Medicine must ‘widen the doors’ to people of color

The pandemic and the death of George Floyd put a glaring spotlight on the gross racial inequities in society, which cut across every facet of life, especially health care. Not only are communities of color disproportionately affected by chronic health issues and disease, but they are also facing enormous challenges in accessing health care.

Race as a public health crisis has gained the attention of every health care organization and policymakers at every level of government. Diversity and inclusion programs are being taken up with new fervor and infused with funding. All of this is important, encouraging, and long overdue.

But all too often the focus is predominantly on patients, not providers. The systemic, fundamental problem of underrepresentation among medical professionals is often overlooked.

A study published in JAMA not long ago showed that the representation of Black and Hispanic men serving as physicians and surgeons has remained unchanged over the last 20 years. In the 21st century, these numbers have hovered around 2.6% for Black men and 4% for Hispanic men. The 2020 Census tells us that the U.S. as a nation is diversifying at higher than anticipated rates, but Black and brown communities are generally not seeing themselves reflected when they go to a doctor’s office or hospital.

It will take a relentless commitment from all stakeholders to correct two decades of inertia, and also to build robust pathways for successive generations to have the support and encouragement to pursue careers in medicine.

The blueprint lies with those of us who have been working on diversity and inclusion efforts long before 2020. It lies with those of us whose representation of race and ethnicity among faculty and staff has not remained stagnant, who are not part of these disappointing trend lines. It lies with those of us whose efforts can be replicated and scaled nationally.

I came to the Moffitt Cancer Center and Research institute in Tampa in 2006 to lead its diversity program. At the time, the concept of a health system investing significantly in an organization-wide effort for diversity and inclusion with both dedicated leadership and an entire team was almost unheard of.

Since then, we have been working intensively to address systemic equity issues in cancer care. On the patient side, that includes everything from efforts to increase the diversity of the center’s patients, to community outreach, and to making more diverse the clinical trials the center runs. A special focus for me is examining ways to “widen the doors” to Moffitt so patients who are out of network for the center, are underinsured, or aren’t insured at all do not self-select out of seeking care at a comprehensive cancer center.

Though we have excelled in achieving greater diversity and representation among our staff, we realized in 2018 that our faculty and leadership numbers lagged when it came to persons of color. Addressing diversity in leadership became a priority and a mission: It was time to widen Moffitt’s doors for faculty and staff.

We started by convening an open forum discussion with the center’s Black faculty members, which led to the creation of our Faculty Diversity in Oncology Program. Efforts began with Black faculty because we identified this community as our largest gap in faculty representation. We plan to expand the program to other groups to help address diversity and inclusion.

Our work in this program over the last three years has been rooted in three core principles: purposeful recruitment and retention; educating leaders on the importance of diversity and inclusion, on patient demographics, and on how essential it is that the center’s faculty looks like its patients and community; and mentorship and sponsorship.

A member of the diversity program was placed on the promotion and tenure committee to support retention; another served as a representative on the leadership interview committee. Black faculty members who begin working at the center are assigned a mentor and sponsor, creating a built-in support system of their peers. We believe this will help with retention and plan to expand the program to other communities of color at Moffitt.

Since the first meeting of the Faculty Diversity in Oncology Program in 2018, 65% of the center’s faculty hires identify as Black, Hispanic, or Asian American; 85% of the executive leadership hires over the last two years identify as Black, Hispanic, or Asian American men. We are constantly examining our composition to improve racial, ethnic, and gender equity across the center’s faculty and leadership, and continue to focus on diversity and inclusion so the center represents and reflects the communities it serves.

It is important to see year-on-year improvements in faculty representation, but a focus on long-term needs must not be lost. As the U.S. becomes a majority minority country, we need to think about what it means to keep pace so today’s youngest patients become the department chairs of tomorrow. Moffitt formed a partnership with the BEST Medical Academy to bring mentorship and shadowing programs to Tampa area students ranging from fifth grade through college, giving them access to hands-on work in the medical field. By exposing young children and adolescents to medical professionals who look like them, and who may have walked their same paths, these kids can “see it to be it.” They see a bigger, brighter future when mentors and others showcase all of the many pathways to a medical career that are open to them.

I choose to look at the JAMA report as a challenge to the entire medical community to do better and more. Rather than being disheartened, let’s look to models of success and scale them. There are myriad approaches health professionals can take to acknowledge and improve diversity among teams in medical practices, regional hospitals, and national cancer centers.

For many people, 2020 stands as a turning point for both diversity and inclusion in health equity efforts nationwide. Now is the time to take action on the commitments we as individuals and organizations made last year to improve diversity and inclusion and address inequities in our health care system. Effecting real change is well within reach — what health care leaders can accomplish in the next five years will help undo the last 20 years the field has been on pause.

B. Lee Green is the vice president of diversity, public relations, and communications at the H. Lee Moffitt Cancer Center and Research Institute in Tampa and a board member of the W. Montague Cobb/National Medical Association Health Institute in Washington, D.C.