IMPORTANCE Diversity initiatives have increased at US medical schools to address underrepresentation of minority faculty. OBJECTIVE To assess associations between minority faculty development programs at US medical schools and underrepresented minority faculty representation, recruitment, and promotion. DESIGN Secondary analysis of the Association of American Medical Colleges Faculty Roster, a database of US medical school faculty. PARTICIPANTS Full-time faculty at schools located in the 50 US states or District of Columbia and reporting data from 2000-2010. EXPOSURE Availability of school-wide programs targeted to underrepresented minority faculty in 2010. MAIN OUTCOMES AND MEASURES Percentage of underrepresented minority faculty, defined as self-reported black, Hispanic, Native American, Alaskan Native, Native Hawaiian, or Pacific Islander faculty. Percentage of underrepresented minority faculty was computed by school and year for all faculty, newly appointed faculty, and newly promoted faculty. Panel-level analyses that accounted for faculty clustering within schools were conducted and adjusted for faculty-and school-level variables.RESULTS Across all schools, the percentage of underrepresented minority faculty increased from 6.8% (95% CI, 6.7%-7.0%) in 2000 to 8.0% (95% CI, 7.8%-8.2%) in 2010. Of 124 eligible schools, 36 (29%) were identified with a minority faculty development program in 2010. Minority faculty development programs were heterogeneous in composition, number of components, and duration. Schools with minority faculty development programs had a similar increase in percentage of underrepresented minority faculty as schools without minority faculty development programs (6.5%-7.4% vs 7.0%-8.3%; odds ratio [OR], 0.91 [95% CI, 0.72-1.13]). After adjustment for faculty and school characteristics, minority faculty development programs were not associated with greater representation of minority faculty (adjusted OR, 0.99 [95% CI, 0.81-1.22]), recruitment (adjusted OR, 0.97 [95% CI, 0.83-1.15]), or promotion (adjusted OR, 1.08 [95% CI, 0.91-1.30]). In subgroup analyses, schools with programs of greater intensity (present for Ն5 years and with more components) were associated with greater increases in underrepresented minority representation than schools with minority faculty development programs of less intensity. CONCLUSIONS AND RELEVANCEThe percentage of underrepresented minority faculty increased modestly from 2000 to 2010 at US medical schools. The presence of a minority faculty development program targeted to underrepresented minority faculty was not associated with greater underrepresented minority faculty representation, recruitment, or promotion. Minority faculty development programs that were of greater intensity were associated with greater increases in underrepresented minority faculty representation.

Context: California is the first and only state to implement a patient‐to‐nurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care—safety‐net hospitals—remains unclear. One concern was that California's mandate would burden safety‐net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety‐net and non‐safety‐net hospitals. Methods: We used a time‐series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety‐net and non‐safety‐net hospitals. Findings: The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (−0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety‐net and non‐safety‐net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety‐net hospitals, although there was a small but significant difference in the effect on staffing levels of safety‐net and non‐safety‐net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non‐safety‐net hospitals following the mandate, while the skill mix remained essentially unchanged for safety‐net hospitals. The difference between the two groups of hospitals was not significant. Conclusions: California's mandate improved staffing for all hospitals, including safety‐net hospitals. Furthermore, improvement did not come at the cost of a reduced skill mix, as was feared. Alternative and more targeted designs, however, might yield further improvement for safety‐net hospitals and reduce potential disparities in the staffing and skill mix of safety‐net and non‐safety‐net hospitals.

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Less than a third of medical schools had programs targeting underrepresented minority (URM) faculty, and those programs that existed differed in scope and goals. These findings suggest that a lack of resources and a preference for programs that target all faculty may limit the development of programs targeting URM faculty. Future research should examine whether diversity programs contribute to URM faculty recruitment and retention.