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Conquering Systemic Racism in Medicine

Kimberly Retzlaff  |  Issue: October 2020  |  

In addition to teaching fellows to recognize and address health disparities, academic medical programs have the opportunity to improve diversity, equity and inclusion. Diversity among faculty and working physicians is lower than the diversity of the general U.S. population. Reasons to increase diversity among medical faculty and working physicians include the understanding that cultural congruence between the patient and physician results in better outcomes, and that physicians from minority backgrounds are more likely to care for patients from vulnerable populations.2

The challenges to achieving diversity in academic medicine are built into the established systems, but they can be overcome in time through awareness, discussion and thoughtful action. Vanessa Grubbs, MD, published her perspective on how to make real change in academic medicine in the New England Journal of Medicine.3 Her suggestions include:

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  • Update admissions processes. In addition to accepting the prototypical medical school student who has good test scores, letters of recommendation, volunteer activities and international experiences, admissions boards should also consider students who have demonstrated the ability to overcome hardships, work through school and still make it to the next level in their educational pursuits.
  • Deliberately diversify faculty and leadership. Such activities as working on diversity, equity and inclusion committees and mentoring students of color should be considered in hiring and promotion decisions.
  • Recognize clinical expertise. Invite people of color as lecturers on medical topics in addition to diversity, equity and inclusion topics.
  • Be supportive. Supporting people of color in academic medicine includes supporting equal compensation, listening to them when they raise issues of racism, and then going the step further to believe, validate and act on these experiences of racism.
    By taking these steps and supporting the diversification of academic medicine, rheumatologists and other rheumatology professionals will help address disparate outcomes among minority patients and improve the practice of medicine overall.

References

  1. ACGME, 2020. ACGME program requirements for graduate medical education in rheumatology. Revised Feb. 3, 2020; effective July 1, 2020. Chicago: Accreditation Council for Graduate Medical Education.
  2. Kim YJ. Advice for minority students considering med school. U.S. News & World Report. 2020 Jun 16.
  3. Grubbs V. Diversity, equity, and inclusion that matter. N Engl J Med. 2020 Jul 23;383(4):e25.

References

  1. Williams DR, Lawrence JA, Davis BA. Racism and health: Evidence and needed research. Annu Rev Public Health. 2019 Apr 1;40:105–125.
  2. Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: A systematic review and meta-analysis. PLoS One. 2015 Sep 23;10(9):e0138511.
  3. Forde AT, Sims M, Muntner P, et al. Discrimination and hypertension risk among African Americans in the Jackson heart study. Hypertension. 2020 Sep;76(3)715–723.
  4. Vince RA Jr. Eradicating racial injustice in medicine—If not now, when? JAMA. 2020 Jul 9. (Online ahead of print.)
  5. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR (eds). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academies Press; 2003.
  6. Owen WF Jr., Carmona R, Pomeroy C. Failing another national stress test on health disparities. JAMA. 2020 Apr 15. (Online ahead of print.)
  7. Nelson B. US healthcare workers march against racism despite the risks. BMJ. 2020 Jun 19;369:m2460.
  8. Thebault R, Fowers A. Pandemic’s weight falls on Hispanics and Native Americans, as deaths pass 150,000. The Washington Post. 2020 Jul 31.
  9. Abbasi J. Taking a closer look at COVID-19, health inequities, and racism. JAMA. 2020 Jun 29;324(5):427-429.
  10. State health facts. Uninsured rates for the nonelderly by race/ethnicity. KFF (Kaiser Family Foundation). 2018.
  11. van Ryn M, Burgess DJ, Dovidio JF, et al. The impact of racism on clinician cognition, behavior, and clinical decision making. Du Bois Rev. 2011 Apr 1;8(1):199–218.
  12. Jorge A, Wallas ZS, Zhang Y, et al. All‐cause and cause‐specific mortality trends of end‐stage renal disease due to lupus nephritis from 1995 to 2014. Arthritis Rheumatol. 2019 Mar;71(3):403–410.
  13. Gómez-Puerta JA, Barbhaiya M, Guan H, et al. Racial/ethnic variation in all‐cause mortality among United States Medicaid recipients with systemic lupus erythematosus: A Hispanic and Asian paradox. Arthritis Rheumatol. 2015 Mar;67(3):752–760.
  14. Chae DH, Martz CD, Fuller-Rowell TE, et al. Racial discrimination, disease activity, and organ damage: The Black Women’s Experiences Living with Lupus (BeWELL) study. Am J Epidemiol. 2019 Aug 1;188(8):1434–1443.
  15. Martz CD, Allen AM, Fuller-Rowell TE, et al. Vicarious racism stress and disease activity: The Black Women’s Experiences Living with Lupus (BeWELL) study. J Racial Ethn Health Disparities. 2019 Oct;6(5):1044–1051.
  16. Bailey ZD, Krieger N, Agénor M, et al. Structural racism and health inequities in the USA: Evidence and interventions. Lancet. 2017 Apr 8;389(10077):1453–1463.
  17. Desmond-Harris J. What exactly is a microagression? Vox.com. 2015 Feb 16.
  18. Mason B. Curbing implicit bias: What works and what doesn’t. Knowable Magazine. 2020 Jun 4.
  19. Ladin K, Emerson J, Butt Z, et al. How important is social support in determining patients’ suitability for transplantation? Results from a national survey of transplant clinicians. J Med Ethics. 2018 Oct;44(10):666–674.
  20. Ladin K, Rodrigue JR, Hanto DW. Framing disparities along the continuum of care from chronic kidney disease to transplantation: Barriers and interventions. Am J Transplant. 2009 Apr;9(4):669–674.

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