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Perspective
August 31, 2020

The Suffocating State of Physician Workforce Diversity: Why “I Can’t Breathe”

Author Affiliations
  • 1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. Published online August 31, 2020. doi:10.1001/jamainternmed.2020.3815

It is a difficult time to witness the outrage of the ravaged and disenfranchised communities of color and the long-standing, systemic oppression of Black people in the US. I find my clinical day job as a radiation oncologist exceptionally fulfilling—supporting, advocating for, and treating men with prostate cancer. What led me to this specialty and disease-site specialization was the firsthand observation that Black men in the US suffer the highest incidence of prostate cancer globally and have a death rate twice that of White men,1 and the apparent ignorance of or apathy about these disparities that I perceived during my training. Yet, the recent health disparities and inequities during the coronavirus disease 2019 (COVID-19) pandemic and the blatant racial and social injustices that have caused multiple Black lives to be unnecessarily killed before our eyes have also affirmed my passion and call to workforce diversity as a means to address health equity.

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    5 Comments for this article
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    Thank you, Dr. Deville.
    DAVID KELLER, MS, MD | disable internal medicine physician
    I thank and congratulate the author (Dr. Deville) for channeling his outrage over the disparities in our profession, and in his specialty, into efforts that will ultimately result in improvements for patients and trainees.

    Observant Jews, Muslims, Sikhs, and other religious minorities, attire themselves in garments that make them identifiable by bigots. Women in medicine are, of course, a group that is readily identifiable, and still subjected to discrimination and disparate outcomes. Asians, too, are identifiable to those who are ignorant enough to be guided by their prejudices. I do not know to what extent the
    adversity experienced by any of these groups compares with that of Black Americans, nor even if such comparisons can or should be made.

    I do not claim to have experienced even a small fraction of the anxiety Dr. Deville describes when he found himself to be the lone representative of Black Americans in a medical situation.

    However, as a trainee, I was once assigned to care for a patient who had a huge swastika tattoo on his chest, and I must admit that I felt fear and intimidation when dealing with him, and the group of visitors he often entertained in his room. I could feel my pulse quickening, difficulty breathing, and my thoughts racing in the fear that he or his comrades would identify me and hunt me down, in the event that he experienced an adverse medical outcome, or merely identified me as a member of an ethnic group they hated due to bigotry.

    With the emotional support and wise counselling of my residency director, I was able to complete my duties with regard to that patient, but it gave me an appreciation, if only minuscule by comparison, of the daunting obstacles the author describes.

    Thank you for your righteous efforts to correct the injustices you encounter, Dr. Deville, and best wishes for your continued success in doing so.
    CONFLICT OF INTEREST: None Reported
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    Diversity of Physician Workforce
    Dr Narayan Bahadur Basnet, MBBS, MPA, PG Ped., Ph.D. | Children's Medical Diagnosis Center (CMDC), Chabahil, Kathmandu, Nepal
    Thank you.
    We did observe a huge diversity of physician workforce in Nepal nearly two decades ago. We tried to find out the situation and reported briefly. The data revealed a diverse pediatrics specialist workforce in terms of geography, gender, educational degrees and ethnic groups (1). The present perspective expressed by the author may be improved by balanced planning on training and distribution of specialist workforce in diverse population.

    Reference:
    (1) Basnet NB, Takashi I. Pediatricians in Nepal. Indian Pediatrics 2001;38:685-686.
    [https://www.indianpediatrics.net/june2001/june-685-686.htm]
    CONFLICT OF INTEREST: None Reported
    Step Up to the Plate
    Xavier Cantu, MD | Private Group Practice
    As a Hispanic in South Texas, I never really felt overt clear racism except once by a white female pediatrician who was doing my interview for admission as a young applicant at a Texas public medical school. I had been a happy graduate from a diverse high school full of air force brats whose most popular and beloved student was the senior Black drum major two grades above me.

    However, I cant speak for elsewhere but I am old enough to have experienced the tremendous advances against discrimination by leaders such as Texan President Johnson and
    MLK . This is now law.

    The term "systemic racism" has become cliche and repetitive and will be without meaning or solution until we identify the specifics of the "systemic." Who are they? Where is it? These are important questions to find answers to the feelings of some people of color .

    The mentoring that was experienced and appreciated by Dr. Deville is precisely the way to raise the percentage of Black children going into medicine. The successful Black community must return to the inner cities to mentor black children into medicine and dentistry. As a chief resident many years ago, i still owe my devotion, success, and empathy to great degree to my Black residency program associate director whose mentoring filled me with aspiration, knowledge, and hope.

    Yes, its time to increase Black physician percentage in medicine and make them celebrities in patient care and research to mirror the successes of Black celebrities as singers, Hollywood artists, and sports players.
    We can all be part of the solution.
    CONFLICT OF INTEREST: None Reported
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    Dirty systemic racism
    Hassan Alayafi, FRCPC | King ABDULAZIZ MEDical City Riyadh
    This should not be the case since medicine is humanitarian science
    CONFLICT OF INTEREST: None Reported
    Thank you Dr. Deville
    Stephen Keith, MD, MSPH | Syneos Health
    I share your frustration and outrage over persistent disparities in health status of Black and other ethnic minorities in the US, compared to their non-minority counterparts. And as you recognize, the continued under-representation of Black and other ethnic minority physicians contributes to these health status disparities. The persistent intransigence of medical schools to increase the number of Black and other under-represented minority students at least to population parity is also frustrating, especially in light of the societal benefits that have been repeatedly recognized from these efforts. Thirty-five years ago I published research demonstrating that Black and other under-represented then recently trained physicians were significantly more likely to enter primary care specialties, care for concordant minority patients, care for greater numbers of patients with Medicaid coverage, and practice in underserved communities compared to their non-minority counterparts (Keith SN, et.al., Effects of Affirmative Action in Medical Schools, NEJM, 1985). And these findings have repeatedly been confirmed over the years since. As well, minority patients prefer and trust concordant minority physicians over non-minority physicians, and increasing evidence has demonstrated that treatment outcomes are improved with ethnically-concordant patient-physician instances. A recent research article suggests that when Black newborns are cared for by Black physicians, the mortality penalty they suffer, as compared with white infants, is halved (Greenwood BN, et.al., Physician-patient racial concordance and disparities in birthing mortality for newborns, PNAS, 2020). I am not arguing that Black and other minority patients should be cared for only by ethnically-concordant physicians; most of my physician colleagues certainly provide excellent care to all their patients. I am arguing, however, that these societal benefits of increasing the number of Black and other under-represented medical students and physicians is justified beyond the moral and ethical imperative. A diverse physician workforce benefits all of us, particularly in this time of disproportionate impact of the COVID-19 pandemic along with long-standing health disparities and inequities. Again, thank you for adding your voice to this effort.
    CONFLICT OF INTEREST: None Reported
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