Will the anti-racism movement lead to real changes in medical education?

In early January, Dr. Princess Dennar resigned from her faculty position at Tulane University School of Medicine. Her name may not be familiar, but her story likely is. She is one of the latest professional casualties of racism in medical institutions.

Dennar was the first Black woman director of a residency program at Tulane. After reporting to her supervisors about racist encounters experienced by her trainees and filing a lawsuit against the school for discrimination in October 2020, she was demoted from her position as program director. 

The Accreditation Council for Graduate Medical Education (ACGME), the organization responsible for setting the standards for residency programs, investigated Dennar’s demotion, which led to probation for Tulane’s medical school.

At Seattle Children’s Hospital, Dr. Ben Danielson, a respected Black physician, resigned as director of the Odessa Brown Children’s Clinic in December 2020, citing discriminatory treatment of faculty, staff and patients. The institution hired former Obama attorney general Eric Holder’s prestige law firm to investigate allegations of racism, which were validated.

Racism in medicine, from the lack of a diverse health care workforce to worse health outcomes for minority patients, is not new, but it’s now getting long overdue attention. As a result, medical schools are increasingly taking action, rolling out new anti-racism programs and roadmaps and voicing stepped-up commitments to health equity, even as skeptics doubt such moves will lead to real lasting change. 

“We (Black people) are not seen as human beings deserving of being treated with equity,” said Dennar in an interview. 

The events at Seattle Children’s and Tulane are rare public admonishments of often overlooked patterns of racism in medicine. The attention these latest instances have garnered begs the question, what’s different now?

Dennar said recent events, such as George Floyd’s killing and the ensuing nationwide protests, have motivated people in medicine “to want to do the right things.”

Philip Alberti, a doctor of social epidemiology and director of the AAMC Center for Health Justice agrees.

“We’re watching injustice right before our eyes. It’s made it more difficult to ignore,” said Alberti. “There’s a lot of desire to say that’s all in the past, for example like Tuskegee, but it’s exactly true today.”

He said that the events over the past two years, including the health and economic disparities splayed open by COVID-19 and the visuals and media coverage of police killings of George Floyd and Breonna Taylor have contributed to medicine’s call to action.

AAMC represents all U.S. and Canadian medical schools and hospital-based training programs. Alberti assumed directorship of the Center for Health Justice when it launched in September 2021. He said, “The goal of health equity means all communities begin at the same starting line, and we think we can get there by health justice.”

Alberti said the Center encourages their members to tap into “community wisdom” and build partnerships to address social injustices underlying worse health outcomes in communities. Partnerships with education leaders, transit systems and food programs, among others, can advance anti-racism policies and research and help cultivate trust of the medical institutions with their communities to ensure they can deliver higher quality care to everyone.

Attention from medical journals, mainstream outlets and social media on racial heath disparities, such as the higher mortality for Black pregnant women and the ordeal of Dr. Susan Moore, a Black physician who posted about neglectful, racist hospital care just before dying from COVID-19, have also raised awareness of structural racism in medicine. 

In the physician workforce, the number of underrepresented minorities, especially Black men and Native Americans, has declined in the past 40 years, according to a STAT News report. 

Among U.S. physicians, 5% are Black or African American, 5.8% are Hispanic/Latino and 0.3% are American Indian/Native Alaskan. In comparison to the U.S. population in the 2020 census, 13.4% are Black or African American, 18.5% Hispanic/Latino and 1% American Indian/Native Alaskan.

The reasons for underrepresentation of minority groups among physicians are complex: poor-performing primary schools, economic barriers (such as the cost of medical school applications and matriculation), limited minority applicants to medical schools, poor academic advising and even discouragement from teachers and mentors. Some students may have never been around doctors who look like them to serve as role models. 

Representation in medicine matters, as a diverse workforce markedly improves health care and life expectancy for minority populations, according to the National Academy of Medicine and other researchers. A diverse workforce may also offer economic benefits for society.

But 2021 brought some encouraging news. 

Medical school applicants increased by 18%, including a broad increase in women and minorities, including Black men. Dr. David J. Skorton, AAMC president and CEO, attributed the increase in applicants, as well as more diverse candidates, to the increased awareness about racial health disparities and the pandemic, including the publicized heroism of frontline physicians. In addition, incoming students showed a commitment to service, with an average of 650 hours of community service per student.

Most of the 155 U.S. medical schools have incorporated specific anti-racism, health equity or community-based programs to confront disparities into their curricula, up from 40% in 2018.

The Commonwealth Fund, which also funds Center for Health Journalism webinars and equity reporting grants, recently highlighted the social justice efforts of eight prestigious medical schools, but noted these wealthier institutions had resources that afforded changes — such as new faculty positions in diversity — that smaller schools might not have. 

For instance, the David Geffen School of Medicine at UCLA created an anti-racism roadmap, with the goal of dismantling racism in their health care system. (In the interest of disclosure, my faculty position is at UCLA DGSOM.)

“The anti-racism roadmap is a scaffolding, starting with the commitment and framework to do the work,” said Dr. Clarence Braddock, vice dean for education and co-creator of the roadmap.

He said the roadmap includes an acknowledgement of racism as a root cause of many inequities and a deep commitment to do the anti-racism work. This included establishing a new leadership role of vice dean for justice, equity, diversity and inclusion (JEDI).

Dave McIntosh, doctor of educational sociology, assumed that role in August of 2021. “How do we impact change in a way that people feel included, valued and respected … in the workplace, such that they can dedicate their time and energy to healing patients and to the science,” he said. His approach includes holding departments accountable for meeting equity goals for students, faculty, patients and the community, which can in turn affect the amount of supplemental funding they receive. 

But there are skeptics of the current anti-racism push in medical education, doubting such steps will be enough to eradicate the centuries-old racism woven into medicine. 

“I don’t think institutions know what true anti-racism is,” Dennar said. It’s not just about having more people of color, she said, but that they can be their authentic selves and bring their culture to the table. 

And not everyone in medicine fully acknowledges there’s even a problem. For example, in the summer of 2021, the Journal of the American Medical Association caused an uproar when an editor there denied the existence of medical racism during a podcast. The protests that followed led to the resignation of the journal’s top editor. The New York Times reported that some members of the AMA sent a letter to their leadership in which they said “the firing of the editors involved in the podcast was perhaps precipitous, possibly a blot on free speech and also possibly an example of reverse discrimination.” 

Many anti-racism programs, including at UCLA, have sprung up in the past two years, and so their impact is not yet quantifiable. McIntosh said UCLA is developing outcome measures. “This is not just work in the dean’s hallway. We need an army of folks who have a critical understanding of how race and diversity influence someone’s ability to be successful,” he said.

Dennar offered her own advice to journalists reporting on medical racism, “Talk to patients, not just doctors and administrators, and start with the pretense that they’re telling the truth.”

Correction: This post has been updated to clarify that AAMC represents U.S. and Canandian medical schools but does not directly accredit them.