Race, Disadvantage and Faculty Experiences in Academic Medicine
Despite compelling reasons to draw on the contributions of under-represented minority (URM) faculty members, US medical schools lack these faculty, particularly in leadership and senior roles.
The study’s purpose was to document URM faculty perceptions and experience of the culture of academic medicine in the US and to raise awareness of obstacles to achieving the goal of having people of color in positions of leadership in academic medicine.
The authors conducted a qualitative interview study in 2006–2007 of faculty in five US medical schools chosen for their diverse regional and organizational attributes.
Using purposeful sampling of medical faculty, 96 faculty were interviewed from four different career stages (early, plateaued, leaders and left academic medicine) and diverse specialties with an oversampling of URM faculty.
We identified patterns and themes emergent in the coded data. Analysis was inductive and data driven.
Predominant themes underscored during analyses regarding the experience of URM faculty were: difficulty of cross-cultural relationships; isolation and feeling invisible; lack of mentoring, role models and social capital; disrespect, overt and covert bias/discrimination; different performance expectations related to race/ethnicity; devaluing of research on community health care and health disparities; the unfair burden of being identified with affirmative action and responsibility for diversity efforts; leadership’s role in diversity goals; and financial hardship.
Achieving an inclusive culture for diverse medical school faculty would help meet the mission of academic medicine to train a physician and research workforce that meets the disparate needs of our multicultural society. Medical school leaders need to value the inclusion of URM faculty. Failure to fully engage the skills and insights of URM faculty impairs our ability to provide the best science, education or medical care.
KEY WORDSmedical faculty underrepresented minorities race
The authors gratefully acknowledge the critical funding support of the Josiah Macy, Jr., Foundation and the supplemental funds to support data analysis provided by the US Office of Public Health and Science, Office on Women’s Health and Office on Minority Health; the National Institutes of Health, Office of Research on Women’s Health; the Agency for Healthcare Research and Quality; the Centers of Disease Control and Prevention, and the Health Resources and Services Administration (contract: HHSP233200700556P). The authors thank Peter Conrad and Sharon Knight, who participated in data collection and data coding, and Kerri O’Connor for manuscript preparation. The authors are indebted to the medical faculty who generously shared their experiences in the interviews.
Specific Contributions From Each Author
Pololi: conception, design, data collection, analysis and interpretation, drafting the article, final approval.
Cooper: analysis and interpretation, drafting the article, final approval.
Carr: data collection and coding, manuscript review, final approval.
United States Office of Public Health and Science, Office on Women’s Health, Contract: HHSP233200700556P
Josiah Macy, Jr. Foundation
Society of General Internal Medicine, 33rd Annual Meeting, 2010. Research plenary presentation.
Conflict of Interest
Brandeis University Institutional Review Board for the protection of human subjects approved the study.
- 2.Nickens H, Smedley B. The right thing to do, the smart thing to do: enhancing diversity in the health professions: summary of the symposium on diversity in health professions in honor of Herbert W. Nickens. Washington: National Academy Press: Institute of Medicine; 2001.Google Scholar
- 3.Kington R, Tisnado D, Carlisle D. Increasing the racial and ethnic diversity among physicians: an intervention to address health disparities. In: Smedley BD, Colburn L, Evans CH, eds. The right thing to do, the smart thing to do: enhancing diversity in the health professions. Washington: National Academies Press; 2001:64–8.Google Scholar
- 5.Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse communities, common concerns: Assessing health care quality for minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey. New York: The Commonwealth Fund; 2002.Google Scholar
- 6.Census 2000: United States Profile. US Census Bureau web site. Available at: http://www.census.gov/prod/2002pubs/c2kprof00-us.pdf. Accessed: July13, 2010.
- 7.Castillo-Page L. Diversity in medical education: Facts & figures 2008. Washington: Association of American Medical Colleges; 2008.Google Scholar
- 8.Association of American Medical Colleges. Faculty Roster 2008. Available at: http://www.aamc.org/data/facultyroster/. Accessed: July 13, 2010.
- 12.Smedley BD, Stith AY, Colburn L, Evans CH. The right thing to do, the smart thing to do enhancing diversity in health professions. Institute of Medicine. Washington: National Academy Press; 2001.Google Scholar
- 22.Association of American Medical Colleges. The Diversity Research Forum: Successfully evaluating diversity efforts in medical education. Washington: AAMC; 2007.Google Scholar
- 23.National Initiative on Gender, Culture and Leadership in Medicine: C - Change website. Available at: http://cchange.brandeis.edu. Accessed: July 13, 2010.
- 24.Biernacki P, Waldorf D. Snowball sampling: problems and techniques of chain referral sampling. Sociol Methods Res. 1981;10:141–63.Google Scholar
- 25.Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Aldine Transaction: Chicago; 1967.Google Scholar
- 26.Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks (CA): Sage Publications; 2006.Google Scholar
- 27.The Sullivan Commission. Missing persons: Minorities in the health professions diversity. Washington (DC): The Sullivan Commission; 2004.Google Scholar
- 29.McIntosh P. White privilege, color and crime: A personal account. In: Mann CR, Zatz MS, eds. Images of color, images of crime. Los Angeles (CA): Roxbury Publishing Company; 1998.Google Scholar
- 30.AHRQ (2004). National Healthcare Disparities Report: Department of Health and Human Services, US Department of Health and Human Services.Google Scholar
- 34.Mullen F, Chen C, Pettersons S, Kolsky G, Spagnola M. The social mission of medical education: Ranking the schools. Ann Intern Med. 2010;152:804–11.Google Scholar