Growing up, it is difficult to remember when it happened, but at some point, I was labeled a smart kid. Being part of “gifted and talented” and a member of the academic team became something that was not only expected, but second nature. When it came to early academic expectations, race did not seem to impact my progression through the primary or secondary education systems. I was smart first, Black second. Despite this, it must have been obvious that I was one of the only Black students in a predominantly White academic environment. In my mind, it was barely an issue, although I did often feel pressure as a representative of my racial group. My Black classmates that did not fare as well in the classroom or who had less social and financial resources to draw on, often had their academic needs under addressed or completely ignored, a fact I was cognizant of from an early age.
Although I was aware of the disparate pipeline for Black and Hispanic students pursuing a path towards medicine during my time as an undergraduate, I did not feel equipped to address this issue until medical school. I was fortunate to attend an institution that not only sought achievers from all backgrounds, but who viewed minority students as a highly prized asset to the educational environment. Not only was I able to pursue my own training in the company of a relatively diverse group of students, but I was able to promote issues related to health disparities and to study disease processes that were predominantly impacting Black communities. Indeed, a JAMA study from 2014 demonstrated that increasing diversity in the physician workforce may result in improved care for minority and non-English speaking patients because non-white physicians are more likely to care for underserved populations.1 In part to offset the slight guilt I felt for training in such a privileged setting, I volunteered at our school’s free clinic and mentored elementary school students from underserved schools in Nashville, Tennessee. This experience of guilt is not uncommon, I have since learned. As people of color progress through secondary and post-secondary training into graduate, professional, and even post-doctoral training, the issue of how to give back and feelings of “imposter syndrome” often morph into something that looks a bit different.
Working within a predominantly White space, a physician of color will many times face either interpersonal or interprofessional conflicts that center around issues of race or a systems-level issue related to caring for patients from a diverse racial or ethnic group. Inevitably, physicians of color will have to deal with a situation that arises where a patient from an underserved racial or social class is the target of a denigrating comment or, even worse, clearly biased or inappropriate treatment. It can be difficult to impossible to speak up if you are in a junior position or you are one of few people of color that holds a leadership position. Even more tricky to handle are incidents or comments that are ambiguous or subtle, which may be characterized as “microaggressions.” An example might be a patient’s refusal to be seen by a particular physician where the reason provided by the patient is ambiguous or the patient is unwilling to give a reason for their request. Once again, this is where having a strong social network can work in your favor. If you are not in a position of power to speak up, you should lean on your colleagues or mentors for advice. They can help you deal with clinical scenarios, co-workers or patients that are not welcoming to minority physicians, students or patients.
As a minority physician, it is important to make use of the resources that are right in front of you. You must seek out mentorship from senior physicians as you progress through training or early career, irrespective of their background. Even better than a mentor, is a sponsor. A sponsor is someone who believes enough in your talent, skill, or potential to put your name forward for a task or opportunity that will help advance your career. Not only can this individual help you grow in your career, but they can help you navigate potentially career-derailing situations. As minority physicians, it is important that we remember to form alliances in predominantly White spaces and, given the demographics of the medical community, our allies may not often look like you. A report from the Association of American Medical Colleges (AAMC) in 2015 showed that the number of Black males entering medical school had not increased since 1978. There have been small increases in the overall percentage of African American (1.1%) and Hispanic (1.8%) enrollees.2 Until the pipeline that encourages students of color to pursue careers in medicine is more robust, it is important to continue identifying mentors and sponsors who can help you even if they do not look like you. Waiting for a mentor who shares a similar race or background to you is simply not an option. The broken pipeline does not have to serve as a permanent barrier to career advancement for physicians of color. This fact should serve to encourage any physician who believes in building a more diverse healthcare workforce to continue recruiting and mentoring the next generation of students so there are more physicians of color to serve in these roles in the future.
1. Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority physicians’ role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities. JAMA Intern Med. 2014;174(2):289–291.
2. Altering the Course: Black Males in Medicine. Association of American Medical Colleges;2015.