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Racism in Academic EM: Finding a Way Forward by Embracing Policies That Benefit Black Physician Recruitment and Retention
By Taneisha Wilson, MD, ScM and Elizabeth Goldberg, MD, ScM
After weeks of serving on the front be cared for by one of their own line for COVID-19 and witnessing how and equitable policies can emerge Black Americans are disproportionately that are informed by physicians who affected by the disease, the latest share experiences with our patients. videos documenting police violence Unfortunately, although 14 percent of against Black Americans are too Americans are Black, Blacks make up much to bear. We know that Black only four percent of physicians. Americans have been subject to generations of racist policies — housing discrimination, educational segregation, Three Ways We Can Change This Legacy disproportionate imprisonment — 1. Barriers to recruiting Black that have led to poor health. We also physicians should be lifted. know that academic medicine is not Meaningful change cannot occur devoid of racism. Under the hashtag without incorporating the voices #BlackintheIvory, academics have been of Black Americans in medicine; sharing personal experiences from their unfortunately, current structures professional lives that expose a system make the pursuit of medicine all but that needs repair. impossible for most Black adults. To
For us it starts with making sure apply to medical school, you must medicine attracts the very people first be admitted to college — a harmed by racist policies — Black tremendous feat considering that most Americans— so our patients can African Americans attend low-income underperforming public schools. In addition, the cost of the medical admission test and medical school applications can run upward of $10,000 — an amount which is prohibitive to many families due to a lack of generational wealth from decades of discriminatory policies.
Empirical research also shows that implicit bias is pervasive in letters of recommendation, where Blacks are more likely to be described as “competent” compared to their white peers who are “stand-out.” In addition, membership in Alpha Omega Alpha, the honor medical society, is more likely to be bestowed upon whites even when controlled for test performance, and we’re going in the wrong direction. Sadly, there were more Blacks in Alpha Omega Alpha in 1985 (1.4 percent) than there were in 2015 (0.7 percent). White physician mentors, educators, and
colleagues should combat their own racial bias and racism in order to better teach and support trainees.
2. Hospital and practice leaders must speak out against racism.
Leaders cannot be silent when women and men are protesting in the streets about racism or when one of their own faces discrimination. Although most leaders are white (people of color make up only 12 percent of boards of directors) everyone can be an ally. Policies that ensure diverse boards, such as quotas and public reporting of board diversity, are desperately needed. Statements about racism and the value of Black lives must be followed with concrete steps to recruit and retain more Black medical students, residents, and attendings. Residency programs can offer paid visiting clerkship programs or “second look” visits, whereby Black medical students can evaluate desirable hospitals at little to no cost to them. Additionally, Black faculty who “do the work” should be compensated for their time spent leading inclusion efforts. This can be done by recognizing their efforts as part of academic promotion criteria and offering buy-downs of clinical time or stipends.
3. Create checks and balances to reveal bias.
Data must be routinely collected and analyzed to ensure equity in hiring, salary, benefits, and promotion. Measures such as representation in number of invited lecturers, stipend payment faculty, faculty recommended for promotion, medical students interviewed and matriculated into residencies — all need to be tracked, scrutinized, and improved upon.
To be sure, fixing racial bias in health care alone will not end violent policing and create equitable societies, but as physicians, we can be community leaders in ushering in change. It must start with “cleaning our own house first.” When we embrace policies that benefit Black physician recruitment and retention we also improve care for our diverse patients. This year, 2020, can go down as the year that we continued our legacy of disregard, ambivalence, and inaction toward Black Americans in medicine or it can be the year in which we righted our wrongs and showed the world we can find an equitable way forward — one that benefits us and our patients.
ABOUT THE AUTHORS Dr. Wilson is an assistant professor of emergency medicine at Brown University.
Dr. Goldberg is an associate professor of emergency medicine and health services at Brown University.
