Diversity For A Reason
By
Leonard Zwelling
https://www.nejm.org/doi/full/10.1056/NEJMp2211874
Readers of this blog know that I am not a fan of across-the-board diversity, inclusion, and equity (DEI) for its own sake. In the mad dash to establish offices of diversity across academia, the reasons for doing so seem to get lost—or at least lost on me. Diversity has become an end in itself, rather than being a means to advance the academic mission. It has increased employment opportunities for many administrators, however.
In a particularly cogent and extremely relevant editorial in The New England Journal of Medicine on March 9, Quinn Capers IV, MD explains why diversity is so important and it is not to win awards for diversity.
The reason this has become so important now is that it is very likely that the Supreme Court will ban the use of affirmative action in decisions regarding who gains access to elite universities. Yet, it is just as clear that having diversity among physicians may be critical to the health of underserved populations. So, what does Dr. Capers say? How will the medical schools, residency programs, and faculties attain a more diverse workforce without affirmative action and why should they?
First, recruitment of minorities into medical schools has met with limited success because the pool of applicants is not big enough and leaders making admission decisions are not really held accountable for seeking such applicants and successfully recruiting them. Capers suggests that such accountability be part of the evaluation of the success of academic departmental leaders.
Second, he suggests that diversity become part of the fabric of the institution and to consider the willingness to serve underserved communities in an applicant’s medical career a plus in the merit column. Thus, it is no longer affirmative action, but rather the system striving toward a desired outcome.
Third, he points out that the more traditional predictors of academic success may not be all that reliable. “A recent study found no differences in standardized-test scores between trainees selected as chief residents and their co-residents.” The person who may be a great clinical leader may not be the one who graduated first in his or her class. Other factors matter.
Fourth, he has developed a system to rate fellow applicants where merit is defined as “evidence of clinical excellence, leadership potential, collegiality, academic curiosity, and diversity competence.”
Fifth, he acknowledges the reality of implicit bias. This needs to be recognized by those making selection decisions and they need education in how to recognize such bias in themselves. This can be done.
Sixth, outreach activities including to institutions serving historically underserved populations should be part of the recruiting process. This takes a lot of work with the onus on the established institutions to reach out to the ones matriculating the historically underserved.
Finally, he readily acknowledges that this process of actively seeking a diverse physician workforce must begin early in the educational process to encourage young people to seek out careers in medicine. Community outreach will be necessary. Internships in medical school laboratories for high school students is a great way to increase the enthusiasm for a career in science. The quest for a diverse physician workforce cannot start in medical school. It goes back to kindergarten.
These are all important points, but he leaves the most important for the end.
“Ultimately, if academic medical centers don’t find ways to enhance the diversity of the physician workforce, they will fall short of their mandate to improve the human condition.”
In other words, all of this is forward looking. None of this is about righting past wrongs or in any way suggesting that anyone should feel guilty about the lack of diversity in our current physician workforce. It is about fulfilling the mission of academic medicine to improve health care for everyone and without diversifying the physician workforce, that will not occur.
Now, THAT’S a reason to do something. It’s not about winning awards or looking diverse. It’s about delivering better health care to all the world. That I can get behind.
Did you know? Dr. Zwelling’s new book “Conflict of Interest” becomes available Spring 2023. Check LenZwelling.com for the latest on this book and information on how you can purchase a copy.
