We have made significant strides toward emergency medicine workplace diversity. That cannot be denied. But given the time and effort we have been putting in, you would think we would have gotten even further. Many of our departments have an office of diversity and inclusion, a women’s wellness group, and programs that support residents who identify as members of underrepresented groups in medicine.

Notice who runs your “diversity and inclusion” programs. Do they identify with one of the underrepresented groups they were formed to support? The likely answer is yes. Since the inception of diversity and inclusion programs, we have tasked women, people of color, and historically marginalized people to drive the change we need to see. But what if, as a consequence, those who promote workplace and leadership diversity are also simultaneously and subtly punished for it? That’s what appears to be afoot, and it is worth unpacking.

Let’s explore how this might happen.

A Case Example

A well-meaning white male chair promotes a mid-career nonwhite woman into a division chief position and, in addition, asks her to run the new women’s group in her department. She takes both opportunities, even though only one is compensated. Over the next year, she is asked to recommend two physicians for promotion at a leadership meeting. She recommends one white woman and one man who is a person of color. They are both objectively qualified.

According to research, this female division chief is more likely to receive negative professional evaluations on her leadership skills because of the demographics of these recommendations.^1,2 Meanwhile, research shows that the white male chair will have no consequences for promoting the woman of color into her job.

In short, when white men in power enhance workplace diversity, they are not punished for it. But when anyone else does it, other evaluators think that they are less effective managers and thus they are penalized.

What We Can Do

What are some solutions? Here are two.

First, continue to support the work of those (white) men in power to embrace diversity and inclusion in the workplace. We should continue to highlight this and encourage power brokers to continue and expand these efforts. We can engage these men within the “ally, advocate, accomplice” framework that I spoke about at this year’s FemInEM Idea Exchange in New York (#FIX19).

• An ally is someone who is not a target of oppression but still works to end it.
• An advocate is a person who publicly supports a change or policy.
• An accomplice is someone who supports the target of oppression when they are going out on a limb.

Second, we need to educate the health care workforce about the unconscious biases that lead to these promotion penalties. The inappropriate negative consequences for women and people of color for promoting or sponsoring underrepresented demographics must be addressed. Often, once harmful habits and trends are exposed, solutions follow. Similar to the adage that “you can’t diagnose a disease you’ve never heard of,” you can’t move to address your own unconscious biases if no one has pointed them out.

In an environment in which nonwhite and female leaders are no longer subtly punished for hiring and promoting a more diverse workforce, the path toward equity will be a less steep climb. In the meantime, let’s identify allies, advocates, and accomplices who are so often steering the ship—those who can move things forward—and encourage them to act and celebrate when there are successes.

The equity movement has come a long way. Among those who themselves have not faced barriers of discrimination, we have seen the posture evolve from denial to recognition to a belief that equity matters. The next step is engaging these brokers to fully act on these beliefs so those who still face these barriers are not held back and not punished for helping others as well. By doing this, we will all benefit.

In the end, the equity equation is not just about lifting the oppressed. It’s the sum total of all of our parts, working together to make the professional landscape better than the one we inherited.