Changing the Face of American Medicine
AAMC conference addresses the need to diversify the ranks of medical school faculty.
By Kendra Hamilton
If the mission of the Association of American Medical Colleges is clear — “to change the face of medicine to reflect the face of America,” said Dr. Charles Terrell, the group’s vice president for diversity policy and
programs, at the opening of AAMC’s recent conference on career development for minority faculty — then another fact is equally clear: The barriers are high.
Racial and ethnic minorities — especially African-Americans, Latinos of Mexican American and Puerto Rican descent and American Indians — are a small proportion of academic faculty at U.S. medical schools, a proportion that appears to be growing at only a glacial pace, Terrell said. American academic medicine, he continued, seems to be “afraid of the dark.”
Indeed, while Whites comprise 76.3 percent of the general population, they make up more than 79 percent of all medical faculty and nearly 89 percent of all full professors in academic medicine, said Dr. Denise Cora-Bramble, executive director of the Goldberg Center for Community Pediatric Health at Children’s National Medical Center in Washington, D.C. Minorities, meanwhile, are more than 23 percent of the population, but only hold 4.9 percent of all medical faculty positions and 2.2 percent of full-time positions.
None of this, of course, was exactly news to the men and women gathered at the Georgetown University conference center for AAMC’s annual Minority Faculty Career Development Seminar.
The group — mostly composed of mid-career faculty but also including a sprinkling of senior faculty looking to improve the minority numbers at their academic organizations — nodded and sighed as conferees discussed the barriers facing people of color, including the low numbers in the pipeline, the desire to pay off school indebtedness and the lack of role models or mentors who could steer them to opportunities in academic medicine.
Even when minorities find their way into faculty ranks, “we’re not happy campers,” Cora-Bramble said. She ran off a quick list of reasons: lower rates of promotion experienced by under-represented minorities; “toxic” competitive environments where harassment and bias are the rule rather than the exception; the “Black tax” of committee assignments that eat up time that could be more profitably spent in research; and conflicting desires for career advancement and for a satisfying family life. The discussion of these issues and annoyances drew the strongest reactions from the audience at AAMC’s conference.
But unlike other conferences on ethnic and racial disparities, the bad news was simply the place where the discussion began, a way of “keeping it real,” said Cora-Bramble. For the two and a half days that followed, conference attendees received a crash course in navigating the tricky environment of academic medicine — both the rules of the game and the “hidden rules” that trip the unwary.
An essential first step was outlined by Dr. Valerie Williams, associate dean for faculty affairs at the University of Oklahoma College of Medicine and director of the Health Sciences Center Faculty Leadership Program: “You have to have a framework for your academic career,” she said. “You have to be able to state clearly what your interest is, and you have to consider how you might share that with other people.”
Indeed, she noted, many an academic career has gone off the rails for lack of a simple plan. “You don’t want to end up with a life that is, in the words of Sir Walter Scott, ‘unwept, unhonored and unsung,’” Williams said.
Career planning requires facing fundamental questions about one’s relationship to academia. The questions can be as simple as, “How do I reasonably fit in?” or as complex as “How do I maintain my integrity around issues that are important to me?”
But Williams’ concept of career planning begins with finding an individual’s passion — that spark that brought them to medicine and kept them motivated during the long years of training. “What you’ve got to do is leverage that passion into something that can be connected to an institution’s mission,” she told the attendees. “That lifts us all up, because if we can get our institutions to see how we fit and vice versa, we can make things happen in our careers.
“You are a unique individual — you bring something unique to the environment,” she continued. “But what you bring has to be recognizable in terms of what your peers find of value because peer review is the coin of the realm in our environment.”
Williams’ emphasis dovetailed into the presentation that followed by Dr. Laura Schweitzer, interim dean of the school of medicine at University of Louisville’s Health Sciences Center. She spoke on demystifying the tenure and promotions process.
“Here are a few words to the wise: Right or wrong, the promotion and tenure process is a political process. So you can’t underestimate the power of your personal relationships when it comes to navigating that process,” Schweitzer said. “It’s all up to you. You have to make the case for your promotion or tenure. You have to state the case in terms of whether you’ve met all the criteria. And you have to state that case in terms of what your institution values.”
Responding to a comment from an audience member who expressed distaste for the ways in which her colleagues vied with one another in tooting their own horns, Schweitzer made no bones about her views: “Promotion and tenure is not a time to be worried about bragging. You have to brag during promotion and tenure evaluations, because if you don’t do it, no one is going to do it for you.”
The inspiring thing about the AAMC conference was that one could see little fires of recognition light up all around the room. During the discussion of “toxic environments”, Dr. Mildred Olivier, an award-winning ophthalmologist from Chicago brought up the case of a friend whose chair wasn’t supportive of her work. “And if your chair isn’t supportive, does it really matter that you have [National Institute of Health] grants?”
Allison Jackson of Children’s National Medical Center found herself struck by a point during Schweitzer’s presentation. Upon learning that most promotions proceeded from either a clinical services track or a research track, Jackson found herself wondering about the track she was on.
“I’m a clinical educator — that’s a track that’s recognized by my hospital but not by George Washington University,” the academic institution with which the hospital is affiliated.
But these are precisely the questions the AAMC’s annual career development programs are set up to answer.
“For those that journey there isn’t always a pathway,” Cora-Bramble said. “That doesn’t mean you’re doomed to fail. It just means you need a serious personal plan.”
Dr. Jordan J. Cohen, president of AAMC, told Diverse that their research has found that the cost of medical education and the length of time it takes to complete medical training may be deterrents for more African -Americans to apply to medical school.
“Although ample loan funds at attractive interest rates are available for medical students, we speculate that African-American families are, in general, less inclined than others to borrow substantial amounts of money,” Cohen says. “We hope to communicate more effectively with prospective African-American college students that an investment in a medical education is not only financially wise but can lead to a most fulfilling career in a field with endless opportunities.”
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