Contribute Try STAT+ Today

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.

advertisement

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.

advertisement

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.”

  • This article is this physician’s genuine experience, and it is quite insensitive to say she is whining or that what she is saying is being political. Unfortunately, what she describes is quite commonplace. It is easy for many of those who have not lived as Black to dismiss her experience and countless others. The statistics on racial disparities in healthcare speak for themselves, and people’s lives are at stake. It would be nice for those who took an oath to care for others to stop and try to put themselves in the place of other’s experiences. If you do not live in Black skin, you will never know what we go through.

    • I do not live in Black skin. The Black people that I show them a dark age spot, on my hand, and tell them that they just have more of a pigment molecule than I do – usually give me a fist-bump or a high-5. The truth that it’s just a molecule, not good or bad, seems to help the people to whom I tell them the facts. I believe the first people were Adam and Eve, exactly as told in the Bible. I believe the Holy Spirit wrote the Bible. (Be careful that you do NOT criticize Him. He is very Holy, and meek, and easily grieved) What more can I do?

  • It is endemic in academic centers. The system tends to promote B or C grade people, some with personality issues and inbred culture

  • Prejudice and stereotyping are consequences of a narcissistic view of the “other”. However, I know of a ivy league medical school that has a rule, do not fail a black student. My experiences with a black surgeon in the army in Korea was poor treatment of a severe knee sprain. This does lead to prejudice.

  • If that’s all you took from this article, I hope you are not servicing African American patients

    • Huh? Directed at me? My main point was to have good mentors available early on in one’s education.
      As to you hoping that I not see minority patients…. you are are too late. My adult Sickle Cell clinic patients would be left high and dry. They all get my personal cell phone number.
      I hope that part of your practice is in an underserved area. You would be a terrific role model.

  • Two of my uncles who were Jewish had difficulty getting into med school in the 1930s, 1940s. Both did their undergraduate studies at Brown University. There were major quotas re Jews in those days. Both eventually matriculated at Georgetown.
    There were plenty of intelligent Jewish students who were denied the opportunity to study medicine.
    The AA situation is different in that there are relatively few AA med school applicants, and most med schools are eager to accept the relatively few who apply.
    And there are several historically black med schools that can not fill their classes with AA students, and enroll students of other races who may also feel isolated but are thrilled to be at a US school.
    My point?? Not sure… but I would rec AA physicians to somehow catch AA college students early on to mentor them and be role models.
    They need to capture the students well before their senior year.
    Perhaps these programs exist… I am not aware of them.
    As to academia I am not sure….but I know of several AA faculty locally at a southern state med school who are thriving.

  • I find it disingenuous that the author, a Harvard and Stuyvesant alum, is complaining about perceived bias when she attended the most elite and privileged institutions in the world. She, along with her sister who is also a physician, went to both of these institutions… how often do two individuals from the same family get into an exceedingly selective institution such as Harvard? It seems obvious she comes from an extremely privileged background yet has the audacity to claim otherwise.

    • Agreed. This piece is an op-ed – i.e. entirely subjective. And a disgruntled one at that. Doesn’t mean it is inherently inaccurate, but without data (like countervailing opinion regarding why the author wasn’t promoted to her satisfaction), we have no way of assessing.

    • Bill, your comment assumes that people who attend elite institutions or come from privileged backgrounds cannot experience prejudice/racism. That is entirely false. Experiencing racism and relative privilege are not mutually exclusive. There are substantive accounts in history to bolster this point.

  • Brava Uche! I hope my “new” institution will provide a better environment for all races and genders. So far so good. How are you? Xo Carol

  • Black people just have a molecule in their skin and hair that makes it dark, different races have different colors and features. I believe the Bible. Stat doesn’t like my comment, so it probably won’t show up?

  • Stop Whining. GO ahead and join the Victim-Industrial Complex. Some individuals can’t hack the harsh reality of medicine in todays world and by all means claim to be a VICTIM. It beat working

    • Wining isn’t exactly wining when there’s a problem that needs to be addressed. It’s one thing to criticize someone’s method of dealing with an issue but “smoke screening it” is why people who are supposedly “cut out for healthcare“ have led us into the worst equitable outcomes out of all wealthy nations. It’s probably time to pay attention to other viewpoints…

Comments are closed.