“I matter, now what are you gonna do?”¹

That is the last line in Dr. Robert Ray, Jr.’s eye-opening and intensely raw blog, where he details his experiences with institutional and systemic racism during his emergency medicine residency. I have read his account several times now, and, as a white woman, I struggle with how to write about it.

Why Is It a Struggle for Me to Know How to Feel or What to Do with It?

I want to explore these feelings further and address my fellow white colleagues. The first thing some of us as white people might do when we read Dr. Ray’s blog is to say things like, “Oh, I feel so badly for him,” or “I can’t believe that happened!” We may think that there is nothing wrong with those responses. But that attitude is perpetuating the problem.

Those responses make Dr. Ray’s experience someone else’s problem. Those comments shield us inside a “white bubble” (or, as I like to call it, my “white force field”), which avoids recognition of racism and renders us impervious to its insidious effects.

We tell ourselves these stories to make sense of the world. But it’s just that, a story. White people do not exist under a non-racist force field that some of us like to believe we do. Look at the victims of racial injustice since 2020—including George Floyd, Daniel Prude, Breonna Taylor, Ralph Yarl, and Christian Cooper, just to name a few. While these discriminatory and brutal acts were shocking, they were not surprising to Black people.

Dear Fellow White People

Realize that all of these events happened inside our white force field. Racism lives among us. Some of us may think that the perpetrators committing these acts are unique outliers; they could not possibly be our friends or our neighbors. Or could they? People like Amy Cooper (the white woman who called the police on Christian Cooper, a Black man, while he was bird-watching in Central Park) may not be that rare—they are doctors, nurses, bosses, educators, colleagues, and, yes, we probably know them personally.²

Many white people rarely think of ourselves in racialized terms. Our worldview has not often been taught to us with that lens. If we have a white friend, we do not tell other white people in our group that our friend is also white because it is simply assumed.³ Moreover, if we acknowledge race, many of us certainly aren’t going to admit that being white bestows advantage (or “privilege,” if you will). Admitting that we exist in a world of racial comfort significantly different from those with black and brown skin may induce guilt or defensiveness, which brings us back to pity and disbelief. Those feelings have been termed “white fragility,” which perpetuates racism, including racism in the house of medicine.^3,4

Racism is pervasive in medicine and has existed for centuries without being entirely eliminated. In 1784, Thomas Jefferson wrote false and incredibly racist physiological theories in his Notes on the State of Virginia.⁵ In 1910, Abraham Flexner, an educator without any background in medicine, examined the state of medical education and produced a report that revolutionized the future of physician training. To this day, you can read that Mr. Flexner was “brilliant” and “creative.” However, what is not highlighted is that Mr. Flexner espoused multiple racist views about the inferiority of black physicians in his report. He wrote that Black medical schools are “wasting small sums annually and sending out undisciplined men, whose lack of real training is covered up by the imposing MD degree.”⁶ As a repercussion of that report, just two out of seven Black medical schools remained by 1920, Meharry and Howard. Those two schools were responsible for educating nearly all Black American physicians through the 1960s.

At this point, the civil rights movement stepped in, and the Association of American Medical Colleges (AAMC) outlined its plan to increase the number of Black physicians. These affirmative actions created more Black representation and thereby increased “diversity” to a paltry 5.4 percent of physicians being Black (as of 2018). However, few genuine efforts to effect change occurred on “inclusion” and “belonging” beyond empty discussions and unanswered calls to action.^7,8

There were others before Dr. Ray who experienced racism inside the house of medicine. In the 1990s, Dr. Damon Tweedy recounted in his book, “A Black Man in a White Coat,” several racist experiences he had during medical training.⁹ He shared an early experience at Duke Medical School when his professor mistook him for a maintenance technician there to fix a dim light in the back of the class. The professor frowned and asked Dr. Tweedy that if he did not come to fix the light, why was he there? Tweedy replied, “I’m a student … in your class.” The professor unapologetically turned around and resumed teaching. Afterward, Dr. Tweedy consciously decided not to pursue the teacher, human resources, or any other means of calling attention to the incident to avoid repercussions.

Surely, these events have been eliminated now in the 21st century? Nope. A study published in 2020 demonstrated that in a cohort of more than 27,500 graduating medical students, 23 percent of Black students reported at least one episode of racial discrimination.¹⁰ Dr. Ray and Dr. Tweedy’s experiences are far from unique if nearly one in four Black medical graduates have reported the same thing.

To make matters worse, in 2020, Dr. Aysha Khoury was suspended and ultimately fired from Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, Calif. without due process after leading a small-group discussion about her own experiences of bias in her medical education.¹¹ Less than a year later, Dr. Derrick Morton sued that same institution for what he called a pervasive “anti-Black” culture at the school that included censoring and demoting Black employees.¹² That Kaiser’s medical school is named after its own Black former CEO de-fines irony.

Racism in Health Care

Implicitly and explicitly, racism in health care and medical education exists. It continues to exist because many of us, as white people, ignore it. Until we confront this issue head-on and honestly acknowledge how we contribute to the perpetuation of this problem, these incidents will continue. Dr. Vanessa Grubbs, founder of Black Doc Village, articulates this well: “a white-dominated physician training system that unjustly excludes, punishes, and dismisses Black medical students, trainees, and attending physicians will continue on.”¹²

If you have read this far, you have a choice. You can turn the page and never think about it again. You can read it, feel righteous indignation, and refuse to believe me that the white force field exists. Or you can work together to create solutions.

I have chosen to be antiracist and join the ACEP section for Diversity, Inclusion, and Health Equity (DIHE). What are you gonna do?

Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience. She is the chair of the USACS diversity, equity, and inclusion committee, the social issues and equity in medicine committee co-chair, and leads physician leadership development for USACS.

References

1. Ray Jr. R. Racism in medical education: An unfortunate ending to my time at Lehigh Valley Health Network. Blog post. https://rrayjr.blog/. Published June 15, 2023. Accessed December 12, 2023.
2. Brownlee D. Dear white people: When you say you ‘don’t see color,’ this is what we really hear. Forbes website. Published June 19, 2022. Accessed December 12, 2023.
3. Jackson R, Rao S. White Women: Everything You Already Know About Your Own Racism and How to Do Better. New York: Penguin Books; 2022.
4. DiAngelo RJ. White Fragility: Why it’s so hard for white people to talk about racism. Allen Lane, an imprint of Penguin Books; 2019.
5. Jefferson T. Notes on the state of Virginia. Philadelphia: R.T. Rawle; 1801: 268-28. Published online February 5, 2010. Accessed December 12, 2023.
6. Savitt T. Abraham Flexner and the black medical schools. J Natl Med Assoc. 2006;98(9):1415-24.
7. Proportion of Black Physicians in US has changed little in 120 years, UCLA research finds. UCLA Health website. Published April 20, 2021. Accessed December 12, 2023.
8. Tenet M. Racial inequality in medicine: How did we get here? Georgetown Medical Review. 2021;5(1).
9. Tweedy D. Black Man in a White Coat: A Doctor‘s Reflections on Race and Medicine. London;Picador:2016.
10. Hill K, Samuels E, Gross C, et al. Assessment of the prevalence of medical student mistreatment by sex, race/ethnicity, and sexual orientation. JAMA Intern Med. 2020;180 (5):653-665.
11. Asare JG. One doctor shares her story of racism in medicine. Forbes website. Published February 1, 2021. Accessed December 12, 2023.
12. Grubbs V. Perspective: Racism in academic medicine is hindering progress toward health equity. CHCF website. Published February 17, 2023. Accessed December 12, 2023.