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Academia and the Profession |

Impact of Race on the Professional Lives of Physicians of African Descent

Marcella Nunez-Smith, MD, MHS; Leslie A. Curry, PhD, MPH; JudyAnn Bigby, MD; David Berg, PhD; Harlan M. Krumholz, MD, SM; and Elizabeth H. Bradley, PhD
[+] Article and Author Information

From Yale University School of Medicine and Yale University School of Epidemiology and Public Health, New Haven, Connecticut; University of Connecticut School of Medicine, Farmington, Connecticut; and Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts.


Grant Support: In part by the Robert Wood Johnson Clinical Scholars Program and by the Patrick and Catherine Weldon Donaghue Medical Research Foundation through the Donaghue Investigator Award (02-102).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Marcella Nunez-Smith, MD, MHS, Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, IE-61, PO Box 208088, New Haven, CT 06520; e-mail, marcella.nunez-smith@yale.edu.

Current Author Addresses: Dr. Nunez-Smith: Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, IE-61, PO Box 208088, New Haven, CT 06520.

Dr. Curry: Division of Geriatrics, Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030.

Dr. Bigby: Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA 02120.

Dr. Berg: Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06510.

Dr. Krumholz: Yale University, 333 Cedar Street, Room I-456 SHM, PO Box 208088, New Haven, CT 06520.

Dr. Bradley: Yale University School of Medicine, Department of Epidemiology and Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520.

Author Contributions: Conception and design: M. Nunez-Smith, L.A. Curry, H.M. Krumholz, E.H. Bradley.

Analysis and interpretation of the data: M. Nunez-Smith, L.A. Curry, D. Berg, H.M. Krumholz, E.H. Bradley.

Drafting of the article: M. Nunez-Smith, L.A. Curry, J.A. Bigby, E.H. Bradley.

Critical revision of the article for important intellectual content: M. Nunez-Smith, L.A. Curry, J.A. Bigby, D. Berg, H.M. Krumholz, E.H. Bradley.

Final approval of the article: M. Nunez-Smith, J.A. Bigby, H.M. Krumholz, L.A. Curry, E.H. Bradley.

Provision of study materials or patients: M. Nunez-Smith.

Obtaining of funding: M. Nunez-Smith.

Collection and assembly of data: M. Nunez-Smith.


Ann Intern Med. 2007;146(1):45-51. doi:10.7326/0003-4819-146-1-200701020-00008
Text Size: A A A

Background: Increasing the racial and ethnic diversity of the physician workforce is a national priority. However, insight into the professional experiences of minority physicians is limited. This knowledge is fundamental to developing effective strategies to recruit, retain, and support a diverse physician workforce.

Objective: To characterize how physicians of African descent experience race in the workplace.

Design: Qualitative study based on in-person and in-depth racially concordant interviews using a standard discussion guide.

Setting: The 6 New England states in the United States.

Participants: 25 practicing physicians of African descent representing a diverse range of primary practice settings, specialties, and ages.

Measurements: Professional experiences of physicians of African descent.

Results: 1) Awareness of race permeates the experience of physicians of African descent in the health care workplace; 2) race-related experiences shape interpersonal interactions and define the institutional climate; 3) responses to perceived racism at work vary along a spectrum from minimization to confrontation; 4) the health care workplace is often silent on issues of race; and 5) collective race-related experiences can result in “racial fatigue,” with personal and professional consequences for physicians.

Limitations: The study was restricted to New England and may not reflect the experiences of physicians in other geographic regions. The findings are meant to be hypothesis-generating and require additional follow-up studies.

Conclusions: The issue of race remains a pervasive influence in the work lives of physicians of African descent. Without sufficient attention to the specific ways in which race shapes physicians’ work experiences, health care organizations are unlikely to create environments that successfully foster and sustain a diverse physician workforce.

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Two steps forward, one step back
Posted on January 9, 2007
Henry Baffoe-Bonnie
Lakeland Regional Medical Center. Lakeland, Florida
Conflict of Interest: None Declared

Nunez-Smith et al have superlatively exposed what most , if not all, black physicians experience on a daily basis; invisibility, marginalization, doubt of ability and at times, overt antagonism because of skin color. Inasmuch as the situation is nauseating and unpalatable it is also true that major strides have been made. 40 years ago the notion of a black US Surgeon General would not have gained public muster. In recent times there has been a black secretary for Health and Human Services. More black physicians are practicing in deep southern enclaves where a generation ago this would have been anathema. Our nation was born with a birth defect; the stigma of slavery. But America has a quality almost unique to herself; the ability to change. The pace of racial integration and acceptance is slow, and understandably so because government cannot legislate morality. As we celebrate Martin Luther King's life next week we, as a nation, should hold steadfast in our zeal to build a society where racial barriers are torn down.

A Summons to Inner Reflection and Collective Action
Posted on February 5, 2007
Ali M. Thomas
Internal Medicine Residency Program Legacy Health System, Portland Oregon
Conflict of Interest: None Declared

Congratulations to Nunez-Smith and colleagues, whose work(1), along with qualititative surveys of residents(2), heralds a fresh paradigm in disparities research"”a summons for greater individual, as well as collective action.

We concur with the view(3)that data confirming the pervasiveness of subtle racism are consistent with American history and culture. In 1944, Swedish sociologist Gunner Myrdal's commissioned study on America's "Negro problem" called it "the moral dilemma of the American"”the conflict between his moral valuations on various levels of consciousness" and the reality of social inequity(4). As recent as 2002 white college students in New England were unaware of their subconscious prejudices, as well as non- verbal manifestations of prejudice detected equally by black students and trained white observers(5). Non-black physicians should follow historical examples of white champions of racial equality(6), remembering, "shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will"(7).

For physicians of African decent this study validates what was known, but often inexpressible. "Racial fatigue" warrants particular attention, as it complicates black recruitment, retention and promotion. As one of us experienced, while one of two African American medicine residents in a hospital serving a majority-black population, not all institutions in black communities support professional diversity"”defined as representation from the community served(8)"“but all have this mandate.

Although the struggle against racism is a constant for blacks in Americans, we have a tradition of being change agents, not victims. In black urban historiography, one of us introduced the concept of "community building" to counter the paradigm of "ghetto formation". When southern blacks flocked north, the fledgling Detroit black community developed many effective self-help strategies to counter racism(9). Let history continue to instruct us.

Other literature, in public administration, suggests a critical mass of black physicians may empower them to better serve black patients.

In 1974, Herbert observed minority civil servants faced several forces restricting their ability to advocate for their communities(10). Twenty years later, survey researchers found lingering problems of professional isolation, but important coping skills at work (11).

Non-black physicians should be open to introspection and wary of unconscious biases, apathy or feelings of superiority. Blacks can substitute bitterness with self-empowerment, isolation with collective action, and "casting" with unapologetic advocacy. While racism in medicine is endemic, a candid but optimistic attitude will facilitate sustained and careful treatment.

References

1. Nunez-Smith M, Curry LA, et al. Impact of Race on the Professional Lives of Physicians of African Descent. Ann Intern Med. 2007;146:45-51.

2. Liebschutz JM, Darko GO, Finley EP, Cawse JM, Bharel M, Orlander JD. In the minority: black physicians in residency and their experiences. J Natl Med Assoc. 2006;98:1441-8.

3. Betancourt JR, Reid AE. Black Physicians' Experience with Race: Should We Be Surprised? [Editorial]. Ann Intern Med. 2007;146:68-69.

4. Myrdal G. An American Dilemma; The Negro Problem and Modern Democracy. Harper and Brothers. 1944. p xliii.

5. Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J. Personality and Social Psychology. 2002; 82(1): 62-68.

6. Thomas R. Understanding Interracial Unity: A Study of U.S. Race Relations. Sage Publications. 1996.

7. King ML. "Letter from a Birmingham Jail". April 16, 1963. quoted in Clayborne C. The Autobiography of Martin Luther King Jr., Warner Books, Inc., New York, New York; 1998, pg. 195

8. Sullivan Commission on Diversity in the Healthcare Workforce. Missing Persons: Minorities in the Health Professions. W.K.Kellogg Foundation. 2004, pg 13. Downloaded from www.wkkf.org in September 2005.

9. Thomas, Richard, Life for Us is What We Make It; Building Black Community in Detroit, 1915-1945, Indiana University Press, Bloomington, 1992.

10. Herbert AW. The Minority Administrator: Problems, Prospects, and Challenges. Public Administration Review. 1974; 34(6):556-563.

11. Murray S, Terry LD, Washington CA, Keller LF. The Role demands and Dilemmas of Minority Public Administrators: The Herbert Thesis Revisited. Public Administration Review. 1994;54(5):409-417.

Conflict of Interest:

None declared

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