A decade ago, the Department of Health and Human Services made “to achieve health equity, eliminate disparities, and improve the health of all groups” one of its goals for Healthy People 2020. It didn’t come close.
Black Americans continue to experience some of the worst health outcomes of any racial group. Black men have the shortest life expectancies. Black women have the highest maternal mortality rates. Black babies have the highest infant mortality rates.
Diversifying the health care workforce to reflect patient populations is one solution. But that is a tall order when health care work environments can be unwelcoming and discriminatory to Black health care providers.
While I write from the physician perspective, similar issues are relevant in nursing and other health care-related professions.
In 2003, the Institute of Medicine’s landmark report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” described the need to increase the proportion of minorities in the health care workforce to address health care disparities. At the time, 3.3% of U.S. physicians were Black, while Black people represented 13% of U.S. residents.
Nearly two decades later, we haven’t come that far: only 6% of physicians are Black, while Black people still represent 13% of the U.S. population.
Academic medical centers are where medical students learn to become physicians and faculty members engage in cutting-edge education, research, and clinical care. But these centers are not upholding their commitment to maintaining diverse, equitable, and inclusive environments for Black students and faculty. There are many reasons for this.
Black faculty members have cited lack of mentorship and sponsorship, barriers to promotion and advancement, and lack of supportive — and sometimes hostile — work environments as factors in their attrition from academic medical centers. In addition to the typical obligations of academic faculty, they are often expected or told to execute “diversity” efforts such as chairing diversity committees, mentoring minority trainees, and the like, and then are rarely recognized or compensated for this invaluable work.
I find it ironic that Black faculty members are unfairly tasked with the complex and overwhelming chore of remedying the structural outcomes of centuries of institutionalized racism that we did not create in the first place.
Last month, I made the difficult decision to leave my faculty position at an academic medical center after more than nine years there because of a toxic and oppressive work environment that instilled in me fear of retaliation for being vocal about racism and sexism within the institution.
I never thought I would leave. My presence and work was significant to my patients, students, and colleagues. But I could no longer stand the lack of mentorship, promotion denial, and work environments embedded in racism and sexism. I also realized it was imperative for me to speak truth to power and that I could have a larger impact through carving a path of my own by forming a company to equip health care organizations with the tools to support a diverse workforce and to provide equitable care to each and every patient.
It’s a shame that I and many of my Black colleagues are leaving academic medicine. We would have ultimately cared for more Black patients, taught and mentored more Black trainees, and performed more critical research to eradicate health inequities.
Black medical students also face considerable challenges. Studies have shown that they report social isolation as well as experiences of racism perpetuated by both peers and faculty members. A recent study demonstrated racial bias in how medical school faculty members described Black students in evaluations compared to non-Black students.
Another study confirmed that the selection process to the prestigious Alpha Omega Alpha honor society, which can play a significant factor in medical students’ future professional success, was embedded with bias, severely disadvantaging minority students. The lack of Black faculty results in fewer potential mentors and role models for Black students and contributes to a leaky pipeline for minority trainees.
I’ve personally seen the impact of my own presence as a Black faculty member. I vividly recall that after giving a lecture four months into the school year, a Black female first-year medical student eagerly waited after the class to tell me how proud she was that I was her first and only Black lecturer.
Even the physical environments of academic medical centers can convey exclusionary messages to students and faculty members. For more than a century, the hallways and auditoria of many such centers have displayed portraits of white men who were accepted into medical schools under racist admission practices and even some who participated in and profited from slavery, colonization, and the oppression of Black people.
Students at Yale School of Medicine have described the school’s portraiture as a “visual demonstration of the school’s values, which they identified as whiteness, elitism, maleness, and power” and noted that “the portraits exacerbated feelings of being judged and unwelcome at the institution.”
Fortunately, some academic medical centers have begun to reconsider how the symbolism in these portraits can influence how minority students and faculty members experience these environments. Last June, Brigham and Women’s Hospital, one of Harvard Medical School’s teaching hospitals, removed the paintings of former department chairs, almost all of whom were white men, from its main auditorium and dispersed them to other parts of the hospital as part of its broader diversity initiatives to improve the sense of belonging among the hospital’s workforce.
If academic medical centers and their leaders cannot adequately support Black students and promote Black faculty, then they will continue to leave. I was not the first to leave such a center and I will certainly not be the last. These centers, as exemplars of clinical, educational, and research innovation, shoulder the responsibility of ending health inequities and creating environments where Black students and faculty members can not only survive but thrive.
Academic medical centers must begin to recognize and rectify the historical and current impact of racism on the health care workforce. Their leaders should listen actively and respond accordingly to the concerns of Black faculty members and students, adopt an anti-racist philosophy, and, through a lens of racial equity, intentionally commit the time, effort, and resources required to dismantle the structural racism and white supremacy embedded in their current institutional cultures.
If not, then Black Americans could be in even worse shape when Healthy People 2030 rolls around.
Uché Blackstock, M.D., is the founder and CEO of Advancing Health Equity.
Hear Blackstock talk more about racism in academic medicine on an episode of the “First Opinion Podcast.”
Great job Uche and continue to expose the disparity in the Health Care Centers but it is just as bad in Advertising, banking, academia, etc.
Please continue to fight there are people of all races who are tired of racism and discrimination.
Stay focused!
You’ve been endowed with intellect, wisdom, and determination. Add a bit of leadership to that and stay in the game. You’ll be much more effective living it rather than writing it.
Man, some of the comments in the string here come right out of the MAGA orange handbook..scary. Thanks to those who are open minded and empathetic . For those who are not, and defensive, I hope you see some light some day. In the meantime, I intend to respect diversity and listen to those who signal there may be some unintentional or intentional biases.
I read only half of this and stopped because the author is a closed minded bigot who only sees race.
Maybe you should go live in a country where only non whites live .
That also goes for some of the comments here. You want all black you blame all whites for any issue of today and things they could not control yesterday.
Go to some of the non white countries and show everyone the special person you are
This article is coming from a place of victim hood with arrogance mixed with hypocrisy of a prejudiced mind.
So sad, Dr. Blackstock felt she could not sacrifice herself any further, and abandoned her academic position; with the unfortunate unintended consequence of withdrawing her mentorship from younger physicians in training. I cannot blame her, we cannot demand that individuals always put any public cause ahead of their own personal needs.
Without a doubt discrimination, overt or covert, exists and is prevalent against diverse racial groups, Jewish people, women {as well as men), individuals from the LGBTQ community, etc. This grossly unacceptable situation needs to be continually confronted and combated by education and dialogue to decrease this egregious lack of acceptable and tolerance.
However, what is omitted from this author’s article is placing blame entirely for black Academics leaving Medical Academic Centers due to inherent racism leading to a lack of mentorship, promotions and myriad other issues without any mention as to the possible contribution of those effected resulting in this unfortunate situation.
For instance, what is the contribution of these Physicians resulting in the problems they are experiencing? Is it that they are so focused and expectant of racism resulting in a self-fulfilling prophesy? Is their lack of promotions due to their work/research performance not being deserving of promotion? Possibly, is the expectation that because one is of a certain racial group that they should automatically be accorded certain entitlements and preferential treatment? Is there any awareness that other ethnic groups were confronted with similar egregious levels of discrimination, such as the Jews, who were faced with severe quotas for admission into medical schools up until the 1960s, but rather than demanding and complaining regarding overt discrimination, overcame it and succeeded based on their own merits within the context of Academic medical Centers? The same holds for Asians, Africans and other ethnic groups.
So while we acknowledge that racism definitely exists and will most likely continue in its various forms, and may not be fully amenable to educative interventions and institutional changes, the only factor that can assuredly be controlled is that individuals impacted by racism, discrimination and other grossly unacceptable animus from society is for individuals from these groups to continue to excel in their performance, evolve realistic expectations as to what medical centers and society at large can actually provide to compensate for injustices experienced in the past, and to modify self-fulfilling beliefs and worldviews resulting in an attitude that does not enhance their opportunities for success.
Perhaps, but doubtful.
I wonder just when, in the scenario described here, the responsibility for change comes back to those who hold the power, instead of being routinely assumed to be the responsibility only of those whose lives have been affected? The assumption here is that we should not speak up about the conditions under which we work. How else are people like you going to grasp that your mentors had a hand in creating it, and you have a responsibility in changing it? Why is it you seem to think that we should not remind you of this?
The problem will not go away until Affirmative Action and quotas go away. I grew up in the pre-AA world. I knew without doubt that any Black person who succeeded was not only qualified, but was among the very best. Post-AA, there’s a suspicion that the person in question is second-rate at best and was “helped” through. So now that person has to prove themselves every time to everyone new. Which they logically perceive as racism rather than enlightened self interest. That’s why fighting racism with more racism is destined to fail. I don’t know what the answer is, but it’s clear that 50 years of racist policy with the goal of atoning for past racism hasn’t worked. Doing more of the same, but harder seems unlikely to work any better.
The fact that you believe that any non-male, non-white candidate needs to be ‘better than’ by a significant margin before you can consider that candidate as equal is appalling racist and sexist and exactly the problem the writer is describing.
The fact that you believe that any non-male, non-white candidate needs to be ‘better than’ by a significant margin before you can consider that candidate as equal is appalling racist and sexist and exactly the problem the writer is describing.
It’s not racism to put measures in place to correct racism. Less-qualified white men have historically, and currently, gained positions over more-qualified women and minorities. If you have suspicion that people only succeeded when they are “helped” if they are a woman or a person of color – but don’t have that same suspicion when it’s a white man – then it’s your perspective that needs to change.
Thank you. Please continue to write!
The UK is not perfect but the American Medical council has a lot to learn from the General Medical council.
This is one of the best articles that I have read about the subject of how Black faculty members are being treated in academic centers.
Keep the good work and continue to write Dr. Blackstock!