The Medical Profession Faces A Crisis Of Diversity, Inclusion, And Equity

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I was immersed in the intergalactic war unfolding in my novel as my daughter slept, head resting on my thigh. Less than one year ago, she curled up in the window seat with ease. Now her contorted legs dangled over the edge fighting for space and comfort.

The flight attendant’s voice boomed from the cabin intercom and yanked me from my literary escape. “Attention passengers, is there a doctor on the plane?” Attempting to remain inconspicuous, my head slowly swiveled to scan the cabin. Hesitant to answer the call, seconds that felt like minutes ticked off as I hoped some other doctor — any doctor — would step up. I had been here before, and I didn’t feel like getting hassled on this flight today.

The lack of minority representation in medicine is distressing, especially for African-American men. Statistics from the Association of American Medical Colleges show that 542 black males entered medical school in 1978 compared to 515 who entered in 2014. This drop is alarming, considering the increase to nearly 180 schools accepting over 20,000 students annually during the intervening four decades. Despite the increased opportunities, fewer black men are applying to medical school.

I am a product of one of those schools, graduating with a handful of black men and women in a class of more than 100 students. Decades later, I am now a trauma surgeon who has handled hundreds of emergencies, sometimes making life-altering decisions in seconds.

Years ago, midway through a 15-hour trans-Pacific flight from Los Angeles to Australia, I was in a similar situation. Without hesitation, I reached overhead and pressed my call button. Moments later, I sat speechless as a flight attendant asked beneath a furrowed brow and incredulous stare, “You’re a doctor?”

I ignored the snickering passengers as he demanded to see the medical license I never carried. To this day, I wonder, if I did, how he would know it was not a fake? Accepting I was his only option, he allowed me to assist.

Black women endure the same indignities. During an in-flight emergency in 2016, an African-American physician offered to assist with an unresponsive passenger. Turned away by the cabin crew, she was told, “We are looking for actual physicians.” In 2018, another physician was repeatedly questioned about her credentials, according to a New York Times report, as she aided the passenger in distress seated next to her.

The newsworthy in-flight emergencies can eclipse the crisis of diversity, inclusion, and equity in medicine. Racial and ethnic minorities account for 26 percent of the U.S. population, but only 6 percent of the physician workforce. A similar disparity prevails in nursing.

Numerous studies validate the benefits a diverse workforce confers upon patients. It will take more than pipeline programs, mentorship, and diversity initiatives to reverse this trend. Progress is not measured by praising the numbers game of representation in medicine if those numbers are excluded from the executive suite, nursing leadership and gatekeeper roles such as department chairs, program directors and deans of admission.

A black man walking the halls of the hospital in a white coat at least looks the part of a doctor. However, sitting in coach at 30,000 feet wearing a Star Trek T-shirt, faded designer jeans and slip-on Skechers may not have the same effect. But that was not the time for self-reflection, nor was it the time for inaction.

So I slid my book into the seatback pocket in front of me, reached overhead, and pressed the call button. My daughter awakened from her slumber, disoriented, and she craned her head from my lap. I smiled as she rubbed tiny fists into her eyes before she pressed her face against the window to marvel at the landscape passing below.

Then I leaned back, took a deep breath, and waited.

Brian H. Williams is a trauma surgeon who blogs at his self-titled site, Brian Williams, MD, and host of the Race, Violence & Medicine podcast.

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