In an increasingly diverse America, patients of all racial, ethnic and cultural backgrounds urgently need physicians who understand them and can relate to their situation. Unfortunately, they don’t always get what they need. In one study, researchers at Johns Hopkins University found that “racial and ethnic minority respondents are more likely to perceive bias and lack of cultural competence when seeking treatment in the health care system overall than whites.” That, in turn, can lead to lower quality care.
So we should be troubled that the most recent figures available show that women of color – nearly 20 percent of the U.S. population ― make up just 11.7 percent of active M.D. physicians. Recently, the health policy team at The Greenlining Institute joined forces with the Artemis Medical Society to try to better understand why, interviewing 20 women physicians of color from around the country and exploring their experiences in great detail. What they found, documented in our new report, “Breaking Down Barriers for Women Physicians of Color,” should disturb anyone who cares about quality health care.
The doctors our team interviewed faced consistent barriers throughout their education and training, often starting in childhood. Forty percent recalled at least one high school or college counselor who tried to discourage them from pursuing a medical career. Some were told that medical school would be too difficult for them, and some were pressured to abandon their dreams of a career in medicine and start a family instead. Nearly half told us that a lack of access to science and math education left them at a disadvantage.
Too often, educators seemed to operate based on stereotypes and unwarranted assumptions. “The challenge with being a little brown girl is that when you tell people it’s your aspiration to be a doctor, they don’t believe you can do it,” one physician told us. “They try to push you into nursing or something else where they have seen someone like you.”
Cost also works to keep women of color out of medicine. While scholarships and other financial aid may help with the cost of college, prospective medical students face thousands of dollars in expenses that they must cover on their own. These include exam preparation courses, Medical College Admission Test (MCAT) registration fees, application fees for medical schools, and travel to and from multiple interviews. While these fees apply to applicants of all races, the racial wealth gap means they hit students of color harder: In the latest figures available, for every dollar of wealth a white family owns, the median Asian-American family has 68 cents, the median Latino family has 10 cents and the median black family has just 8 cents. For those on the wrong end of that wealth gap, thousands of dollars in application costs can be a deal-breaker.
Once they get to medical school and residency, many students experience racism and sexism. One Latina physician recalled that her male co-residents circulated a vulgar and derogatory video demeaning Latina doctors: “The other residents were laughing as they shared the video with each other even though I was in the program, and even if I was in the room while they watched,” she remembered. “Moments like that made me feel like program faculty didn’t care about me. Even though I reported these incidents, there were no consequences.”
For these women, sexism reared its head in multiple forms. Some felt discrimination and harassment for starting or wanting to start a family. More than one third recalled instances during medical school and residency in which male students were encouraged to voice their opinions while women were more likely to be silenced.
All of these pressures – and many more laid out in our report – keep the numbers of women of color in medicine artificially low. That’s bad for patients as well as these aspiring doctors. So what can we do?
For one thing, medical schools can diversify their faculties. Institutions training physicians for a diverse nation should not be an “old white boys club.”
Second, residency programs – which more often lack the detailed rules about discrimination and sensitivity training for faculty that most colleges and universities have – need to get serious about curbing discrimination. Among the doctors we interviewed, 40 percent said that at times they felt unclear about how to report offensive or inappropriate behavior during residency. Of those who understood the reporting system, many felt uncomfortable filing a report because they did not believe their work environment would support or understand their grievance.
On a more basic level, we need better access to math and science education for girls and young women of color. And colleges and medical schools must do more to provide support structures and mentorship for diverse students – something that nearly everyone told us they didn’t get enough of.
If we start doing these things, we’ll not only have a better health care system, we’ll have a healthier, more equitable society.