Advancing Diversity in Critical Care: Challenges in APP Recruitment and Education

Introduction: Advanced Practice Providers (APPs), including Physician Assistants (PAs) and Nurse Practitioners (NPs), are essential to meeting the complex needs of a growing and increasingly diverse U.S. population. In critical care (CC), where acuity is high and health disparities are magnified, a diverse workforce is crucial for delivering equitable, culturally responsive care. Yet, diversity gaps persist within APP training programs, limiting exposure to varied perspectives, which can affect the quality of care for underrepresented communities. To better understand barriers and identify solutions, we surveyed PA and NP program leaders on recruitment practices aimed at building a more diverse CC workforce.


Methods: In 2024, we developed a 16-question survey informed by literature and expert APP input. The survey was distributed to 380 accredited U.S. PA and Acute Care NP (ACNP) programs to assess institutional diversity challenges and recruitment strategies, particularly for CC pathways. Responses included multiple-choice and open-ended questions. Quantitative data were analyzed in Excel; qualitative comments were thematically coded.


Results: Seventy programs responded, representing a balanced geographic and institutional spread (61% PA, 39% ACNP). Seventy percent of respondents reported concern about the lack of diversity in their student populations. This concern was consistent across program type, region, and affiliation (p > 0.05). Identified barriers included limited faculty diversity, low awareness of APP career paths among underrepresented groups, and financial obstacles for applicants. Barriers specific to CC training included insufficient CC rotations, a shortage of preceptors, and perceptions of poor work-life balance. Reported strategies to enhance diversity included the use of diversity statements, holistic admissions processes, and proactive outreach. Qualitative themes emphasized the need for earlier exposure to healthcare careers and structured mentorship to develop a diverse pipeline into CC roles.


Conclusions: While many APP programs are committed to inclusion, significant gaps remain in recruitment, exposure, and support, particularly in CC. Solutions include early outreach, mentorship, expanded CC clinical access, and institutional partnerships that reflect the communities we serve.