URM faculty bring knowledge and experience of different backgrounds and world views to medical schools. Our findings suggest that these valuable attributes and abilities, instead of being perceived and received as beneficial, are often responded to as untoward contributions and become barriers to acceptance in the systems of academic medicine.
Isolation and feeling like an outsider resulted from a combination of barriers to communication and relationship formation with majority faculty; scarcity of faculty of color; and lack of role models. Lack of family instrumental support and social capital combined with education-related debt added to the burden of trying to advance professionally. Faculty experienced disrespect, discrimination, racism and a devaluing of their professional interests in community service and MHD. Women faculty commented on the double disadvantage of gender and minority status.
URM faculty experience social as well as professional discrimination and may feel justifiably angry. The “tokenism” and “window dressing” they describe pertains to at least three concepts: a lack of authenticity among institutional leaders in efforts to include minorities; the burden of having to represent one’s entire race; and being on the receiving end of special programs and assumptions that the achievements of people of color are due to special favors rather than merit. Faculty ascribe a pivotal role to leadership in combating discrimination and achieving diverse faculties. Many leaders lack the experience of having different types of people in leadership roles, and it may seem risky to put power in the hands of less experienced people. Most URM faculty come from non-affluent families (in contrast to many white majority students) and incur substantial debt during training. URM physicians supported their households and often their extended families. The combination of this and dedication to their communities contributed to URM leaving academic medicine.
While published research on diversity in medical school faculty report on a single school,18
on URM physicians in practice15
and some national recommendations,27
this paper’s contribution is in-depth data on the experience of URM medical faculty from diverse subspecialties, collected from five disparate schools in different US regions. While we have focused on URM faculty, other faculty of color may contend with many of the same disadvantages. The findings on relational barriers align with our study results in non-minority faculty.28
Limitations of the study are those inherent in qualitative studies with relatively small numbers of participants: selection or sampling bias, potential for response bias and the subjective nature of analytic strategy. Even so, qualitative studies singularly allow voicing of perceptions of individuals who voluntarily share such information. We found the themes to be consistent and highly congruent for faculty of varying rank, discipline and sex across the five schools.
McIntosh observed that people who benefit most (in the short term) from privilege systems are mostly unaware of and blind to the existence of privilege systems. This preserves the myths of moral and managerial meritocracy.29
This likely occurs because the exposure of bias is often painful and disturbing, particularly among individuals who explicitly hold egalitarian and humanitarian views. Having inherited unconscious biases that are manifested unintentionally in interpersonal interactions, these individuals may feel guilty about their own advantage (acquired typically without effort or consent on their part) and its role in keeping others disadvantaged. Through elucidation of URM faculty experiences, we hope to raise awareness among health professionals, educators, administrators and policy-makers of obstacles to achieving the goal of having URM faculty as leaders in academic medicine.
Medical schools and their policies need to reward service and research on community-based health care and MHD, similarly to other accomplishments and research if this work is to be shouldered by a broader set of faculty. Health disparities in the US are among the highest in the developed world, and reducing them is a major health priority.30–32
Successful strategies to reduce disparities must address the physician workforce.27,33
We propose that having more URM faculty in senior and leadership roles in medical schools will support training a more diverse physician population and increase the cultural awareness and skills of all physicians-in-training and biomedical scientists. These factors will contribute to a greater capacity to care for underserved groups and to better elucidate the causes of and solutions to health disparities. Failure to fully engage the skills and insights of URM faculty means that we don’t have the best science and the best medical care that we could have. We agree that medical schools and their leadership should be evaluated on the extent to which their graduates meet the health needs of the nation.33–35
Achieving a diverse medical school faculty would help meet the institutional mission of academic medicine to train a physician and research workforce that meets the needs of our multicultural society.