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The problem of inequity in D.C.’s healthcare workforce

Washington, D.C., is considered to have the most powerful seat in the world. Pockets of the District, however, are riddled with a lack of economic opportunities and optimal healthcare. Not all residents are living the American Dream. At JBRF, we know how vital gainful economic opportunity is to Black women’s overall health and how the healthcare sector offers many employment opportunities. We also know how critical it is for Black patients to have representation amongst healthcare professionals to receive culturally competent care. 

In May 2022, Mayor Bowser and DC Health joined forces to launch the Mayor’s Healthcare Task Force, a collaborative initiative aimed at revamping, fortifying, and expanding the healthcare workforce in the District. “Our healthcare workers have been incredible throughout the pandemic. At every stage of the pandemic, they’ve demonstrated the utmost professionalism and compassion. But they’ve been through a lot, and this task force will put forth fresh ideas for best supporting current and aspiring healthcare workers. We have an opportunity, right now, to bring more residents into a high-demand field and, in doing so, to provide relief and support to our amazing frontline healthcare workers,” said Mayor Bowser. Comprising leaders from various sectors, including education, employment services, healthcare, and government, the Task Force embarked on a mission to address the challenges related to pay, racial and economic inequities, and structural unemployment, among other things faced by the District’s healthcare workforce.

To tackle these challenges comprehensively, the Task Force organized itself into six subcommittees, each dedicated to examining specific barriers hindering the healthcare workforce. These subcommittees delved into the issues, offering insights and crafting short-term, mid-term, and long-term recommendations to help expand the healthcare workforce and ensure equitable expansion.

JBRF was invited to contribute as a member of two subcommittees. Our President and CEO, Lori Jackson, contributed to the sub-committee focused on Increasing District Resident Employment in Healthcare Occupations, which presented recommendations centered around broadening training opportunities, reducing entry barriers, and enhancing recruitment and retention strategies for the workforce.

Another subcommittee dedicated to Enhancing Access to High-Quality Allied Health Training Programs provided recommendations for boosting the numbers of Home Healthcare Aides (HHAs) and Certified Nurse Aides (CNAs).  JBRF’s Director of Strategic Programs, Manon Matchett, contributed. Their suggestions included streamlining approval processes and augmenting support through scholarships and tuition assistance programs.


Background on the task force: Why now? 

The Task Force was set up to identify strategies to rebuild, strengthen, and expand the District’s healthcare workforce, which has been dramatically impacted by the COVID-19 pandemic. However, the shortage in the healthcare workforce existed before the pandemic as well. The demand has outpaced the supply of qualified and able healthcare workers due to a higher demand for nurses and other healthcare professionals, an aging workforce, and an expanded scope of practice for many professions. The shortage of employees also represents sustainable employment opportunities–and the economic development that goes along with that–for Black women living in Wards 7 and 8. However, systemic barriers consistently stand in the way of meeting the demand.  JBRF’s role on the task force was to consistently highlight these barriers and offer recommendations on how to lower them.


The Historic Barriers 

The Task Force sought to understand the current challenges of shortages from a historical, local, and national context to ensure that the proposed recommendations are not myopic. These recommendations should give way to long-term solutions that are strategically designed to target persistent inequities in workforce and health outcomes. 

Included in the Healthcare Workforce Task Force report is a study from twenty years ago wherein the Institute of Medicine documented that medical practitioners within the healthcare system exhibited a high prevalence of implicit bias, contributing to negative health outcomes for people of color.

Subsequent research revealed that the proportions of minority medical students, including Black, Hispanic, and American Indian or Alaska Native students, increased at a much slower rate compared to students of other races and ethnicities, notably white students.

As a consequence, the physician workforce and other healthcare professions have repeatedly failed to mirror the demographics of the U.S. population. Unless intentional actions are taken to disrupt these trends, the historical and contemporary racial underrepresentation in the upper echelons of the healthcare workforce, coupled with overrepresentation at the bottom, as indicated by the Brookings study, will remain in the foreseeable future.

“Our experiences prior to, during, and since the COVID-19 pandemic have heightened awareness of the depths and persistence of structural racism in the healthcare sector and across its workforce. This includes recognizing its detrimental impacts on the health of communities and people of color both nationally and in the District., “ the report says.


Systemic Disparities in Employment 

Despite the availability of a pool of potential workers who could contribute to a more representative healthcare workforce, a significant challenge arises in the form of “structural unemployment,” wherein there is a mismatch between the skills of the workforce and the skills an employer is looking for. As a result, the skilled workforce still ends up in an involuntary state of unemployment. Similar to the impact of the Great Recession, the COVID-19 Pandemic has also affected unemployment in the District. Additionally, during periods of recession, not only does overall unemployment worsen, but structural unemployment can also persist, keeping unemployment rates high long after the recession has ended. Addressing structural unemployment is complex because even if new jobs are created, they often tend to be of low quality. 

In the context of Washington, D.C., while the metropolitan area unemployment rate was the tenth lowest in the nation overall (2.7% in early 2023 vs. the US rate of 3.5%), data showed the highest Black-White unemployment ratio at that time to be 6.7-to-1. These racial and ethnic disparities also have a geographic root in the city, which is further emphasized by historic and contemporary segregated living arrangements and the persistence of structural and institutional racism. Additionally, social determinants of health, like unemployment, are much more concentrated at the ward and neighborhood levels, as highlighted in the 2018 Health Equity Report. Overall, data concerning unemployment paints a grim picture of racial, ethnic, and structural challenges in East of the River neighborhoods.

The data reveals some glaring inequities that do not come as a surprise: Black workers consistently face higher levels of unemployment and are more likely to be underemployed compared to their white counterparts. Additionally, a substantial portion of unemployed Black workers experience prolonged periods of joblessness. The existence of structural barriers and disparities that hinder employment opportunities for Black residents are not limited to any specific economic conditions but are consistently seen across both favorable and challenging economic times.

Conclusions from the preliminary data were loud and clear. Many of the District’s unemployed or underserved were Black men and women who continue to face disparities like no other when it comes to healthcare and workforce-related equities. These fundamental aspects create a vortex that is impossible to escape, especially for those who reside East of the River in Wards 7 and 8 of D.C., and negatively impact health outcomes for this population. Therefore, this was a tremendous opportunity to look deeper into historical data on systemic issues, stressors, unemployment patterns, and skillset mismatches that prevent people of color from thriving in the healthcare workforce in Washington, D.C.

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