Why should we strive to make medical education and health care more diverse, and how can that be done? Those were two key questions explored by a HUBweek panel hosted by STAT.
The panel was moderated by Dr. Jennifer Adaeze Okwerekwu, a resident in psychiatry at Cambridge Health Alliance and STAT’s Off the Charts columnist. Panelists included Dr. Joan Y. Reede, dean for diversity and community partnership and professor of medicine at Harvard Medical School; Dr. Marshall Forstein, director of training for the division of adult psychiatry at Cambridge Health Alliance; and Elena Olson, JD, executive director of the Center for Diversity and Inclusion at Massachusetts General Hospital.
Here are some excerpts of the lively discussion, edited for length and clarity.
Why is diversity important?
Reede: I am a professor of medicine at Harvard Medical School. I say that to make a point: There are only three female African American professors at Harvard out of a faculty of 12,000, and just 107 female African American professors across 145 med schools in the country.
Forstein: I came out as a gay man before medical school. I have tried to be out and open my whole professional life to demonstrate … that it is not only safe to be gay, lesbian, bisexual, or transgender, but that there need to be people to act as role models as well. There’s no way we’re going to become a safer world if we don’t begin to embody respect for differences.
Olson: There’s nothing more important and pressing today than health inequities. Justice and equity in health and education are two keys areas where each and every one of us can make a difference. Massachusetts General Hospital has a four-pronged mission: research, education, patient care, and community health. Diversity is the driver to excellence in every single one of them.
What does it mean to be marginalized or underserved? How can the needs of marginalized or underserved communities be met?
Reede: To be marginalized means not having a voice. Being marginalized can happen to doctors. You can be in the academy but that doesn’t mean your voice is heard. Diversity and inclusion are about making sure that individuals’ voices get heard in ways that lead toward excellence. We need different voices in the room. It’s important that all physicians respect and better understand the needs of their patients and reflect their interests. That doesn’t mean you have to match in skin color or language, but it can be helpful.
Olson: When we talk about underrepresentation in medicine we are talking about really small numbers. In the United States, African Americans, Latinos, and Native Americans make up about 30 percent of the population. But they represent only about 7 percent of physicians. We need to have to have a workforce in health care that represents the people it is serving. The outcomes of increasing diversity aren’t soft, like oh my gosh we will feel better about this tomorrow. Instead they are improved outcomes — a healthier nation, a better business model, and more people wanting to go into medicine.
Marshall: What makes good doctors? Good MCAT and board scores do not correlate with good doctoring. We need to see people for who they are. We should be putting resources into the local school [system] to bring students in to health care earlier.
I am a strong believer that you cannot be what you cannot see. What sorts of investments do we need to make to promote diversity in medicine?
Reede: It is important to start early, to be part of the community, and to contribute back to that community. At Harvard Medical School, we are involved with everything from developing curriculum for schools, training teachers, providing opportunities like bringing in biology students to our labs, and offering summer programs and career exploration programs. The mistake we make sometimes is thinking that because we give you a touch of extra exposure at one point in time it’s supposed to last you for the entirety of your life. What’s needed are multiple points for entry, exit, and reentry, from middle school through medical school and junior faculty positions. We often talk about how to get kids to be doctors. Instead, we need to think of kids as pluripotent stem cells who can turn into anything.
Olson: For our institutions, good leaders make a difference. If you don’t have resources and commitment from the top, you can do nothing.
Marshall: There’s a Chinese saying: In dreams begin responsibilities. Dreams need to start early. Many of our kids are struggling in communities where the parents are so strapped to provide the sense of dream. As communities, we need to create opportunities where families get the support so they can provide that dream.