California will be home to an additional 12 million people and there will no longer be a “White
majority”; estimates project that by 2030, Latinos and Asians will make up about 58% of the
population (Bates & Chapman, 2008). California’s racially and culturally diverse population is
not reflected in the makeup of University of California medical schools’ faculty demographics
despite decades of efforts to expand diversity and inclusion. Proposition 209 was enacted to
counter some recruitment and retention efforts that were thought to be discriminatory or to grant
preferential treatment to minorities. As a federal contractor, however, the University of California
system must comply with state and federal affirmative action laws. As a result, Proposition 209
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does contain some language that states the prohibitions do not apply if the actions are necessary
to gain or maintain eligibility for any federal program in which ineligibility would result in a loss
of federal funding (UC, 2002). Thus, the exact nature of the actions involved in recruitment,
hiring, and retention of faculty can affect accreditation, funding, and compliance with state,
federal, university, as well as LCME guidelines.
This study revealed that a low turnover rate and budget-induced cutbacks have left the
UC medical schools with very few openings annually for ladder-rank faculty and staff positions.
Ultimately, the number of people who are qualified to teach at a UC medical school is limited to
the number of people who successfully graduated from medical school or an appropriate field of
research. This suggests that the problems encountered now in increasing diversity may continue
to grow much worse as the percentage of medical students from underrepresented minority
groups continues to drop even though their percentage among the general U.S. population
continues to rise. In theory, Proposition 209 limited the range of options and considerations the
UC system could use to recruit and retain a more diverse medical school faculty, which might
have resulted in a dramatic backward slide in faculty diversity. In reality, while progress has been
slow, diversity among UC medical school faculty has been increasing. But rather than
Proposition 209 being the only significant factor in the rate of change, another important
hindrance to diversity appears to be an enduring perception among those with hiring authority
that achieving diversity and a top quality faculty are mutually exclusive.
Perceived contradictions. The first of the subordinate questions was addressed through
interviews with leaders and faculty of the David Geffen School of Medicine at UCLA who were
asked about the extent to which they recognized a conflict between the LCME accreditation
standards and Proposition 209. With the exception of those who were directly responsible for
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legal compliance in policymaking and personnel oversight, the respondents ignored the implied
contradiction between the LCME standards’ requirement to increase diversity among faculty and
Proposition 209’s prohibition against the university system considering racial, gender or similar
factors when hiring faculty and staff. Instead, the people involved in recruitment and retention
for particular positions made few changes in either their assumptions about candidates or in their
actual selection process. Among the interviewees, most insisted that the candidates’
qualifications, experiences, and abilities were the only factors to be considered when hiring;
additionally, they denied that they personally considered racial, gender or similar factors during
the hiring process. It is worth noting that many of the respondents had either not heard of the
LCME, or were unaware of what the diversity-related accreditation requirements were or that
they had changed.
Modifications made. It is not surprising, then, that when interviewees were asked what
modifications they had made to earlier recruiting practices to improve faculty diversity without
violating Proposition 209, those same people involved in hiring for specific positions offered up
few examples of changes they had made personally. That is, while top-level administrators were
able to point to changes made at the policy level (e.g., establishing a diversity office), interviews
of those who would be most directly responsible for implementation of such changes were
largely unaware of the policy changes that had taken place. Many people naturally prefer the
familiar and established to initiating or accepting change; there is a tendency for people to
maintain the status quo unless forced to do otherwise. This appeared to be true among the
interviewees: few expressed serious concern with the current level of diversity among the faculty
of the UCLA DGSOM in particular or the UC medical schools in general, and thus not many
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indicated that they kept fully informed about or pushed for any changes in diversity policies or
practices.
Promising recruitment practices. Among those UCLA personnel interviewed, only one
offered a specific example of a recruiting practice that showed promise in increasing diversity:
the residency program. The inference that can be made from the example is that working with
residents affords those involved in hiring an extensive preview of at least some of the available
talent; this longer-term exposure might reduce rejections due to preconceived ideas and
diversity-related biases by encouraging people to consider more applicants that they might
otherwise have rejected without such first-hand knowledge of the applicants’ abilities. However,
while it is true that working closely with residents from underrepresented minorities might lead
to more applicants from those URMs being hired, there may be no better representation of URMs
in the current residency program than in pre-Proposition 209 days.
Best practices. The main purpose of this study was to determine what best practices have
been developed by University of California medical schools to achieve faculty diversity within
the bounds of Proposition 209. While the interviews of personnel from the David Geffen School
of Medicine did not yield much in the way of specific examples of best practices, the responses
were nevertheless extremely useful in explaining significant factors that may contribute to the
disparity in minority faculty recruiting as discovered in the other data-gathering portions of the
study, namely the review of demographic statistics and the records research and document
analysis. Additionally, the information pointing toward these best practices was strengthened by
findings in the literature review, which revealed that while the percentage of minority healthcare
consumers is growing, thus far the percentage of minority practicing physicians in the state has
not kept pace. Across the country, an estimated 25% of the patient population comes from
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underrepresented racial and ethnic minority groups, compared with just 7% of practicing U.S.
physicians (Nelson, 2003). Nor has representation on the UC medical faculty kept pace.
Both the qualitative and quantitative data-gathering methods used in this study revealed a
number of barriers to improving faculty diversity, most of which were based on attitudes and a
lack of information about how or whether to address the issue of hiring a diverse faculty as well
as a mismatch in supply and demand. Identifying and developing ways to address these
attitudinal barriers formed the foundation of most of the recommendations for best practices that
appear in the Recommendations section below.
Recommendations
Implications of the Study
The research herein suggests that historical, traditional, and legal hurdles still exist and
the need for diversity among UC medical school faculty has become greater than ever. Both the
literature review and the data collection in the study itself suggest that the primary reason why
faculty diversity does not accurately reflect population demographics is that the issue of diversity
has generally been considered from the White majority paradoxical perspective of how to
achieve diversity without changing the status quo. If this perspective were to change, it is
conceivable that diversity representation among the UC medical faculty might increase not only
at a faster pace, but in a manner that becomes both more organic and sustainable, as a more
diverse faculty encourages student diversity, which in turn reinforces the talent pool for faculty.
This focus on changing perspectives figures strongly in the Best Practices discussed in the
Recommendations section.
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Best Practices: Recommendations for UC Medical Schools
The best practices proffered below are based on the understanding that minority medical
school students should have the benefit of learning from minority faculty, mentors, and role
models, and that students and faculty alike should be able to provide culturally competent
healthcare to all populations, including those in underserved minority populations. Some of the
Best Practices described below are built on or revisions of Best Practices listed in the University
of California Affirmative Action Guidelines for Recruitment and Retention of Faculty (2002). All
are based on information gathered (a) through records and documents published by and about the
University of California system in general, the UC medical schools, and the David Geffen
School of Medicine at UCLA in particular; (b) from interviews with people associated with
faculty recruitment, hiring and retention at the David Geffen School of Medicine at UCLA; and
(c) from supporting data, information, theories, and analyses uncovered in a review of the
literature.
Diverse search committees. It is clear from the literature review, as well as from the data
gathered during the study, that people tend to hire others who remind them of themselves. This is
especially true when the people doing the hiring are part of the majority demographic. While
Proposition 209 in theory prohibits considering diversity characteristics in hiring, the case can be
made that appointing members to a search committee in proportion to national demographics
does not constitute preferential treatment. This would be an objective, similar in nature to the
“placement goals” (UC, 2002, p. 3) in the guidelines. The findings in this study indicate that UC
medical schools should do more than just make a “special effort…to ensure that minorities and
women have equal opportunity to serve on search committees” (UC, 2002, p. 4) but should
routinely select search committee members from underrepresented minorities and women in
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percentages that correlate to the projected demographics of either the student population or the
future patient population. While this would be a violation of Proposition 209 if it were applied as
a quota-style requirement, endeavoring to develop search committees that better reflect the future
patient population would not. Creating the ideal search committee for increasing faculty diversity
should not be based on so-called “reverse discrimination” techniques such as including more
female and minority members than White male members, but it should use the same method
ostensibly used in hiring: qualifications are more important than diversity, but any time there is a
choice between two qualified persons, the search committee should choose women and
underrepresented minorities over White men.
Position announcements designed to widen the net, not narrow it. The UC recruiting
guidelines state that position descriptions should be drafted carefully and broadly using language
that describes candidates’ backgrounds, experience, talents, skills, and responsibilities in
language that is as inclusive as possible (e.g., “experience working with students from diverse
backgrounds,” “commitment to improving access to higher education for disadvantaged
students,” or “previous activities mentoring women, minorities, students with disabilities, or
other underrepresented groups”) (UC, 2002, p. 5). This is supported by the responses from
interviewees who suggested that UCLA should work to increase diversity in its residency
program to affect the applicant pool pipeline. The guidelines also suggest that position
announcements include the system’s commitment to considering dual-career appointments and
“spousal employment opportunities” (p. 5). This study confirms the usefulness of that approach,
but suggests even more inclusive language whenever possible, such as substituting employment
opportunities for “significant others” rather than “spouses” and making it clear that the school
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has a diversity office and commitment to inclusivity and active coexistence within both its
academic and extracurricular cultures.
Broadened advertising and networking efforts. The UC guidelines require that faculty
position search efforts include “all available avenues for publicizing the position, including
national publications, personal contacts, listservs, mailing lists, professional and academic
conferences, and Web” (UC, 2002, p. 5). The guidelines do not name specific publications or
approaches. As the findings of this study suggest, people tend to hire people most like
themselves. A natural extension of that would be that people would hire people who read the
same publications they do. Hence, a school heavily staffed by White men over 50 might not
automatically include such resources as Black Issues in Higher Education, Indian Journal of
Pediatrics, Hispanic Outlook in Higher Education, or Journal of the Gay and Lesbian Medical
Association. Naturally it would be impractical to advertise every position it every medical,
academic, or education publication, but the research herein suggests that it would be worthwhile
to search out and explore the demographics and distribution figures for a wide range of
professional media outlets, including international medical publications, international medical
associations, and perhaps even more general-interest media outlets and networking organizations
aimed at educated persons but targeted more specifically toward readers/subscribers from
underrepresented groups. Efforts should also be made to communicate with and eventually
recruit medical students and residents with a commitment to academic career medicine, with an
emphasis on those from medical schools with a high level of diversity and medical schools from
countries other than the United States and its territories.
In November 2009, recognizing that change was perhaps too slow in coming, a group of
faculty members at the David Geffen School of Medicine founded a group called Faculty
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Partners for Diversity, with the goals of (a) providing a “think tank” environment for developing
programs and opportunities for increasing diversity; (b) acting as an advisory board to review
ideas and programs for feasibility; and (c) to form task groups dedicated to designing and
implementing new diversity programs (Faculty Partners for Diversity, 2010). This group tries to
widen its network of non-majority faculty members and schedules regular programs by and for
medical school faculty members. For example, on April 5, 2012, the Faculty Partners for
Diversity’s Women in Research task group hosted Dr. Nancy Jenkins of the Methodist Cancer
Research Program, to speak at a networking lunch on career trajectories in science and offer “an
opportunity to connect with women faculty who are actively engaged in research across different
disciplines, but who face similar career issues [and share] experiences” (FPD, 2012, p. 1). The
school’s Office of Diversity Affairs formed another such group, Community Partners for
Diversity, in 2010. The community leaders and activists who founded the group “expressed a
strong interest in participating with the medical school” and sought to create a group that would
address issues faced by faculty, fellows and residents:
Community Partners for Diversity is envisioned as a broad-based group of community
leaders, business executives, and UCLA neighbors who will act as a sounding board to
help us develop new ideas and concepts, identify areas that we may have overlooked, and
help us look at ourselves more critically: what are the opportunities for and barriers to
diversity at UCLA, and more particularly at the School of Medicine. We look to the
Community Partners to bring different perspectives to our goals, promote support for new
programs and pipeline initiatives, and to provide resources and community for new
faculty members, enhancing work-life balance. (CPD, 2010, p. 1)
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There is evidence that this sort of networking among multiple universities, communities,
businesses, and activist groups can be effective (President’s Task Force on Diversity, 2009;
UCLA, 2012a, 2012b).
Proactive informational outreach. The UC recruitment guidelines made it clear that,
despite the apparent contradictions with Proposition 209, informational outreach for faculty
recruitment may inquire specifically about promising female and minority candidates. The
following section states its position in proactive informational outreach well after the passage of
Proposition 209:
In addition to broad advertising, search committees may engage in other types of
proactive informational outreach to increase the numbers of outstanding applicants for
faculty positions, including women and minorities. As search committee members write
letters or make phone calls to their colleagues to ask about promising candidates, they
also may specifically inquire about promising women and minority candidates. As search
committee members attend conferences or other academic meetings for the purpose of
recruiting or networking with potential candidates, they may also make a specific effort
to attend conferences or meetings attended primarily by women and minorities in the
field. Search committees should ensure that female and minority members of the campus
faculty are not excluded from consultations regarding their knowledge of potential
candidates, and should actively encourage all faculty to refer potential candidates. All
academic disciplines have professional organizations and most of these have
subcommittees for women and/or specific minority groups. Search committees may
broaden the pool by utilizing the resources of these specialized academic and professional
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organizations and also by making efforts to identify individuals who have achieved
excellence outside academe. (UC, 2002, p. 6)
These findings suggest that instead of limiting these outreach efforts to search committee
members and merely ensuring that others are not excluded from consultations, all faculty
members should be routinely queried about their knowledge of anyone who may be qualified for
an open or impending faculty position.
Begin with the deepest and widest possible applicant pool. Many of the UCLA
personnel interviewed for this study indicated that there were few or no qualified minority or
female applicants for most medical school faculty positions. Geographical distance is no longer
the hindrance to recruitment or hiring that it was before the information age. While it is next to
impossible to know how many qualified candidates for a position there may be worldwide at any
given time, research into the number of medical students graduating now or in the near future
and the number of practicing medical personnel—not just in the United States, but worldwide—
suggests that the applicant pool has the potential to be both highly diverse and filled with
exceptionally qualified candidates. The initial phase of applicant selection should not take place
until it has been established that the percentage of “diverse” applicants approximates the
demographics of either the student population or the future patient population. This will no doubt
require expanding recruitment efforts far beyond the border of the state of California and the
continental United States to include Alaska, Hawaii, all U.S. territories, and the major cities on
every continent.
Use medical students to help recruit university and high school applicants. Medical
students are highly effective in sparking the interest of young people for the medical profession
(Drouin, Denis, Nadeau, and Chénier, 2006). In addition, Drouin et al. (2006) found that those
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medical students who participate in recruitment efforts found their teaching experiences to be
both stimulating and educational, and inspired many of them to pursue teaching in addition to, or
sometimes instead of, clinical practice. These medical school student efforts might include
speaking at or representing a medical school at a career day or job fair for high school or
undergraduate university students; acting as a mentor (e.g., science tutors) for high school or
undergraduate university students; or providing volunteer guidance counseling for high school or
undergraduate university students. This outreach serves the dual purpose of (a) engaging the
interest of students who might choose to enter medical school (and hence consider, at some
future date, joining the medical school faculty) and (b) allowing junior medical personnel to
enhance their teaching and speaking skills, to act as role models for their potential future
colleagues, and to determine whether they have an interest in teaching full or part-time at a
medical school at some point in their own careers. Straus, Straus, & Tzanetos (2006) reported
that mentors played an important role in the decision of medical students and early-career
practitioners to pursue a career in academic medicine. They noted in addition that residents’
interest in academic medicine decreases over time, which is why junior medical students would
be the preferred choice for these outreach positions. This could be linked effectively with the
programs such as UCLA’s Community Partners for Diversity and the Faculty Partners for
Diversity programs.
Create in-depth faculty development programs. A study by Wingard, Garman, and
Reznik (2004) found that a junior faculty mentoring and development program at the UC San
Diego Medical School improved retention rates. The savings in recruitment costs were greater
than the cost of the mentoring program, leading Wingard et al. (2004) to conclude that structured
mentoring can be a cost-effective way to improve retention and boost the skills required of
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medical school faculty. These findings were supported by Daley, Wingard, and Reznik (2006),
who found that the four-year retention rate of URM junior faculty who had participated in a
faculty development program increased from 58% to 80%, and the rate of junior faculty in
academic medicine increased 75%. They concluded that a junior faculty development program
combining professional skills development and focused academic career counseling with
instrumental mentoring can significantly improve retention of URM medical school faculty.
Likewise, Ries et al. (2009) found that those who had participated in a faculty development
program were reportedly 67% more likely than non-participants to indicate that they intended to
stay with the school after their probationary period. After adjusting for gender, ethnicity, and hire
date, Ries et al. (2009) concluded that faculty development programs aimed at junior faculty in
academic medicine can positively affect retention.
Make diversity training programs mandatory for all faculty and medical students.
Overall, readings in the area of diversity, population studies, and underrepresentation suggest
that the main reason that faculty diversity does not correlate with demographics is that the issue
has generally been considered from the White majority paradoxical perspective of how to
achieve diversity without changing the status quo.
Recommendations for Further Research
The pool of medical students feeds the future pool of medical school faculty. It is beyond
the purview of this study to list the efforts to improve student diversity given the constraints of
Proposition 209, but it would be helpful to pursue a study similar to this one but focused on
increasing student diversity.
Several avenues of further research that would be useful concern the “availability” and
“data pool” issues. Specifically, it would be useful to explore the different ways available for
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reaching people who are qualified to join medical school faculty, or those who hope to do so in
the future, and to develop a way of tracking and updating a resource database for that purpose.
While the big names in media outlets and medical journals are fairly easy to identify and track, it
is the niche-oriented and narrowly targeted but apt journals, conferences, organizations, and
networks that would be of particular interest in increasing diversity. Along similar lines, it would
be interesting to see a longitudinal study of the various schools’ definitions or guidelines for
determining the pool of available qualified candidates measured against the changes in diversity
representation. For example, in the days before easy access to computer data, recruitment was
significantly limited by such things as mailing costs and advertising fees for the major medical
journals, major urban periodicals and newspapers, and a handful of organizations. It would be
interesting to know if greater access to a global applicant pool has changed diversity
representation in a significant way over time.
The most important but complicated avenues for further research would be those relating
to attitudes. That is, if people hold certain beliefs that are based not on facts but on assumptions,
misperceptions, faulty logic, bad information, prejudices, and similar features, is it possible to
alter those people’s beliefs in a significant and permanent way? And how would altering those
beliefs (e.g., there aren’t enough qualified women or minorities available to fill these faculty
positions) cause them to alter their related behaviors (e.g., use the same methods, resources,
technique, procedures and strategies that have resulted in the disproportionate hiring of White
men into faculty positions)? Psychologists, psychiatrists, behaviorists, life coaches, and drill
instructors might suggest that it is possible; parents, economists, and political theorists might
suggest that it is not. If it is possible, how can it be done?
100
Conclusion
The interest in increasing diversity among medical school faculty is predicated on the
research-based theory that medical school students benefit of learning from and being mentored
by people similar to themselves, from a racial and gender perspective, who are able to serve as
positive role models. Female and minority students should be able to see themselves reflected in
the demographic makeup of their faculty members, mentors, and academic and professional role
models. In addition, students and faculty alike should be trained to provide culturally competent
healthcare to all populations, including the underserved. The benefits of diversity are well
documented.
The research conducted for this study adds still more evidence that historical, traditional,
and legal hurdles still exist to increasing faculty diversity to a point that better reflects state,
national, and patient population demographics. The findings, however, suggest strongly that the
primary reason why faculty diversity among UC medical schools does not accurately reflect
population demographics is that the issue of diversity has generally been considered from the
White majority paradoxical perspective. That is, the issue has been viewed as though the goal is
to achieve diversity without changing the status quo. That is not possible. As the state and the
nation both shift increasingly toward a higher percentage of non-White citizens, the percentage
of ladder-rank positions on UC medical school faculty will have to shift as well—away from the
distinctly disproportionate representation by White men.
The interviews with personnel from the David Geffen School of Medicine were
especially telling, as they affirmed much of the information uncovered during the literature
review with respect to hiring biases, entitlement, tradition, assumptions, prejudices, and
misperceptions. While it is impossible to state so definitively based on the evidence presented
101
here, the findings suggest that the greatest barrier to achieving faculty diversity is a philosophical
one. That is, attitudes, not legislative guidelines or labor pools or slow turnover rates, are what
holds back the rate of change.
As these behavioral factors weighed heavily on the ability of the medical schools to
achieve a more appropriate (and mandated) level of diversity, it will likely require a more
concerted execution strategy to achieve success. In addition to ensuring that all faculty with
hiring responsibilities are inculcated in the best practices above, there must also be an
accompanying atmosphere of accountability to support diversity. If the schools truly believe in
the transformative power of a more diverse population to achieve both better learning outcomes
among their students as well as better healthcare outcomes among the future patients of these
students, then all faculty must be employed to achieve this change. Faculty must be held
accountable for attending diversity training and participating in outreach efforts in an effort to
reverse the behavioral barriers to success. In addition, the job posting and hiring system must be
redesigned and continuously reevaluated to require diverse search committees and candidate
pools. Only when accountability is introduced into these prescribed solutions will changes begin
to take place not only at a faster pace, but in ways that are both more organic and more
sustainable. Faculty diversity encourages student diversity, which in turn reinforces the talent
pool for faculty.
102
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APPENDIX A
UNIVERSITY OF CALIFORNIA DIVERSITY STATEMENT
RECOMMENDED TO THE UNIVERSITY OF CALIFORNIA BY THE ACADEMIC SENATE OF THE
UNIVERSITY OF CALIFORNIA
Adopted by the Assembly of the Academic Senate May 10, 2006
Endorsed by the President of the University of California June 30, 2006
Adopted as policy by the Regents of the University of California September 20, 2007
The diversity of the people of California has been the source of innovative ideas and creative
accomplishments throughout the state’s history into the present. Diversity — a defining feature
of California’s past, present, and future — refers to the variety of personal experiences, values,
and world views that arise from differences of culture and circumstance. Such differences
include race, ethnicity, gender, age, religion, language, abilities/disabilities, sexual orientation,
socioeconomic status, and geographic region, and more.
Because the core mission of the University of California is to serve the interests of the State of
California, it must seek to achieve diversity among its student bodies and among its employees.
The State of California has a compelling interest in making sure that people from all
backgrounds perceive that access to the University is possible for talented students, staff, and
faculty from all groups. The knowledge that the University of California is open to qualified
students from all groups, and thus serves all parts of the community equitably, helps sustain the
social fabric of the State.
Diversity should also be integral to the University’s achievement of excellence. Diversity can
enhance the ability of the University to accomplish its academic mission. Diversity aims to
broaden and deepen both the educational experience and the scholarly environment, as students
and faculty learn to interact effectively with each other, preparing them to participate in an
increasingly complex and pluralistic society. Ideas, and practices based on those ideas, can be
made richer by the process of being born and nurtured in a diverse community. The pluralistic
university can model a process of proposing and testing ideas through respectful, civil
communication. Educational excellence that truly incorporates diversity thus can promote mutual
respect and make possible the full, effective use of the talents and abilities of all to foster
innovation and train future leadership.
Therefore, the University of California renews its commitment to the full realization of its
historic promise to recognize and nurture merit, talent, and achievement by supporting diversity
and equal opportunity in its education, services, and administration, as well as research and
creative activity. The University particularly acknowledges the acute need to remove barriers to
the recruitment, retention, and advancement of talented students, faculty, and staff from
historically excluded populations who are currently underrepresented.
113
APPENDIX B
Employment Numbers for the UC Medical School Faculty, 1996 –2004
Source: Echiverri, A., Joy, H., & Kanu, A. (2007). Representing the new majority Part II:
A status report on the diversity of the University of California medical school faculty.
114
APPENDIX C
Employment Percentages for the UC Medical School Faculty, 1996 –2004
Source: Echiverri, A., Joy, H., & Kanu, A. (2007). Representing the new majority Part II:
A status report on the diversity of the University of California medical school faculty.
115
APPENDIX D
Appendix D-1
UCLA Faculty Diversity Statistics, David Geffen School of Medicine, 2008
116
Appendix D-1 Continued
Source: 2008 David Geffen School of Medicine Diversity Statistics
117
Appendix D-2
UCLA Faculty Diversity Statistics, David Geffen School of Medicine, 2011
118
Appendix D-2 Continued
Source: 2011 David Geffen School of Medicine Diversity Statistics
119
APPENDIX E
Interview Questions
Question 1
To your knowledge, did your school make changes to its hiring practices after the passage of
Proposition 209 in order to (1) improve compliance with the proposition, (2) improve faculty
diversity opportunities following the initial implementation efforts, or (3) both. If so, what were
those changes?
Question 2
In order to meet the LCME accreditation standards for faculty diversity, has your school made,
or will your school need to make, modifications to its faculty recruiting practices? If so, how are
these practices likely to change?
Question 3
Given the changes in LCME accreditation standards that now require medical schools to achieve
faculty diversity in the context of their respective local and national responsibilities, do you
believe this creates a contradiction with the tenets of Proposition 209?
Question 4
What is your perception of how Proposition 209 applies to hiring practices at state institutions
such as UC medical schools?
Question 5
What recruiting practices currently in place at your school have shown promise in achieving
faculty diversity while remaining in compliance with Proposition 209?
Abstract (if available)
Abstract
The Liaison Committee on Medical Education (LCME), the accrediting body for schools of medicine in the United States and Canada, has accreditation standards that require faculty gender and ethnic diversity to reflect that of the general population and contend that medical students of different races and backgrounds benefit from a multi-racial, multicultural teaching force whose members may serve as role models and mentors. In the State of California, Proposition 209 prohibits state institutions such as the University of California (UC) schools of medicine from using racial, gender or similar factors when hiring faculty. This study examined how these schools have worked to address the contradiction between LCME accreditation standards and Proposition 209 directives. It also sought the best practices that have been developed by UC medical schools to achieve faculty diversity as required by LCME accreditation standards while maintaining compliance with Proposition 209. ❧ Through demographic analysis, records research and interviews, it was discovered that UC medical schools lacked a comprehensive awareness campaign to inform faculty with hiring responsibilities of both the diversity-related requirements in the LCME accreditation standards and the true benefits to medical care of hiring a more diverse faculty. As a result, slowness in achieving greater faculty diversity may be more attributable to psychological barriers related to beliefs and attitudes rather than to legal or statistical challenges. Identifying and developing ways to address attitudinal barriers formed the foundation of several of the best practices recommendations outlined in the study, as well as implementing a regimen for accountability in achieving success in diversity hiring.
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Asset Metadata
Creator
Schnabl, Jody C.
(author)
Core Title
Achieving faculty diversity at University of California medical schools while maintaining compliance with proposition 209
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Education
Publication Date
07/26/2014
Defense Date
07/02/2012
Publisher
University of Southern California
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accreditation,diversity,medical schools,OAI-PMH Harvest,Proposition 209
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