A wealth of information has been amassed on the topic of race/ethnicity and careers in healthcare management. In this concluding section we focus on the possible interrelationships of some of the main career outcomes. In the cross-sectional study, we were most interested to determine if the pattern of lower career attainment among blacks compared to higher career attainment of whites was as true in 1997 and was the case in 1992.

We learned that several key findings observed in 1992 have not improved. For example, a higher proportion of white women now work as senior level executives than black women. Corresponding to this is the finding that the gap between white and black women’s salary increased and that as discovered earlier, a lower proportion of blacks than whites work in hospitals. Not surprisingly, black women remain less satisfied than white women with several areas of their jobs—pay, security, sanctions given when errors are made, supervisor’s respect and autonomy.

The pattern observed for women is not, however, repeated for men. Here we saw greater similarity between the proportion of blacks and whites who achieved high level management positions and correspondingly, a lessening of the salary gap between black and white men as well. Somewhat surprising was the fact that black men’s satisfaction with their pay and fringe benefits actually declined in comparing the 1992 and the 1997 study participants. It will be recalled that in the cross-sectional study, these are different individuals who nevertheless, are believed to represent a cross section of each race/ethnic group.

The possible explanations for the declining satisfaction among black men relative to whites in pay and fringe benefits are (1) they are responding to the continued existence of

a 12 percent gap that persists in black and white men’s pay despite having narrowed the positional gap; (2) they are reacting to the accrued inequity experienced by members of their race, and, like the experiences observed in newly liberated states, are giving vent to their pent up frustrations. In any case, the "bottom line" results appear overall positive for men in this five year follow-up study.

While the above discussion considers the results of the cross sectional study, the following two paragraphs summarize the results of the follow-up survey. The follow-up study tracked the careers of the original 1992 respondents. Recall that these individuals are followed more to learn about evolving career paths than to provide a national picture of career differences that currently exist. We showed that comparing positions attained, few differences are now evident between both black and white men and black and white women. Moreover, though fewer blacks appear to be employed in hospitals than whites, the differences are not significant. Further, comparing salaries, the gap between black and white men has declined from 10 percent in 1992 to 7 percent today. Unfortunately, the gap between black and white women’s salaries has persisted at about 17 percent.

As was evident in the cross-sectional study, black women and men are significantly less satisfied than their white counterparts with their pay and fringe benefits. The explanation for the growing gap may be the same as those reasons postulated above.

We turn next to consider the changes that were uncovered relative to 8 specific recommendations that accompanied the 1992 report. The recommendations were formulated by ACHE and NAHSE to reduce the inequities between blacks and whites uncovered at that time. What has been the impact of each? Specifically, Recommendation 1 urged "executives... to recruit and promote black managers, with requisite preparation, at all levels." Are the experiences reported by this 1997 cohort better than the 1992 cohort relative to recruitment and promotion?

If we consider first position, (Table 15) we can see that among women, blacks continue to be more often recruited into sector management e.g., ambulatory care, associations etc. But among men, there has been a leveling out—whites and blacks are about equally likely to begin their careers in general management. On the other hand, whites continue to be disproportionately recruited to hospital positions and to organizations under not-for-profit church sponsorship whereas blacks less often take their first position in a hospital and more often begin their careers in governmental organizations.

Table 20 suggests that compared to white women, black women are less often promoted from senior vice presidencies to CEO. However, few differences appear to exist between black and white males’ promotions. Table 21 shows that blacks and whites were about equally optimistic about the likelihood of their being promoted in the coming year. We conclude that Recommendation 1 has apparently benefited black men but not black women.

Recommendation 2 suggested that the first healthcare management position is related to the current position attained and that blacks and whites should seek organizations similar to those in which they hope to build their careers. This was not ascertained in this study.

Recommendation 3 called for blacks and their employers to work together to recruit for various positions. As we discussed in Table 25, blacks continue to be less involved in recruiting physicians than whites and the disparity has now extended to white’s being more involved than blacks in recruiting nurses and administrators as well. The recommendation has not been effected.

Recommendation 4 indicated that networking and informal collegial interaction appear to enhance career attainments. We showed that while black men socialize with minority and white managers as much as whites do today, black women continue to socialize less with them at lunch. We conclude that Recommendation 4 has apparently benefited black men but not black women.

Recommendation 5 called for professional organizations of healthcare executives to develop policies that encourage their members to endorse affirmative action and equal opportunities. In 1995, the ACHE strengthened and reissued its policy statement on enhancing minority opportunities in healthcare management. However, as evident in Table 36, today, the proportion of black executives endorsing management’s responsibility to take public positions on these issues remained nearly the same (about 80 percent) but the proportion of whites actually declined 20 percent since the 1992 survey. Whites in the study are probably reflecting a more general backlash against preferential treatment for any group. We conclude that while the processes of Recommendation 5 were effected, the outcomes have actually suffered a reversal.

Recommendation 6 asked that more efforts be made to increase access to financial assistance for black students in health services administration programs. This study did not address that issue. We know that the Institute for Diversity in Health Management has worked for such assistance since its founding by the AHA, ACHE and NAHSE in 1994 as has the ACHE in the aforementioned policy statement.

Recommendation 7 suggested the results of the study should be disseminated widely—especially to executive search consultants. It was thought that their daily experience with hiring and promotion decisions make them a valuable resource to suggest techniques that would enhance the career opportunities of black healthcare executives. In fact, a special presentation was made to executive search firm representatives in October, 1993. In addition, subsequent presentations have been made by the Institute for Diversity to search firm representatives.

Recommendation 8, to conduct another study in 3 to 5 years is represented by this report.

Although only some of the objectives of the 1992 study were realized (or partially realized) in the past half decade, it might be worthwhile to conclude by emphasizing one major challenge that emerged from this research. In 1997, contrary to the views of the minorities, less than half—44 percent of whites felt that the quality of relationships between minority and white mangers could be improved. This is a scant improvement from the findings reported 5 years ago. Clearly, before a problem perceived by over 80 percent of blacks and about two thirds of hispanics and asians can be solved, it must acknowledged. It is hoped that this second report has provided ample additional evidence about the persistent and pervasive inequities in the career attainments of minority healthcare managers.