The Disenfranchised Physician—The Costly Impact of Prejudice
By Bob Sweeney
One might imagine that an august profession such as medicine would be the least likely venue for institutionalized prejudice. But that is not the case. Clinical and scientific institutions harbor the same patterns of discrimination and ethnic condescension that continue to plague the United States over 400 years after the first slaves were imported to Jamestown.
About 75% of those who graduate from medical schools in the United States are white, but the distribution of practicing physicians is quite different. About 56% of all doctors in practice nationally are white, while 22% are of Asian descent and about 5% are African-American. As is evident, the shortage of trained medical personnel in underserved communities creates career opportunities for those providers hailing from other places. The clinical professions, including medicine, are no more immune to our history and culture of prejudice than any other significant portion of society, and, similar to many other institutions in our society, medicine has a woeful history of outright racism and abuse towards Black, Indigenous, and People of Color (BIPOC). Prejudicial reactions come in many forms that add to the other burdens impelling practicing physicians to become embittered and resentful about their careers.
BIPOC are oft times assumed by much of the public to be unqualified for positions involving high competence or skill. On airplanes, if they volunteer to help in an emergency, it is not uncommon for the flight attendants to give these would-be physician helpers the second degree as to their credentials. In emergency departments, patients encountering a BIPOC physician, frequently ask for a “real doctor”. In extreme cases, BIPOC physicians have been arrested while trying to provide aid to people injured in accidents or to victims of crime. Experiencing these insults is detrimental, but even hearing about them creates unease for doctors in practice, particularly young physicians and women.
Medical schools and residencies have traditionally instructed students and residents to be prepared for abusive patients. However, unless supervising faculty or senior medical staff are prompt to publicly support those in training or early in practice, an atmosphere can evolve that implicitly condones such unfortunate behavior. Allowing patients or other staff to articulate racist or other prejudicial comments about their care givers is equivalent to laughing when an office mate or party goer makes ethnic generalizations or innuendos.
The perception that both their colleagues and the patient world view BIPOC physicians as below par has an additional impact on stress and burnout beyond the various issues facing their white colleagues. Self-esteem is a perishable psychological asset; continual erosion at the social and clinical margins can wear anyone down. One report (NEJM, October 31, 2019) concludes that:
“Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) can contribute to burnout and suicidal thoughts.”
The issue cuts both ways as well, since prejudice seems to increase among physicians with burnout symptoms (Mayo clinic study reported in JAMA Network Open, August 26, 2019).
The world is changing. We face a pandemic that threatens not only our way of life, but, for many people, their very ability to make a living. In parallel, the majority of our citizenry have risen up in one voice to counter racist acts and comments from public authorities. The chorus reflects all races and creeds. Will similar voices rise up in medicine to call out and extinguish the tolerance for prejudice that has too often characterized medical training and medical care for the last 150 years? I fervently hope so.
Bob Sweeney, Principal & Managing Partner
Global Health Impact Fund LLC