BLOG: Is it really a ‘leaky pipeline’ if we are actively pushing people out?
I am a Black physician in training, and at times, I feel like I may lose my spot.
In 2015, Black residents accounted for approximately 5% of all residents, yet they accounted for almost 20% of those who were dismissed, according to reporting by the Accreditation Council for Graduate Medical Education.
Underrepresented minority (URM) individuals attempting to pursue a career in medicine are exiting the “leaky pipeline” at many time-points on the medicine journey (from college premed track, medical school, residency, fellowship and beyond) at disproportionately higher rates compared with their counterparts.
‘Unexpected departures’
Within my own experience, I can reflect on times when it felt like fellow URM trainees were unfairly targeted and had unexpected departures under obscure circumstances.
While working as a medical scribe, I can recall overhearing hospital staff discussing how the only Black orthopedic resident at the time was let go — yet another URM resident they had seen to have been mysteriously dismissed from their program.
Even just a few weeks ago, the former Chief Diversity Officer at University Hospital resigned, later recounting her experience of feeling targeted, demeaned and disrespected as a Black female physician in a leadership position.
The issue with the “leaky pipeline” analogy is that it describes the phenomenon as a passive occurrence — as if it were bound to happen without external influences. Prior research and my own lived experience would indicate that this is simply not the case; often obstacles forcing URM individuals out of the workforce are factors outside of their control.
Deficits in educational and sponsorship opportunities, and elements of both structural racism and microaggression stop qualified and motivated URM individuals from advancing further along the medicine journey, especially when securing positions of leadership.
Pervasive disparities
We are seeing that racial and ethnic disparities are pervasive in the physician workforce, as the racial and ethnic demography of the active physician workforce in 2019 did not reflect that of the U.S. population in the 2020 Census.
Less is known about the racial and ethnic representation in leadership, especially within oncology. Our team has previously published about disparities in NCI-Designated Cancer Center leadership in JAMA Network Open and wanted to better understand the diversity of teams who created national cancer guidelines.
This summer, I worked to evaluate the National Comprehensive Cancer Network and found, unsurprisingly, that significant racial and ethnic disparities exist, with disproportionately white and Asian committee members compared with both the U.S. Census and active physician workforce.
Even committees creating guidelines for the deadliest cancers in Black and Hispanic patients were not more likely to have Black and Hispanic members — some committees did not have a single Black or Hispanic member. This work serves as important baseline data, which I hope to see improve over my career as I do residency, fellowship and, ultimately, enter into the physician workforce.
Personal path
My work with Dr. Chino encouraged me to reflect upon my own experiences as a Black woman navigating the path into medicine.
Mentorship has gotten me to where I am today — it opened doors and provided me with opportunities to demonstrate my merit. Many of these pivotal mentorship experiences were possible through programs and initiatives dedicated to supporting URM students.
In college, I participated in the Summer Undergraduate Minority Research Program at the University of Pennsylvania in which I was paired with two research mentors, both anesthesiologists, who took me under their wing to learn about their field and conduct health services research. This was my first introduction into clinical medicine and the rewards of research. I continued working with one of my mentors throughout college and into my postgrad years. This experience served to be a key highlight on my medical school application, helping me secure a place at Rutgers New Jersey Medical School (NJMS).
While at NJMS, I joined my school’s Student National Medical Association (SNMA) chapter and was matched with a student mentor who had previously participated in the Memorial Sloan Kettering Cancer Center Summer Pipeline Program. My student mentor encouraged me to apply, ultimately connecting me with Dr. Chino. The Pipeline Program provides funding and a research mentor to URM students, and it helped me with resources and opportunities to support my success in medicine.
Overall, my experience thus far has shown me that pipeline programs can help provide opportunities to students like me to navigate both the academic and hidden curricula of medicine.
Opportunity began before I even started medical school, however. I think about where I would be today had my parents, both Haitian immigrants, not made the calculated decision and immense effort to move our family to a better-resourced area with greater access to social, economic and educational opportunities. They understood the impact of one’s environment on their future ability to succeed. Because of their sacrifice, I was able to attend well-funded public schools, take SAT prep courses, get into an Ivy League university and, ultimately, get accepted into medical school.
Growing up, I did not fully realize the significance and impact of my parents’ efforts. I did not see them as the registered nurse with an hourly wage and the self-employed cab driver who worked tirelessly to keep up with mortgage payments and steep property taxes to allow my siblings and me to attend the good schools we did. I now see that if it were not for my parents’ efforts, I may not have found the audacity to pursue a career as a physician.
‘Everyone should be involved’
With all the opportunity that has been bestowed, I have made it my mission to serve as a resource to those like me who are also interested in a career in medicine. I have mentored high school students interested in STEM and premed and college- and graduate-level URM women applying to medical school, in addition to currently serving as SNMA co-president and mentoring first-year medical students. I have used my experiences (both successes and failures) to help these students achieve their goals and offer encouragement, ensuring they know that they too have a place in the medical field.
Patching the pipeline should not be the responsibility of only those it affects. Everyone should be involved for the betterment of society and to best care for patients. Those in positions of power need to advocate for holistic review of applications for both trainees and hires, offer admissions and hiring committee seats to diverse staff (and reward these efforts), increase funding for enrichment opportunities catered to URM individuals (like those programs that benefited me) and seek to actively educate themselves and diversify their ranks.
Unfortunately, there is always a looming fear I could be lost from this “leaky pipeline” like so many other promising Black medical trainees. I have realized that my merit and my parents’ investment may still not be enough to propel me forward and allow me to succeed when pervasive societal ills continue to foster unequal footing and discrimination. After all, all it takes is one biased senior faculty member to spike my career, especially if there are no supportive people in positions of power to defend me.
My hope is that — through all our collective efforts to change the status quo and support URM trainees — we will be able to make the “leaky pipeline” a phenomenon of the past.
References:
- Accreditation Council for Graduate Medical Education. Diversity and inclusion in graduate medical education. Available at: https://southernhospitalmedicine.org/wp-content/uploads/2019/10/McDade-ACGME-SHM-Presentation-McDade-Final.pdf. Accessed Sept. 28, 2022.
- Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Accessed Sept. 28, 2022.
- Llorente E. “Racism pervades this N.J. hospital, former exec says. She was forced out because of it, she claims.” NJ.com. Published Sept. 13, 2022.
- Morgan A, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.12807.
- U.S. Census Bureau. Quick Facts. Available at: https://www.census.gov/quickfacts/fact/table/US/PST045221. Accessed Sept. 28, 2022.
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Evanie Anglade is a second-year medical student at Rutgers New Jersey Medical School. She can be reached at ea535@njms.rutgers.edu. She wrote this blog post under the guidance of her mentor, Fumiko Chino, MD, radiation oncologist at Memorial Sloan Kettering Cancer Center.