Are People of Color, MD, Leaving the Medical Profession?
Overt and Covert Racism and a White-Dominated Leadership that Refuses to Acknowledge It
A few years ago, I was shocked and disappointed that my doctor decided to leave medicine. As a mixed-race female of South American (Bolivian) and Chinese descent, she had experienced discrimination and racism throughout her career — even during medical school, years earlier. But I didn’t realize how bad it had become until she told me she would no longer be available as a practicing doctor.
At first, I felt angry towards her: how could she abandon me when I needed somebody to understand what it is like to be a nonwhite patient? It is already difficult enough finding women of color (or for that matter, people of color) in the medical field, and now I would be obligated, again, to look for somebody who might understand the social dimension of our difficulties as nonwhite patients in a very white dominated country. I offered to take her to lunch in an attempt to understand — and to foster a potential friendship — and realized the extent of her difficulties only after listening to stories that she didn’t tell me as a patient due to a sense of professionalism. We met after she stopped working.
She proceeded to tell me her history of racism as a medical professional. Her problems in this arena started on day one of medical school, when she was asked if she was ‘an affirmative action candidate’ by two of her colleagues twenty years earlier, and this sort of attitude — a ‘you don’t belong here because you’re not white’ or, ‘if you are here, you didn’t really earn it, like us white people’ continued throughout her training, from other students to mentors to patients.
However, in the last few years — she reports even before Trump became president — she noted a rapid increase in overt racism which was not new but more obvious. Perhaps more worrisome, she noted a marked absence of appropriate perception and response on the part of white-dominated leadership, ultimately allowing the racism to remain acceptable and refusing to acknowledge her situation fully.
“When I was a first-year medical student, we had a class to introduce us to interacting with patients…the point of this exercise was to prep us for treating patients who would offend us. We were taught that we needed to maintain our composure and redirect the conversation to patient care, and that we must avoid getting upset or getting into arguments.
At this, I couldn’t help but laugh. Women and people of color have been dealing with stereotypes their whole lives. We don’t need a test kitchen to learn how to do our job in the face of discrimination — we need this behavior to become less acceptable.”
“‘Are you a Doctor?’ The Unchecked Racism Faced by Doctors of Color.” Vidya Viswanathan. Vox, January 7, 2019.
In the few years before she decided to leave, she experienced:
1. Multiple statements such as ‘Where are you from?’ AND ‘Go back where you came from.’
2. Questions such as ‘Are you really qualified to be a doctor? What kind of education do they have where you came from?’ (she has been educated at an American medical school with an ‘MD’ degree, in an area called ‘Family Practice’.)
3. Once, when she sat down on a chair and leaned towards a patient with diminished hearing how he felt, he pulled off her name tag and said ‘Go back where you came from.’
4. In another incident, she turned to a patient’s family member, who was sitting in the room, and asked if he had any questions. He smirked and said ‘rich doctors like you should quit medicine, since you gave all of us opioid addictions.’ She noted that neither pain nor opioids were being discussed at the time, and that his response seemed completely unrelated to the issue at hand.
After this last incident, she reported the event to the hospital administration, and of all issues that led to her retirement, none was as relevant as the administration’s responses: a refusal to perceive her as fully human:
1. They offered her counseling for her ‘stress.’
2. They pointed to a policy in which patients cannot request a different doctor for reasons of race and ethnicity. When she asked what protection she had, as the victim of repeated racism, they pointed to the policy.
She explained in detail why these responses are extremely inappropriate and why they were the final impetus to leaving medicine.
“‘Until you get individuals who understand and appreciate the culture and the challenges within (minority) communities, you can’t address the risks and implications that the individuals in those communities go through,’” said Antoinette Hardy-Waller, CEO of the Leverage Network.”
(Racism is Still a Problem in Healthcare’s C-Suite, Livingston, S. Modern Healthcare, February 24, 2018.)
1. Offering the Victim of Racism Counseling for Stress Rather Than Addressing the Racism:
Offering the victim of racism counseling for ‘stress’ is not problematic in and of itself. However, it should be followed by addressing the real issue: racism in our society, particularly among white people, and the fact that her safety as a human being has not been addressed. When she was offered counseling, she politely refused, stating that this is the only source of contention. Thus, she isn’t the one with the problem: it is the racist, and a system which re-victimizes her instead of addressing racism.
This stance refuses her status as a victim of racism and thus erases a portion of her humanity. Furthermore, it places the blame on her by implying she is psychologically unwell.
Ultimately, her resentment at being utterly ignored and left vulnerable festers, as should be expected. Eventually, she quit, due to the fact that she didn’t require ‘stress’ counseling, she required support that would remove her from the racist context, as well as a vehement response from leaders acknowledging the degree to which our society is embedded with racism.
2. A Policy Forcing People of Color to Tolerate Ongoing Racism:
As she explains, this is a more complex problem because of the highly-penetrated racial homogeneity (whiteness) of higher-level administration in hospitals which stubbornly hold onto a white majority. Many hospitals advertise this — as if proud of their white supremacist legacy! — by displaying portraits of these white men (and a few white women).
This does nothing more for many people of color than underline our absence, invisibility, and inferiority compared to white people, and ultimately help explain our consistently inferior health outcomes — a wide range of people of color — compared to white people. This apparent ignorance is reflected in the dominance, and thus the responses to racism reflect a complete ignorance of the embedded experiences of racism. These unacceptable responses are akin to fostering racism by allowing it to continue unabated.
I found it shocking that, while she had an experience that included repeated, overt racist statements, she was told to tolerate it because the patient is ‘ill’ and ‘stressed out.’ This phrase is akin to stating that Roseanne Barr is racist due to Ambien with the attendant implication that we are to tolerate her racism. Illness does not make a person racist — clinging to racist beliefs which ultimately buttress one’s power and economic advantage — that makes people racist. Clinging to a false sense of merit — that makes people racist. I would argue that ANY racist breach, verbal or physical, include a consideration of the actual victim: the doctor who was just subjected to a racist rant.
There can be no doubt that the deep investment in white power that keeps these medical and healthcare institutions extremely homogenous at leadership levels has caused a serious rift in basic human morality: a lack of basic human regard for the way in which nonwhite people — including doctors — are treated. I have worked to try to dismantle my own racism as a nonwhite, nonblack person of color as well as that of others for almost half a century, and it is shocking that doctors are suddenly excluded from the basic dictates of humanity but are simultaneously expected to continue to show this same humanity to others. Health care leaders are unable to perceive the dilemma because they have the profound privilege, as a group, of never experiencing it. This argues strongly for replacement with those who do understand: people of color.
These problems, like most, are embedded in a larger system of white supremacy supported through continued ignorance. This ignorance takes the form of denial that racism is central, and likely results from the highly privileged status of being white: of not dealing directly with this onerous reality. I doubt, based on my experiences, that this set of people will ameliorate a problem when they don’t really know what it is and seem to have no proclivity towards choosing representatives who have dealt with racism.
As a result of this deep-seated ignorance, my doctor did not feel heard — a status she states has been real for her for decades — but also, at some point, did not even feel safe. She pointed out that this has nothing to do with ‘stress’ — she is well able to handle a family including two children, other obligations, and social events — this is about reframing the context such as to erase her victimization, thus assuring it continues.
She explained to me that, ultimately, she disappears in this context. And if she disappears — only to appear again when somebody wants to blame her for their opioid addiction (this person is not even her patient!) — why ever would she stay in that context? She was lucky enough to have a husband who paid off the last 12K of her student loan and allowed her to leave this toxic profession for greener pastures.
As a doctor, she is intelligent and educated well. She had no trouble finding a job — albeit with a slightly lower salary — for a corporation in which her requisite contact with racist people has been eliminated. The corporation states overtly that racist language and attitude will not be tolerated, and she is assured that if it happens, the client will be reassigned.
I wonder why, after many years of education and training, she receives lesser acknowledgement as a human being in her work as a doctor than she seems to get in any other context. Isn’t this the field where we want to encourage humanity and protect vulnerable people? She didn’t leave the human race when she went to medical school; she is still human. And she deserves the support of her employers.
How many of us, as patients, will have to suffer these losses before we witness changes? I certainly would not suggest she remain a practicing doctor under these circumstances, but it would be (not even) progressive for hospital and healthcare systems to seriously evaluate their higher-level administration and leaders and decide whether or not this representation requires complete overhaul.
Most of them are incapable of coming down from the C-suite and examining the patients themselves. It behooves them to consider this when they decide how to deal with the virulent racism that is chasing nonwhite doctors from the medical profession. The loss of even one is a profound loss, indeed. I would expect we will see the loss of many more as long as the human victim, in this context, is rendered invisible.