Last year, like many in my shoes, I got the briefest of glances into systematic racism and its impact on life and death. Like many, I felt outraged. Like many, I needed to do something. So, I blogged about it.
Of course, I say that tongue in cheek, aware that words mean little. Here’s what I stated in the last post:
I started this series with the intent of discussing a few steps I want to take within our program. Admittedly, they are near the apex of the health impact pyramid above. They also are introductory and insufficient. But, they are tangible and accountable: judge our program by these actions and our outcomes.
What were these introductory efforts? I committed to:
- Promote regular implicit bias and DEI education in our curriculum, inclusive of the entire department
- Increase emphasis on meeting demographic recruitment targets specifically for gender and race/ethnicity at least consistent with our local community
- A more holistic application review process
- Required implicit bias training for all members of the application and interview committees
And how has it gone? We now have an annual DEI grand rounds, which last year was dedicated to gender issues and sexual discrimination (#1). We increased efforts towards holistic review, although struggled with implementation and concrete measures (#3). All faculty members involved in recruitment participated in one of several implicit bias training modules (#4).
A bit more critique and update on those in a bit, but I wanted to highlight #2. Here is a table of our data from the 2020-2021 recruitment cycle:
Ophthalmology
Residents GME Nationwide Physician Female 35% 44% 51% 41% 39% 27% URM 10% 16% 22% 6% 4% 7%
- Female = Gender designation “she/hers/her” in SF Match letters of recommendation. Many biases therein.
- URM = Self-Identified Black or African American, Hispanic or Latino, American Indian or Alaskan Native
- Community = 2019 Fayette County, KY Census Data
- Nationwide Ophthalmology Residents = ACGME Data Resource Book 2019-2020
- GME = University of Kentucky current residents and fellows
- Nationwide Physician = AAMC workforce data report 2019
The back patting response is to say “we increased the diversity of our interview invitations given our application pool.” The realistic outlook, however, is to glance at the next column and see we haven’t even matched the demographics of our local community. Scrolling further to the right on that table demonstrates how much work we have left locally and nationwide to create a physician network that resembles the patients we serve.
To emphasize that point, AAMC data in 2015 found that 100 less Black men applied to medical school in 2014 than 1978. In 2019, 8% of medical students nationwide were Black, 4% of GME trainees were Black, and 5% of practicing physicians were Black, compared to 13% of the US population. Between 2017 and 2020, 200 more Black women applied to medical school than the preceding years – actually an overall decrease in percentage because of an increase in the number and positions in schools – and further, 70 less Black men applied during that time. Similarly, at the University of Kentucky, the percentage of Black men admitted to medical school has declined over the past five years. A review of ophthalmology match outcomes between 2016-2020 demonstrate that women match at a higher rate than men for all racial and ethnic groups, with the exception of Black women, and further, that Black applicants in general have a lower match rate than other racial and ethnic groups (unpublished data, AUPO).
So, yeah … judge us (me) harshly.
I have one more post I’ll put up next week with a bit more reflection on our efforts and updated plans for the future.