Uché Blackstock's experience at her last employer may sound depressingly familiar to many Black employees across America.
Blackstock is an emergency medical practitioner who served eight years as an assistant professor at New York University's School of Medicine. She is also a black woman who recognized the multiple ways that racism and sexism harmed the health of her patients. Determined to make a difference, she began training on unconscious biases in her medical school and elsewhere, and eventually became head of the faculty of recruitment, retention, and inclusion for the NYU Diversity Office. But while the extra work she did is critical to addressing long-standing problems in medicine – an area that underserved color patients and few black or Latin American doctors – Blackstock said her contributions have been undervalued by colleagues and supervisors, those who were not personally affected by unconscious – or conscious – bias.
"People think medicine is innovative and pushing its limits – but it's probably one of the most conservative environments I've been in," says Blackstock. "It's very resistant to change."
By late 2019, she made a decision to quit academic medicine, and recently left a promotion to associate professor and a searing Stat News about "a toxic and depressing work environment that made me fear retaliatory for being vocal." Racism and Sexism within the Institution. "
A NYU spokesman noted that it had promoted Blackstock and said in a statement emailed that the school "continued to promote diversity in the workplace and combat the effects of unconscious and conscious bias in medicine".
Blackstock now runs her own consulting firm, Advancing Health Equity, and has become an increasingly visible public expert on the impact of the COVID-19 pandemic and systemic racism on black patients and other people of color. She also holds on to part-time clinical work and spent the worst part of the New York pandemic this spring treating coronavirus patients at an emergency clinic.
Earlier this summer, Blackstock planned to stop seeing patients in order to focus more on their health care equality work. Since then, she has decided to keep practicing at reduced hours, meaning the medicine can retain one of the few professionals it desperately needs more of: the 24,100 black women who make up only about 2.6% of all active doctors in the US turn off.
Self-billing in health care
"It's a significant problem," said Laurie Zephyrin, a doctor and former director of reproductive health at the US Department of Veterans Affairs who is now vice president of delivery system reform for the Commonwealth Fund.
“One study after another shows the positive benefits of having a diverse workforce in delivering health care,” she adds. "It's important to train, recruit, and retain multiple vendors – color vendors, black women, black men."
The need for a more diverse workforce, and the repeated failure of many employers to create one, is likely to resonate with black workers and other black workers in various industries, as the Fortunes Working While Black project and the RaceAhead newsletter have documented. But in medicine, whose position lies slightly outside the for-profit corporate sector – and, as Blackstock points out, whose reputation for innovative, science-based thinking – is sometimes unclear, the stakes are increasing how severe its discrimination and lack of diversity can be.
The low proportion of black women doctors is a far-reaching and long-standing problem in medicine. According to the Association of American Medical Colleges, only 36% of doctors are women of any race. Only 5% of all active doctors are black, compared to 13% of the US population who are black.
The numbers are equally bad, if not worse, for Spanish or Latin American doctors: according to the AAMC, only 5.8% of doctors are Hispanic, compared to 18% of the total US population; Only 2.4% of active doctors are Spanish women.
These statistics compete with the staggering lack of diversity in large tech companies that have criticized the low single-digit percentages of the Black and Latinx employees they employ in recent years. Amid a pandemic that disproportionately killed people from the same communities and a national reckoning on racism, some doctors and public health experts are shedding new light on the longstanding racial inequalities that harm the health of people of color in America. and this is exacerbated by the small number of professionals from these communities who are capable of attaining the highest positions in medicine.
"On my more optimistic days, I think that the conversation we are having now about these systemic issues of race and inequality could potentially be really put to good use by the health industry," said Adia Harvey Wingfield, professor of sociology at Washington University in St. Louis and author of Flatlining: Race, Work, and Health in the New Economy.
"However, there needs to be an industry-wide focus on self-billing of how healthcare patterns and practices contribute to the marginalization and exclusion of black workers," she added. "The healthcare industry would need to be explicit and open about racial diversity – not just turning it into something that is expected to happen by chance."
Hospitals and health care facilities "often don't do the work necessary to make rooms more accessible and accessible to color communities," but leave the work to their few black staff, says Adia Harvey Wingfield, professor of sociology at Washington University in St. Louis. Sean Garcia
As the numbers show, chance did not get black doctors very far in medicine. The reasons for their low labor force include many shared in the broader discussion of systemic racism: Black Americans have less access to wealth, housing, education, and health care, which means that black students who are interested have doctors to become, in general, have more obstacles to overcome in order to enter and stay in the field.
Some of these socio-economic differences start with early childhood education and “access to solid MINT education in K12 through 12” and then continue through higher education, Wingfield says.
Nor is it enough just to be able to qualify for medical school and be able to pay for it. Applicants must also fly across the country for interviews and pay for exam preparation and exam fees themselves. This process often costs up to $ 10,000. This is just a prelude. The average medical student has a debt of around $ 200,000. (In 2018, NYU began taking some of these costs off of its medical students by guaranteeing free tuition.)
"We know that black Americans have disproportionately fewer resources than white communities when it comes to income and wealth," says Wingfield. "For doctors, these problems extend to a number of institutions and make it difficult to get started and stay in the field."
Black job candidates often face structural internal barriers in other areas of health care as well, apart from obvious prejudice or unconscious bias. For example, some nursing programs require traditional four-year degrees instead of community college degrees, which "can inadvertently weed out black applicants interested in the area," says Wingfield.
And then there are the obvious cases of racism and systemic bias reported by black doctors and other healthcare workers in their education or at work. "Traditionally, racism in healthcare was not addressed at all in our education," says Blackstock. "It's more like that now – I think medical schools are really trying to include it in their curricula – but it's been a tough pressure that really comes from black students and faculties at those institutions."
Obviously, there is also a need for better education about the health effects of systemic racism well before medical school is under way. David R. Williams, a public health expert and professor at Harvard University, has spent his career teaching medical students – and says many of them arrive completely unsuspecting.
Williams blames this ignorance not on his students, but on a society that has enabled many white Americans to attain positions of privilege and power without knowing or anticipating the systemic effects of racism. During a career at Yale, the University of Michigan, and Harvard, "I've taught some of America's finest and brightest students," he says. "And many of them – I would say most of them – have no idea of the level of racial inequalities that exist."
Even before the pandemic, which disproportionately harmed black and brown people, black Americans had shorter lifespans and were more likely to suffer from a variety of chronic illnesses. For example, black women are at particularly high risk of heart disease and stroke and are much more likely to die of childbirth and breast cancer than white women.
These problems are exacerbated by a workforce dominated by white and male doctors who are often prone to dismissing health concerns of women and people of color or relying on harmful stereotypes to treat them. For example, while researching her book, Wingfield observed stereotypes that she attributes in part to the continued impact of the drug epidemic of the 1980s and the "war on drugs" policy of punishing rather than treating people with drug addiction.
"Many black practitioners that I interviewed still see traces in their work of where white peers make racial stereotypes about patient populations," she says. "They expect these patients to be just" drug users looking for a solution, "or people who are too lazy or unintelligent to take care of their health."
As a result, black doctors and other healthcare workers who want to combat these racist beliefs and ensure that black patients are treated fairly in the healthcare system often do the unpaid work Wingfield calls "racial outsourcing."
This includes "black workers doing more to make sure patients feel they are getting a fair and equitable experience in healthcare," she explains. "Institutions do not do the work necessary to make spaces more accessible and accessible to color communities, but leave that work to the few black professionals who are employed."
As a result, these employees often feel "exploited and used by the institutions in which they work," says Wingfield. "For black healthcare workers, this inequality means that they have to do a lot more work for patient care – not just in dealing with patients who may suffer from existing health inequalities, but also in dealing with colleagues and, in some other cases, superiors, who make their job difficult by mistreating the patients they care about. "
Now she and other public health experts and doctors are cautiously optimistic about the attention medical schools, hospitals, and other health organizations are paying to national protests against racism – and the long-term changes they will need to make to address their own systemic ones Problems.
Tina Sacks, assistant professor at UC-Berkeley's School of Social Welfare and author of Invisible Visits: Middle-Class Black Women in the American Health System, says she's been encouraged by some medical students she is advising on a joint Berkeley program at UC-San Francisco. Most of these students aren't black, but "They've started questioning and really resisting how this outdated way of thinking about race is actually contributing to health inequalities," Sacks says. "It's not just about unconscious bias. These medical students say," It's obvious, and we're being trained to sort people by race when it has nothing to do with their underlying health. "That helps me a lot when we think about the future of American medicine. "
Back in Brooklyn, Uché Blackstock hopes that her endorsement as part of this larger reckoning can help draw more attention to the many ways that greater diversity in medical leadership can improve health outcomes for all patients.
“It has to be worked and it has to be a multi-faceted approach,” she says. “We know that a diverse workforce is one of the solutions. It is not the solution, but it is one of them. "
More about the most powerful women in business from capital::
- The next Clorox boss will increase the number of Fortune 500 female CEOs to 38, the highest yet
- Women are more concerned about layoffs than their male employees
- As the daughter of Rep. Ilhan Omar showed her that Congress cannot pass the money on to the next generation
- Republicans have a problem with women, and it could cost them the Senate
- Meet Candace Valenzuela, who could become the first Afro-Latina in Congress