As a surgical intern, my days started early, and I was tired as I entered Mr. M’s room that evening armed with a nasal feeding tube and lubricant. Mr. M was an African-American gentleman in his early 50s. He looked worn and much older than his years. Mr. M had end-stage liver disease and was on the liver transplant list. With a distended abdomen full of fluid, improving his nutrition and optimizing his condition for the long road ahead was imperative. Mr. M glowered sullenly at me. Not to be outdone by his obvious resentment, I breezed in smiling brightly. “Oh, it’s you this evening?” he asked in a disgruntled tone. Despite the almost palpable distaste, I continued cheerfully, “Yes. Why? Don’t you like me?” Without batting an eyelid, out came his surly response, “No. It’s not that I don’t like you, but if I am given a choice, I would rather drive a Cadillac over a Toyota. ” I gasped. The cold remark almost felt like a physical assault. Obviously, Mr. M was referring to my white male colleague (unlike myself) who had left for the evening. I quietly placed the nasogastric tube and left the room. That was almost two decades ago. Much water has flown under the bridge, but some mindsets have not changed at all. On the one hand, leadership and hospital administrators may be trying to address bigotry from patients, but they mirror them in their own administrative practices. Prejudices between individuals, many racially centered and some centered on professional insecurities continue. Talented individuals coming into the medical profession continue to face discrimination from patients and colleagues. “Human progress is neither automatic nor inevitable,” observed Martin Luther King, Jr. A systematic review published in 2014 showed that despite seeing an increase in the number (25 percent) of underrepresented minorities attending medical school, they comprise only 7.3 percent of all faculty members. This review also provides evidence that racism, promotion disparities, funding disparities, lack of mentorship, and diversity pressures exist and affect minority faculty in academic medicine. Furthermore, a recent Medscape survey revealed that less than 35 percent of medical professionals are non-white, with the orthopedic specialty (which incidentally also has the highest reimbursement) having the lowest diversity. Hospital administrations seldom acknowledge or attempt to settle grievances. Rather, they thrive on these inequities and often turn a deaf ear so that their reputation and the financial bottom line are not affected. In the name of “standard of care” or “quality control,” many minority physicians are quietly weeded out of the system. Many administrators in leadership positions have no emotional intelligence or empathy and are barely sensitive to issues affecting their “colored/foreign” staff. Their self-esteem is often built on demeaning and undervaluing their less privileged colleagues. Their “unofficial connections” with the upper echelons of the administration allow them to carry out their “atavistic agendas” with no questions asked. Diversity is now a part of many institutional values; however, discrimination continues at every level. An agenda of augmenting diversity alone has not resulted in any meaningful changes in the inequities that affect groups who are underrepresented in medicine. Therefore, it is imperative that individuals and institutions be channeled towards a growth mindset and use adaptive expertise to realign efforts from a goal of diversity toward a deliberate stance of antiracism in medical education. This paradigm shift can only take place in a culture that empowers us to unlearn entrenched assumptions and dogma, acknowledge and grow from our errors, tolerate risk, and cultivate shared purpose and inclusivity. As recently as August 2021, surveys have revealed significant underrepresentation of minority and African-American physicians and disparity is across all specialties, which can be traced to structural racism and unconscious bias. Inclusive excellence can be achieved only by making a sustained effort to ensure that faculty from diverse backgrounds can progress to senior leadership roles. Rather than evaluating a potential leader with their four-page resume detailing many relevant or irrelevant publications, true leaders should be selected by an unbiased evaluation from their subordinates. And while hospital administrations are busy collecting different colors and models of Cadillacs to adorn their institutions, I will submit to you that the Toyota has more durable engineering, is longer lasting with less maintenance and fewer complaints, and does not need to run on premium fuel. Source
