In January, we published “Diversity in Recent Leadership Positions,” which highlighted the recent accomplishments and honors of Leon L. Haley Jr., MD, MHSA, FACEP, CPE; Marcus L. Martin, MD, FACEP; and Lynne D. Richardson, MD, FACEP. Well, Dr. Haley, Dr. Martin, and Dr. Richardson have landed roles that reach way beyond emergency medicine alone. Announcements are one thing, but how great leaders achieve success is quite another. The road to leadership is shaped by many experiences and many people, both positive and not so positive. In an interview with ACEP Now Medical Editor in Chief Kevin Klauer, DO, EJD, FACEP, these three emergency medicine icons talk about their career paths, influences, and experiences. Here is Part 1 of that conversation; Part 2 will appear in the December issue.

KK: I can imagine it’s been a challenge to get where you are, achieving success beyond what most people could ever hope for while overcoming many obstacles. So let’s share your stories. Leon, tell us about your current position.

LH: I am the vice president for health affairs and dean of the College of Medicine, Jacksonville, for the University of Florida.

KK: Outstanding. What were some of the interim positions or stepping stones that gave you the leadership experience for your current role?

LH: I started off as the chief of emergency medicine for Grady Health System and was a faculty member at Emory University in Atlanta. I started that role in 1997. In 2001, I assumed the additional titles of deputy chief medical officer and deputy senior vice president of medical affairs for Grady; in 2003, I became the vice chairman for the department of emergency medicine for Emory University, and along the way, I went from assistant to associate to full professor. In 2013, I was asked by the new dean of the School of Medicine to assume the position of executive associate dean for Emory at Grady. I was in that role from July of 2013 until December of 2016, then I was offered the position to move here to Jacksonville.

KK: Marcus, let’s hear a bit about your background and how you’ve transitioned into your role.

MM: Thank you for hosting this interview, Kevin. I am a native Virginian. I am currently in Charlottesville at the University of Virginia (UVA), and I’ve been here for 22 years. I grew up in a little paper mill town—Covington, Virginia—where fathers and uncles all typically worked in the paper industry, and I followed suit, going to NC State University to get degrees in the pulp and paper technology and chemical engineering. I became a production engineer and did some research in the paper industry.

After a major accident in the paper mill, I decided I no longer wanted to work with mechanical pumps or fluid dynamics, but I would like to take a shot at the human pump. So Eastern Virginia Medical School (EVMS) opened its doors in 1973; I applied—one of 1,200 applicants—and was granted admission to the school. I became one of 24 charter students, and the first African-American to graduate from EVMS. From there, I did my residency at Cincinnati General. I worked on the Navajo reservation as the general medical officer; the U.S. Public Health Services in Staten Island, New York; and then Allegheny General Hospital in Pittsburgh for 15 years in various roles.

I progressed to vice chairman of emergency medicine [at the Medical College of Pennsylvania], and I was the interim director of the division of emergency medicine, department of surgery from 1995 to 1996. I was also acting chairman of the department of emergency medicine, Medical College of Pennsylvania, at the Hahnemann/Allegheny, campus from 1995 to 1996. I accepted the job as chairman of the department of emergency medicine at the University of Virginia in 1996. I came in as the first African-American chair in the UVA School of Medicine for any department. I’m currently the vice president and chief officer for diversity and equity for the entire university. I was honored with the Marcus L. Martin Distinguished Professorship of Emergency Medicine in the School of Medicine at UVA, which is the first endowed professorship in the department of emergency medicine at UVA. There are only three African-Americans with an endowed professorship named after them—Julian Bond, Thurgood Marshall, and Marcus Martin—so, wonderful company that I’m honored to be with.

Human variations should not interfere with our duty to patients, inclusive of religion, race, ethnicity, any social standing, low-income patients, sexual orientation, ability, or disability. I feel very strongly about that. Anyone who comes into the emergency department or passes out in the street, it is my duty to help. —Marcus L. Martin, MD, FACEP

KK: Lynne?

LR: I’ve actually had three careers in emergency medicine because I came out of residency on a clinical/administrative track. I was chief of emergency services at a public hospital quite early in my career. I had become a physician because I was committed to serving a community that had been traditionally underserved. So for me to return to my hometown, which is New York City, Harlem, to help run an emergency department for people in that community seemed to be fulfilling the reasons why I had become a physician. I was good at it. I think it was meaningful, but clinical operations, although I felt like what I was doing was very important, was not perhaps, as intellectually satisfying as something that was more on the academic side.

I got the opportunity to make a lateral transition from clinical operations into medical education at Mount Sinai as residency director to establish a residency program. That really came about through a personal connection with Shelley Jacobson, who had just been selected as the first chair of emergency medicine in the new department of emergency medicine at the medical school at Mount Sinai. He had been the director of the emergency department when I was at Albert Einstein College of Medicine as a student and actually had a lot to do with my going into emergency medicine. It was really that personal connection that gave me the opportunity.

Then I got another opportunity offered to me, which was to do a midcareer fellowship in health services research, which gave me the tools to then make another lateral transition from graduate medical education into research.

KK: I’ll ask Leon first. Can you share some of the positive experiences and maybe some of the challenges that you encountered as you were starting to move into leadership roles?

LH: From a positive standpoint, I think I was fortunate and blessed to have two mentors early in my career, both of whom were white men, who were very supportive of my growth and development and were very out-front as it relates to making sure that there was improved or increased diversity in their respective departments. Initially, when I was at Henry Ford [for residency], my first advisor, Michael Tomlanovich, was the vice president of administration for the health system and had been the chair of the department when he was still a faculty member in the department. Mike was really the first person who started to help me guide my administrative career and think about combining academics, administration, and clinical care. He has been supportive always. I actually got my master’s degree while I was still working full-time, and Mike was very supportive.

Arthur Kellermann recruited me to Emory back in 1996–97, and I think Arthur has been a good, if not a great, role model with really trying to promote diversity in his leadership team. He had a very diverse leadership team—white, black, homosexual, heterosexual. I think he’s also been very promotive of my career and making sure that I could advance appropriately up through the ranks.

You know, there are negative things that have always popped up that people probably never notice. At Grady, for example, we have two medical schools that support the institution from a clinical standpoint, both Emory and Morehouse. Morehouse is a largely African-American medical school with a lot of history in terms of producing African-American physicians. One of the things that I always encountered was there were patients and sometimes even staff who could not assume that I was an Emory physician. Not to say that Morehouse is bad or Emory is bad, but the assumption was that, as an African-American male, I could only work for Morehouse. Those were just some of those little things we had, subtleties we had. I had to tell people, “Yup, I work for Emory, and I’m pretty qualified.”

When I got my first position, I was relatively young and African-American. I think there were subtle things about doubting my decision making or my thoughts around expertise in administration. Nothing overt, quite honestly, but certainly little subtle looks or digs, people questioning, or occasionally people would try to go around you because they didn’t trust your judgement or believe you. The other thing is—and Marcus and Lynne will probably tell you the same thing—there’s always the challenge of, you’re African American, you know you are, and you feel like oftentimes you carry the weight of the race on you a little bit. You’re always trying to prove yourself, work extra-hard, and be twice as good but hoping that you’re doing things well so that people don’t condemn the race because you didn’t do something well.

KK: I appreciate you sharing that with us. Marcus, your perspective?

MM: Having role models, and a couple people come to mind right away—Glen Hamilton and Richard Levy, among others at the University of Cincinnati, were great role models—they got me involved on the national scene. I initially became president of the Society for Academic Emergency Medicine (SAEM) around 2001, and I was president of the Council of Emergency Medicine Residency Directors (CORD) in the late ’90s. In both of those cases, I was the first African-American to be in that office, and served on the boards for SAEM and CORD, each for 12 years. While I was at Allegheny, I worked on the Council of Residency Directors’ logo, the one with the apple. That was a joy to see come to fruition. Ultimately, we established the Academy of Diversity and Inclusion in Emergency Medicine, and I was one of the founding members.

Just as Leon said, the things that tend to face minorities are being confronted with implicit biases or microaggressions, things that tend to happen on a day-to-day basis. First, as physicians, we practice the art of medicine, and as we practice, we try not to permit any human variation to get in the way or to cause us to do anything but the right thing by the patients. Human variations should not interfere with our duty to patients, inclusive of religion, race, ethnicity, any social standing, low-income patients, sexual orientation, ability, or disability. I feel very strongly about that. Anyone who comes into the emergency department or passes out in the street, it is my duty to help. But we’re in times now when we have white supremacy groups—as you all are probably aware, about 600 members of the alt-right, Unite the Right, white supremacy, KKK that violated our grounds here at the University of Virginia and the city of Charlottesville, resulting in three people who died. You would think that we would not be faced with these kind of challenges these days. These are real aggressions, and there are certain microaggressions that are subtle. I’ve been called the N-word while seeing patients in the emergency department. In some cases, the patient may be demented, but in other cases, the patient turns out to be a racist. I have not been deterred by it. I’ve been able to work through it and perhaps have someone else see a patient and come back to me. Then I’ll go back and let them know I’m the person in charge.

Out of that, we’re working on a second book, Diversity and Inclusion in Quality Patient Care. We wrote and edited a book, Sheryl Heron, Lisa Moreno-Walton, and I, and Leon contributed. We’re working on another book, Case Continuum, we’re calling it. It’s about 70 cases. We’re asking people who have personally experienced microaggressions or implicit biases to write about when a patient may say, “I don’t want a Mexican doctor,” “I don’t want a female doctor,” “I don’t want a gay doctor,” “I don’t want a Muslim doctor,” “I don’t want a foreign doctor,” and it goes on and on and on. That book should be finished in March.

I could give you tons of examples. I was in several roles at Allegheny General in Pittsburgh as a residency program director, then I became the acting chair of the department my last year there. However, we were a division of surgery and the chair of surgery favored a younger person who was a white male who happened to be one of my residents I had trained. I had been there much longer than he. The person who was the chair left, and it was a natural progression for me after all of the work I had done, but I had to fight for that. Fortunately, the majority of the faculty stood up and wrote letters of support, and I became the chairman. Coming to UVA, the first African-American chair, newly minted department, there were some people who didn’t quite welcome me. So, yeah, the aggressions have been, in form of microaggressions, subtle, but there have been outright biases as well.

KK: Lynne, how about you?

LR: I always had the benefit, at least in terms of the people to whom I directly reported, of dealing with people who treated me fairly and valued the contributions that I could make. However, that was not always the case. I had so many experiences early on in high school and in college in dealing with more overt kinds of racism and bias. By the time I began my career as an emergency physician, I had a pretty well-developed tool set for dealing with that. I was fortunate; there were lots of people who helped me along the way, sometimes in very casual ways, but I really never had the kind of mentorship that I now try to give to the young faculty, fellows, and residents that I mentor. I think I understand very clearly the importance of mentorship because I largely built my career without it, and I think that made lots of things very difficult. I had to perhaps wait longer, fight harder for opportunities that mentors might have helped me get access to. I tried to do good work and kept trying to learn as much as I could. I was always very driven by making a difference as opposed to getting ahead, but I managed somehow to get ahead while I was making a difference.

There’s some very interesting research that there is a cumulative effect to these microaggressions and the ways in which certain groups experience racism in this country that probably makes a substantial contribution to some of the differences in health statuses and some of the health disparities that we see. There is a different body of literature that looks at the more overt and explicit forms of racism, but I think the microaggressions are important to understand because they are so ubiquitous and so constant for many of us. And I think if you are from a group where you have not experienced this kind of behavior, you really don’t appreciate the level of stress it adds to your everyday life. I think many of us have formulated very effective strategies to deal with it, but it takes energy. As the research continues to come out, it will be more and more clear how adversely these microaggressions affect people.