A résumé with a name like Emily or Greg received 50% more callbacks than the same résumé with a name like Lakisha or Jamal. Having a white-sounding name was more beneficial than 8 years’ work experience.
We heard stories from our students and faculty of color. I will highlight two. A medical student of color was called to the ED and was stopped by a nurse who thought he was a custodian. A senior faculty member was returning to his alma mater medical school in North Carolina as a visiting professor and was traveling from the airport to the medical school in a rental car. He was stopped and detained because he was black. His hosts came to his rescue and were required to prove that he was indeed visiting at their invitation. Needless to say these and other stories were startling in 2015. America is not post racial.
As a result of the retreat, we are now finishing a plan to make UCSF an inclusive institution for all who work here. The plan includes both short- and long-term elements, and an investment of at least $10 million to recruit and develop faculty from populations that are underrepresented in medicine.
Today’s doctor-patient relationship has become more and more collaborative. Patients actively look for doctors whom they feel they can talk to, who will understand their special concerns, their background, and their culture. There is neuroscience behind this. Research by Mahzarin Banaji, the coauthor of “Blind Spot,” found that we are in fact wired to react more positively to someone who looks like us.
All of us probably understand why a woman might want to choose a female gynecologist. Why a Chinese family will prefer a doctor who speaks their language. Our patients, too, are looking for physicians, for dermatologists, whose skin reflects theirs. They feel better if their doctor looks more like them.
The website Blackdermatologists.org is meant to help patients find exactly that. Guess how many black dermatologists are listed there in the whole State of California. Three. None of them are in San Francisco. None of them are across the bay in Oakland, a city with a large African American population. I did some research via other websites and found one African American dermatologist in the East Bay.
It’s one thing to be underrepresented in medicine, it’s another thing to be unrepresented. The lack of access to a physician who looks like our patients, whose background and experience might reflect theirs, is crucial. But what about the lack of research focused on African Americans, Latinos, and other underrepresented populations by people who understand the culture from the inside and what questions to ask?
I came across such an example in JAMA Dermatology, in an study titled, “Hair Care Practices as a Barrier to Physical Activity in African American Women” (JAMA Dermatol. 2013;149:310-4). My first reaction to this article was “what?” But that’s my unconscious bias talking. In fact, this study points to something significant. We know regular exercise is important for health. Research shows that African American women are the least likely to meet recommended levels of physical activity. Therefore, we want to be aware of any barriers to exercise for that population. But who would have imagined that one of the barriers to exercise for black women was hair care? This never would have occurred to me.
The people who did think to investigate this were in a team led by and including African American women dermatologists and researchers. So now that this is a known barrier, it can be addressed with patients. This is just one example of the type of knowledge we gain if we have a more diverse group of physicians and clinical researchers.
We know we don’t have enough practicing physicians of color in medicine in general, and in dermatology in particular. We easily fall back to the pipeline as the excuse for the situation. So, let’s look at the pipeline. Unfortunately, the current numbers are not encouraging. According to data from the Association of American Medical Colleges, from 1980 to 2013 the number of applicants to U.S. medical schools rose by 4,296. In 1980, 2,507 applicants were African American/black (7.1%), but by 2013 that number only rose to 3,490 (8.8%). During that same time period the number of Hispanic/Latino applicants rose from 5% to 10%.
How many of the applicants entered medical school? From 1980 to 2013 the number of African American/black students rose by 235: from 999 to 1,234, or 6.5% to 7%. At the same time, Hispanic/Latino students rose from 5.2% to 10.6% of entering students.