Racial/Ethnic Representation Among American Board of Family Medicine Certification Candidates from 1970 to 2020

Background: Because improved patient outcomes and experiences have been associated with health care workforce diversity, efforts to create a diverse family physician workforce have increased. However, a metric that could properly measure family physician representation in various contexts has seldom been studied. Objective: The goal of this study is to propose a new metric logRQ and use it to examine the diversification progress of American Board of Family Medicine (ABFM) certification candidates relative to national, state, and historic populations, as well as medical school matriculants. Methods: We obtained race/ethnicity for certification candidates from the 2014 to 2020 ABFM Certification Examination Registration questionnaire and examined racial/ethnic representation relative to various populations via logRQs. Results: The total sample comprised 26,368 initial certification candidates and 55,347 continuing certification candidates. Asian, Hispanic, and Black's logRQ increased by 0.51, 0.42, and 0.41, respectively, in initial certification candidates compared with continuing certification candidates. In addition, logRQ standard deviation ranged from 0.19 to 0.87 across States, indicating state-level variation. Although Black and Hispanic remained underrepresented, the degree of underrepresentation had improved substantially across the past 5 decades, with logRQ increasing from -2.12 (Black) and -1.16 (Hispanic) in the 1970s to -0.46 (Black) and -0.68 (Hispanic) in the 2010s. The race/ethnicity logRQs of 2020 initial certification candidates relative to 2013 to 2014 medical school matriculants were all near 0, reflecting equitable representation. Conclusion: We utilized the proposed metric logRQ to quantify the advancement in representation among ABFM certification candidates in different contexts. The proposed logRQ may serve as a useful tool to monitor representation progress systematically.