By Samuel Raine
As America begins to refocus the national lens on systemic racism and racial injustice during these troubling times, it is important now as a medical community to participate in the discussion. The motivation should be self-evident as we sift through the endless sea of COVID-19 publications once again identifying African American/Black patients as being more adversely impacted by a pandemic than their White counterparts. Calling for more research to be accomplished at a later time is not enough. Action now is essential.
Tackling a systemic issue that spans centuries may seem daunting for a multitude of reasons—it most certainly is for me. It seems intangible. I am impatient. I am busy. I am exhausted. I am uncomfortable. I am not as well informed as I could be. These may be valid excuses, but they are also undeniably lazy ones. I do not need to try and start a sweeping movement across the nation right now to participate in the national discussion regarding race. In fact, I wouldn’t really know where to start with a project of that scale, so I wouldn’t dare ask you to do the same. We do know where we can make tremendous strides in racial equity and justice: in our immediate spheres of influence.
A sphere of influence (yes, I know, it sounds very life coach–esque) is made up of the immediate social networks in which we can engage in conversations and be persuaded. Historians analyze these relationships when discussing topics ranging from world leaders to the rise and fall of the Roman Empire. Marketing gurus capitalize on these systems to build brand awareness and business. We as individuals in the medical community are a part of many spheres of influence, all rooted in our personal and professional identities, our daily hobbies and passions, our religious backgrounds, and more. Identifying where we have room to participate in the goal for racial equity and equality requires a quick and honest look within. What are my spheres of influence? I am a third-year medical student and club leader—I have influence among my future physician peers and at my school. I play first base in an LGBTQ+ softball league—I am valued by my teammates and am quite possibly intimidating to my opponents. I am an Air Force veteran—I have a vast network of men and women, many of whom I’ve never met, who would be by my side at a moment’s call. I can begin to leverage these connections towards the small steps we can all make together to bring forward equity in our local healthcare systems.
These spheres provide a plethora of opportunities in which to make change toward racial equity and justice in medicine. We can make these changes because we are comfortable in these spheres of influence, because it was our conscious choice to be a part of them. As a student, I can take a look around the hallway and realize that less than 1% of my college’s student body identifies as African American/Black. Within 15 minutes, I can draft a call-to-action letter to the Deans calling for review of the diversity statement to improve underrepresented-in-medicine (URiM) populations. Within my circle of veterans, I can reach out to my African American peers to learn from their experiences serving our country, and how they have been affected by nonminorities telling them how they should feel when an NFL player kneels in protest. Maybe I can e-mail the local LGBTQ+ center to inquire about partnering with my peers on a research investigation addressing the disproportionate HIV transmission rates among African American/Black LGBTQ+ citizens in my county (1). All of these potential changes in my spheres add up and contribute to systemic change.
Are you a residency program director? Maybe you can take a few minutes to evaluate how your program recruits and retains URiM applicants. A study of 418 applicants at one program found that 5.5% of applicants canceled interviews due to the lack of a diverse resident population (2). Furthermore, using United States Medical Licensing Examination (USMLE) Step 1 scores as an initial filter in application screening may be endangering the benefits of a diverse program (3). Are you a fellow health sciences student? Spend some time organizing a moderated lunchtime panel to discuss race openly and honestly among your colleagues. Are you a registered voter? Read up on your local election candidates, understand their positions on law enforcement and health infrastructure investment in predominantly African American neighborhoods. Most importantly, do not forget to vote by signing up for mail-in options if your state allows! Are you a curriculum developer? Expand the presentation of clinical findings of diseases on non-White skin. As a health care administrator, you could hire a consultant to assess your health screenings and treatment patterns in minority populations. Perhaps you could assist HR with hiring care teams that are more reflective of your patient population.
Systemic change toward racial equity and justice takes everyone’s seemingly small actions in order to succeed. Relating it to a large motor, there are major components that we as individuals can’t work on today. We aren’t even able to visualize some of the pieces because they’re obstructed from view, perhaps like our unconscious bias. However, within the comforts of our spheres of influence, if we think of every small action toward the greater good as a screw, bolt, washer, wingnut, or bearing, we can slowly replace a worn-out machine with something that runs more harmoniously than ever before. Let us do our part, now, toward replacing a racially unjust medical system by identifying our spheres of influence, investigating areas of opportunity within our networks, and acting on any prospects to make change.
References
- Emory University Rollins School of Public Health. AIDSVu. Accessed at aidsvu.org on 27 February 2020.
- Fairmont I, Farrell N, Johnson AP, et al. Influence of gender and racial diversity on the otolaryngology residency match. Otolaryngol Head Neck Surg. 2020;162:290-295. [PMID: 31931673] doi:10.1177/0194599820901492
- Williams M, Kim EJ, Pappas K, et al. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: a retrospective cross-sectional study. Health Sci Rep. 2020;3:e2161. [PMID: 32318628] doi:10.1002/hsr2.161
Samuel Raine
Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine
Graduating Class of 2022