Achieving Latino Equity in Medicine, Nursing, and Dentistry Education: Accelerating the Path Forward

By Martín-José Sepúlveda, Antonia M. Villarruel, and Hortensia de los Angeles Amaro
May 9, 2022 | Commentary


Health professions are increasingly acknowledging legacies of racial/ethnic prejudice, discrimination, and exclusion. These legacies stem from institutional or sectoral policies, regulations, procedures, and behaviors that create and mutually reinforce disadvantage and inequity for racial and ethnic minorities (systemic racism) (Bailey et al., 2017). Institutions and professions in medicine and health care are actively examining the impact of racial/ethnic inequity in these domains (Hahn et al., 2018; IOM, 2003). A key aspect of such inequities is the historical underrepresentation of some minority groups in health care professions. Underrepresented minorities (URM) include those who identify as African American or Black, American Indian, Alaska Native, Latino or Hispanic, Native Hawaiian, and other Pacific Islanders (NIH, n.d.).

Such underrepresentation negatively affects the quality, education, and cultural competence of the future health care workforce (LaVeist and Pierre, 2014; Phillips and Malone, 2014). It also contributes to the shortage of URM health care professionals, who disproportionately practice in communities with health care professional shortages, care for more patients from their own racial or ethnic group, and consistently receive higher satisfaction ratings and outcomes among underserved communities (LaVeist and Pierre, 2014; Weissman et al., 2001; Komaromy et al., 1996). These deficiencies in the health care workforce pose a significant threat to addressing health disparities and the health system’s ability to care for the Latino population and other URM individuals, especially given their significant projected growth in the U.S. population (Vespa et al., 2020; The Sullivan Commission, 2016).

Remediation efforts to rectify inequities in representation of URM health professionals should address the experiences and degree of disparity for each group. This manuscript aims to provide greater insight into Latino underrepresentation in medicine, nursing, and dentistry and to describe an approach for accelerating change in Latino underrepresentation in these three professions.


Minimal Progress

Recently, Ramirez et al. (2021) addressed the need to eliminate disparities in medicine for those who identify as Latino, or culturally heterogeneous people in the U.S. with ethnic heritage from the Caribbean, Mexico, Central and South America, and Spanish-speaking countries worldwide. In 2020, those who identify as Latino comprised 19% (62 million) of the U.S. population—larger than all other URM groups combined (58 million) (Lopez et al., 2021; United States Census Bureau, 2021). Between 2010 and 2020, Latino population growth accounted for 51% of the U.S. population increase, and this population is projected to increase to 128 million by 2050, then comprising 29% of the U.S.
population (Krogstad, 2020; Passel and Cohn, 2008).

Data from professional associations in medicine (allopathic and osteopathic), nursing, and dentistry provide deeper insight into recent trends of Latino representation. Progress in increasing representation to reflect the U.S. Latino population is slow. From 2016 to 2020, those who identify as Latino represented 10% to 11% of applicants, 8% to 10% of enrollees, and 5% to 6% of graduates in allopathic medical schools (AAMC, n.d.). Osteopathic medical school trends from 2016 to 2020 show similar proportions of Latino applicants (8% to 10%) as allopathic medical schools but lower proportions of enrollees (5% to 7%) and graduates (4% to 5%) (AACOM, n.d.). In nursing, only enrollment data on race and ethnicity are available and indicate significant inequity and minimal Latino growth from 2016 to 2020 for both master’s (8% to 10%) and doctoral degrees (5% to 8%) (AACN, n.d.). In contrast, enrollment of those who identify as Latino at the bachelor’s level is higher, but with minimal growth in enrollment (12% to 14%). Finally, Latino inequity in dentistry parallels that in medicine (ADA, n.d.). The proportion of Latino applicants to U.S. dental schools was unchanged between 2016 and 2020 (9%) and similar to the medical profession (8% to 10%) (ADEA, 2018; ADA, n.d.). Enrollment in dental colleges (8% to 10%) was similar to allopathic medical colleges (8% to 10%), but higher than in osteopathic medical colleges (5% to 7%) (ADA, n.d.). As a result, the proportion of Latino dental graduates (7% to 9%) for the 2016 to 2020 period exceeded that in medicine overall (5% to 6%). It is not surprising, therefore, that only 4% of medical school leaders and 2% of hospital leaders are Latino (Ramirez et al., 2021).


Systemic Causes and Invisibility

The significant underrepresentation of those who identify as Latino in these three health professions results from systems dynamics involving multiple components, defined as subsystems in complex systems science (Sterman, 2003). The subsystems include not simply the educational pathway for careers in these professions (K–12, colleges, professional schools) but also social, economic, and environmental subsystems affecting family life, school versus employment demands, mobility, educational achievement, access, and affordability. Effective long-term and sustainable changes that alter the systems dynamics to produce an overall outcome of equity for Latino individuals
and other URM in medicine, nursing, and dentistry are needed. Although subsystems outside of education in medicine, nursing, and dentistry are contributing factors to Latino equity, they are beyond the scope of this commentary. Instead, the authors focus on changes in the medical, nursing, and dentistry education subsystems, which can help produce improved outcomes. The authors ask: How can these changes be approached in these professions?

Substantive change in the three professions and their institutions and actors, such as health education and research grant makers and funders, can be achieved through a rigorous systematic approach. This requires movement beyond missions and diversity statements—but also a commitment to examining, improving, and reengineering diversity missions, leadership, data, metrics, accountability for outcomes, resources, partnerships, communications, engagement, and related policies and processes. Although these strategies are not unique to improving Latino equity, the authors present a few considerations that are likely to significantly impact Latino equity. For example, equity missions must include clear outcomes, quantitative targets, and explicit timelines for achieving them, and institutional leadership must be held accountable for failing to meet these objectives.

Inequities in Latino representation in medicine, nursing, and dentistry, coupled with Latino invisibility in the scientific literature and public discourse, are shocking, given that the Latino population is the largest minority group in the United States. Throughout U.S. history and today, the Latino population has been subjected to anti-Latino and anti-immigrant policies, stigma, discrimination, and racism—including in health care and education (Amaro and Prado, 2021; Findling et al., 2019; Zambrana, 2018; Zambrana and Hurtado, 2015; Vasquez, 2013; Lopez et al., 2010). Gross inattention to Latino inequities in health care professions and education continues to render the Latino population invisible, even among intentional plans to advance URM diversity and representation. Contributing to this invisibility is the prevailing national focus on Black–White inequities in the United States, referred to as the Black–White binary paradigm of race (Gonzalez-Sobrino and Goss, 2019; Alcoff, 2003). This paradigm leads to an incomplete understanding of the role of inequities and racism affecting other URM groups and renders their histories and disparities invisible (Amaro and Prado, 2021). Thus, systems change to address the underrepresentation of the Latino population in the three identified health professions must start with giving visibility to this disparity and lifting up the history and the effects of systemic racism, discrimination, and colonization on the Latino population.


Remediation Approaches for Medicine, Nursing, and Dentistry

Health education schools should consider promising approaches to increase the number of Latino individuals in medicine, nursing, and dentistry. One promising approach is building strong pipelines from community college, to baccalaureate, and then to graduate education. For example, in nursing, models have been implemented to accelerate the proportion of registered nurses who complete baccalaureate or master’s programs. These models have been implemented in more than 30 states and include accelerated options for a master’s degree in nursing for associate degree graduates, regionally or state-shared curricula, and outcomes-based curricula (Campaign for Action, n.d.). Another approach to increasing diversity in applicant pools could be eliminating standardized tests, which can discourage application, and employing a more holistic approach in applicant evaluation for admission (AACN, 2020).

Accountability for achieving Latino and other URM equity must also be required from governing bodies of health education entities (e.g., boards of directors); entities that represent the profession (e.g., honorific and professional organizations); entities that financially support health education (e.g., government agencies and foundations); and entities accountable for evaluating adherence to quality standards in medical, nursing, and dentistry education (e.g., certifying agencies). These entities are essential components of the health profession subsystem because they influence and enable the existence and functioning of health education. As such, they affect Latino and other URM equity by their actions or inaction.

Honorific professional organizations should publicly disclose and remediate URM membership underrepresentation. Grantmaking and funding organizations should adjust their decision-making processes both to prioritize funding for institutions that are achieving prespecified URM equity objectives and to substantially increase financial and program support for URM students in these fields to reduce attrition that may be due to educational debt burdens. Boards of trustees must ensure that URM equity targets and timelines are in place and replace leaders who do not meet these performance objectives. Finally, certification bodies in medicine, nursing, and dentistry can promote Latino and all URM equity by including URM representation targets and timelines as a component of institutional or program certification.

Eliminating Latino and other URM inequity in medicine, nursing, and dentistry is complex and requires implementing a rigorous approach that extends from quantitative goals and timelines to management and board accountability to communication and transparent public disclosure. Critically, it requires that organizations and their leaders understand the historical and contemporary biases that render the Latino population invisible and take steps to include them in the forefront of the inequity discourse. These steps can accelerate rates of change and move these health professions toward equitable URM representation.


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  1. Alcoff, L. M. 2003. Latino/as, Asian Americans, and the Black-White Binary. The Journal of Ethics 7:5-27.
  2. Amaro, H., and G. Prado. 2021. Then and Now: Historical Landscape of HIV Prevention and Treatment Inequities Among Latinas. American Journal of Public Health 111(7):1246-1248.
  3. American Association of Colleges of Nursing (AACN). 2020. White Paper: Promising Practices in Holistic Admissions Review: Implementation in Academic Nursing. Available at: (accessed March 7, 2022).
  4. AACN. n.d. Table 11a. Race/Ethnicity of Students Enrolled from Generic (Entry-Level) Baccalaureate, RN to Baccalaureate, Total Baccalaureate Programs, Master’s, Research-Focused Doctoral, and DNP Programs in Nursing, 2011-2020. Available at: (accessed March 7, 2022).
  5. American Association of Colleges of Osteopathic Medicine (AACOM). n.d. Data on the Current State of Diversity in Osteopathic Medical Education. Available at: (accessed March 7, 2022).
  6. American Association of Medical Colleges (AAMC). n.d. 2021 FACTS: Applicants and Matriculants Data. Available at: (accessed March 7, 2022).
  7. American Dental Association (ADA). n.d. Dental Education. Available at: (accessed March 7, 2022).
  8. American Dental Education Association (ADEA). 2018. Diversifying the Dental Workforce and Maximizing Community Care: Summer Health Professions Education Program (SHPEP) 2006-2015. Available at: (accessed March 7, 2022).
  9. Bailey, Z. D., N. Krieger, M. Agénor, J. Graves, N. Linos, and M. T. Bassett. 2017. Structural racism and health inequities in the USA: evidence and interventions. The Lancet 389(10077):8-14.
  10. Campaign for Action. n.d. Transforming Nursing Education. Available at: (accessed March 7, 2022).
  11. Findling, M. G., S. N. Bleich, L. S. Casey, R. J. Blendon, J. M. Benson, J. M. Sayde, and C. Miller. 2019. Discrimination in the United States: Experiences of Latinos. Health Services Research 54(S2):1409-1418.
  12. Gonzalez-Sobrino, B., and D. R. Goss. 2019. Exploring the mechanisms of racialization beyond the black-white binary. Ethnic and Racial Studies 42(4):505-510.
  13. Hahn, R. A., B. I. Truman, and D. R. Williams. 2018. Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States. SSM—Population Health 4:17-24.
  14. Institute of Medicine (IOM). 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press.
  15. Komaromy, M., K. Grumbach, M. Drake, K. Vranizan, N. Lurie, D. Keane, and A. B. Bindman. 1996. The role of black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine 334(20):1305-1310.
  16. Krogstad, J. M. 2020. Hispanics have accounted for more than half of total U.S. population growth since 2010. Pew Research Center. Available at: (accessed March 7, 2022).
  17. LaVeist, T. A., and G. Pierre. 2014. Integrating the 3Ds—Social Determinants, Health Disparities, and Health-Care Workforce Diversity. Public Health Reports 129(Suppl 2):9-14.
  18. Lopez, M. H., J. M. Krogstad, and J. S. Passel. 2021. Who is Hispanic? Pew Research Center. Available at: (accessed March 7, 2022).
  19. Lopez, M. H., R. Morin, and P. Taylor. 2010. Discrimination, Deportation, Detainment, and Satisfaction. Pew Research Center. Available at: (accessed March 7, 2022).
  20. National Institutes of Health (NIH). n.d. Underrepresented Racial and Ethnic Groups. Available at: (accessed March 7, 2022).
  21. Passel, J. S., and D. Cohn. 2008. U.S. Population Projections: 2005–2050. Pew Research Center. Available at: (accessed March 7, 2022).
  22. Phillips, J. M., and B. Malone. 2014. Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity. Public Health Reports 129(Suppl 2):45-50.
  23. Sterman, J. D. 2003. System Dynamics: Systems Thinking and Modeling for a Complex World. Massachusetts Institute of Technology Engineering Systems Division Working Paper Series: ESD-WP-2003-01.13. Available at: (accessed March 7, 2022).
  24. The Sullivan Commission. 2016. Missing Persons: Minorities in the Health Professions. A Report of the Sullivan Commission on Diversity in the Healthcare Workforce. Available at: (accessed March 7, 2022).
  25. Ramirez, A. G., R. Lepe, and F. Cigarroa. 2021. Uplifting the Latino Population From Obscurity to the Forefront of Health Care, Public Health Intervention, and Societal Presence. JAMA 326(7): 597-598.
  26. United States Census Bureau. 2021. Supplementary Tables on Race and Hispanic Origin: 2020 Census Redistricting Data (P.L. 94-171). Available at: (accessed March 7, 2022).
  27. Vasquez, Y. 2013. Perpetuating the Marginalization of Latinos: A Collateral Consequence of the Incorporation of Immigration Law into the Criminal Justice System. Howard Law Journal 639. Available at: (accessed March 7, 2022).
  28. Vespa, J., D. M. Armstrong, and L. Medina. 2020. Demographic Turning Points for the United States: Population Projections for 2020 to 2060. United States Census Bureau. Available at: (accessed March 7, 2022).
  29. Weissman, J. S., E. G. Campbell, M. Gokhale, and D. Blumenthal. 2001. Residents’ preferences and preparation for caring for underserved populations. Journal of Urban Health 78:535-549.
  30. Zambrana, R. E. 2018. Toxic Ivory Towers: The Consequences of Work Stress on Underrepresented Minority Faculty. Rutgers University Press, Newark NJ.
  31. Zambrana, R. E., and S. Hurtado. 2015. Locked Doors, Closed Opportunities: Who Holds the Magic Key? In The Magic Key, edited by R. E. Zambrana and S. Hurtado.


Suggested Citation

Sepúlveda, M.-J., A. M. Villarruel, and H. de los Angeles Amaro. 2022. Achieving Latino Equity in Medicine, Nursing, and Dentistry Education: Accelerating the Path Forward. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC.

Author Information

Martín-José Sepúlveda, MD, ScD, is Distinguished University Professor, Office of Research and Economic Development at the Florida International University. Antonia M. Villarruel, PhD, is Professor and Margaret Bond Simon Dean of Nursing and Senior Fellow, Leonard Davis Institute of Health Economics at the University of Pennsylvania School of Nursing. Hortensia de los Angeles Amaro, PhD, is Distinguished University Professor and Senior Scholar on Community Health, Herbert Wertheim College of Medicine and Robert Stemple College of Public Health and Social Work at the Florida International University.

Drs. Sepúlveda, Villarruel, and Amaro are all members of the National Academy of Medicine.

Conflict-of-Interest Disclosures 

None to disclose.


Questions or comments about this paper should be directed to Martín-José Sepúlveda at


The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.

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