How many of the applicants matriculated? In 1980, 39.4% of African American/black applicants matriculated, but in 2013 the rate fell to 35%. What explains the data? Lack of role models? Lack of qualifications? Unconscious bias? An exclusive climate? Continued racism in our country? I don’t pretend to know the answer, but we always fall back on the pipeline as the excuse for the situation. So, what are we going to do about the pipeline?
Given the current state of the pipeline, the question may not be “what is the ideal” but “what is an achievable goal for dermatology?” In 2014, 47 of 731 applicants to dermatology programs were African American and another 47 were Latino. I don’t know how many of these finally matched, but only 6.4% of the applicants were either African American or Latino. This is well below their representation in the population at large.
There may be many reasons why physicians of color are not choosing dermatology as a specialty. Not surprisingly, many of them go into primary care. There is nothing wrong with that. You could argue that having African American and Latino doctors in primary care is where they are most needed, where personal relationships are most crucial. But that should not be an argument against trying to improve the general pipeline and diversify our own specialty pipeline. One goal could be to double the annual number of UIM applicants. I think this is achievable and would have an impact.
Here’s how we might get there. For those of us who are involved in the training of new dermatologists, we have to “lean forward.” Instead of receiving those who choose to come to us, we have to reach out to them. We have to engage, mentor, and ask questions. Find out about hidden bias, your own and others. Understand how your organization or institution can be enriched by having a more diverse pool of learners and leaders.
For those of you who are in practice, there is something you can do as well: You can plant a seed. You all see young people with skin problems. Many of them are and will be from underrepresented populations. Some of them may strike you as particularly bright and lively. So when you have the opportunity to talk to such a bright young woman or young man, ask, “Have you ever thought about becoming a doctor?” And if that strikes a spark, ask, “Have you thought about becoming a dermatologist?” Do this twice a day, 10 times a week, and 500 times each year.
If you do only that, whenever you have an opportunity, you may just plant a few seeds that will make a difference down the line. You will never know the outcome, but it’s worth doing. There’s no downside.
For those of you who are involved in organizations such as the American Academy of Dermatology or the Dermatology Foundation, what can the leadership in our field do? Think about mentorship, role models, scholarships, outreach, and pipeline programs. Think about recruiting colleagues who are UIMs into leadership positions. Let’s be the most inclusive specialty in medicine.
Ultimately, our goal is to have a workforce that mirrors our population. I know this is not achievable in the short term. It will take decades. But this will never occur if we don’t take the first step. To ensure the future of dermatology, let’s all lean forward and embrace this task. Diversity matters in medicine.
A board-certified dermatologist, Dr. Bruce U. Wintroub is interim dean of the University of California, San Francisco School of Medicine. He has been professor and chair of the department of dermatology at UCSF since 1985. This text was extracted from a plenary presentation he delivered at the 2015 annual meeting of the American Academy of Dermatology meeting in San Francisco.