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As a medical student, I never saw myself as a future CEO or anything close. I was often the only Black person in the room in classes and rotations. After I became an attending, I spent a great deal of time and mental energy fitting in. Speaking up and having opinions were luxuries I couldn't afford, let alone aspiring to leadership.
What made a difference? Having a mentor.
My mentor, Wes Curry, MD, one of the few Black CEOs leading a healthcare organization, encouraged me to consider leadership. His example, and that of fellow trailblazers Bernard Tyson and Lloyd Dean, greatly expanded my horizons and influenced my career path.
Curry taught me it's not enough to create "opportunity" for diverse physicians. We need to go the extra mile and extend a hand to the next generation -- and we need to do so in every setting, from the physician practice to the elementary school classroom. This requires us to roll up our sleeves and take action through mentorship, advocacy, community building, and outreach.
There's no nice way to say it. The stats on healthcare representation are pretty dismal. I'd even go so far as to say disgraceful, because some of them are moving in the wrong direction.
Some examples:
- Only 6% of U.S. physicians identify as Hispanic and only , despite these groups making up 19% and 13% of the population, respectively. There's some evidence that the number of Black male physicians has slightly since the 1970s.
- While the gender gap is closing, 64% of practicing physicians are male.
- Though it's harder to find numbers for LGBT and gender-nonconforming physicians, we know that fear of discrimination is a major barrier to care for and there's an acute need for culturally competent clinicians to serve this population.
How Underrepresentation Harms Us All
We've all seen examples of bias directly harming patients. One is Susan Moore, MD, an Indiana physician who was hospitalized with COVID-19. When Moore, who is Black, complained of severe pain, her doctors refused to administer more narcotics and suggested sending her home. "I put forth and maintain that if I were white, I would not have to go through that," she wrote at the end of a Facebook post detailing her struggle, which tragically ended in her death from COVID-19.
While stories like Moore's are shocking, the effects of underrepresentation are also more subtle. Often, taking the form of narrow perspectives. Physician leaders may fail to recognize their own biases or not realize their worldview is limited, which over time maintains the status quo, entrenching inequities like lack of access.
Finally, underrepresentation means a lack of role models for diverse students and clinicians. Even if they "make it," they may focus on fitting in rather than being themselves. This is a missed opportunity to bring different experiences and perspectives to their team, which may help solve a problem or foster more understanding.
The Power of a Hand Up
As much as we may want it, talk about it, and invite it, representation doesn't just happen. We can't simply pay lip service and wait for opportunity to manifest -- this ignores the real barriers diverse clinicians face.
We must start by acknowledging that the playing field isn't level. This is a reality that I hope changes, but for now it's still very prevalent across all aspects of society. One of the most impactful ways I know of to combat it is to act as a champion for people you identify as needing extra promotion and visibility to move ahead in their careers. I call this giving a "hand up" to help drive forward career vision and help people realize their full potential.
The "hand up" concept invites all of us to take action to eliminate structural barriers and connect on a human level to the next generation of medical leaders. This needs to happen at all levels of the leadership pipeline, from the elementary school classroom to the boardroom.
What's a "hand up" look like?
Seeking mentors can feel risky for underrepresented students and physicians. In many settings, there aren't enough Black, Indigenous, and people of color (BIPOC), LGBT, or women leaders to meet the demand so it's imperative each of us offer support where we can.
Self-education. Developing cultural competence makes us better mentors, colleagues, and clinicians. It also frees people from different backgrounds from having to educate others or act as spokespeople.
Program development. Leaders can break down institutional barriers by creating intentional pathways within their organizations to support the advancement of diverse students, clinicians, and leaders.
As individuals and groups, there's no shortage of non-profit organizations we can volunteer with or support to creating opportunity in the communities we serve.
Together, we have the power to improve healthcare by helping the next generation of clinicians be more representative of their patients. I invite you to actively seek out opportunities to give a hand up to underrepresented groups so we can build the most diverse, passionate, and talented generation medicine has ever seen.
Imamu Tomlinson, MD, is an emergency physician and healthcare executive.
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