Rationale and Methods for Diversity Efforts in Medicine

[jacoavlu]

@AR curious if you got any solutions?

[AR]

@AR curious if you got any solutions?

Depends on which problem you're talking about. Also solutions are tough. Improvements are less so.

[resident_1]

In this country if you live in a wealthy (not even super rich) zip code you will have access to good schools/healthcare/groceries/parks/activities for kids.

If you live in a poor zip code you will not have any of this. We can graduate more non-white doctors but I don't think it will change what care people in poor zip codes will continue to receive.

Our entire country has ongoing decline in life expectancy and quality of life (lets not forget for whites as well) . Drug world and criminal world has gotten worse and worse. Cost of healthcare and education keeps going up.

You think getting more diverse med students will improve healthcare outcomes? That telling people about concepts like implicit bias, to think differently, etc will actually change anything?

The effort needed to improve-quality of lives for urban communities has been known for decades (search 1968 Kerner Commission).Those efforts were not and seems like never will be implemented. Its quite costly (and no political will to push it through).
I think covid accelerated inequality as well. Schools in cities are at segregated levels. People going to suburbs or teleworking in nicer areas, homeschooling or private schooling their kids as public schools couldn't handle covid, etc.

The current focus is to dump resources to ongoing geopolitical conflict with Russia and China.

Discussion about this issue quickly get stuck on internal conflicts between various classes of people that we are experiencing today in many aspects of our tense society.

Maybe after that physician graduates residency at Stanford or NYU or Penn the government assigns them to work in an inner city clinic for 3 years (instead of that sub-specialist flying off to suburbs to make $$$). Of course that won't happen (but there will be lots of articles in their alumni magazines about inclusion,diversity).

We as doctors have big hearts. But we wont do anything in this situation. Its simply a national effort issue and the government is doing something else.

[jacoavlu]

Depends on which problem you're talking about. Also solutions are tough. Improvements are less so.

OP seemed to indicate two general and possibly related problems

if I may paraphrase 1) diversity in medicine / among doctors and 2) minorities getting inferior care

most of this thread seems to be arguing around 2

curious if and how you feel 1 and 2 are related and improvements

[AR]

OP seemed to indicate two general and possibly related problems

if I may paraphrase 1) diversity in medicine / among doctors and 2) minorities getting inferior care

most of this thread seems to be arguing around 2

curious if and how you feel 1 and 2 are related and improvements

I think that the causes of #2 are multifactorial and #1 is one of those. Even stuff like improving access for minorities, like lordosis alluded to, would improve #2 without really addressing #1.

Solving #1 is hard. It does sound like the simple step of just taking names off of applications (when deciding whom to interview) would be a small improvement . I've got some Christmas stuff going on right now, so I'll try to stop by later and post more on this topic.

[Turf Doc]

https://youtu.be/YJ3tFPTUhAE

Definitely bias exists. Inputs of quantitative and qualitative data and subjective information leads to a decision and the related results and consequences.
Bias leads to suboptimal decisions. Missed opportunities and poor results.

• Med school admissions: the med school doesn’t get the best possible candidates.
• Orchestra auditions: the orchestra chooses lower quality musicians.

The primary responsibility in the decision is to yourself and the organization. Making the optimal choice by eliminating as much bias as possible.
The difference is the focus. Eliminating your own bias is beneficial to you.
Eliminating someone else’s bias (for whatever rationalization) is actually superfluous. Gives you and your organization absolutely no benefit.

“A Boy Named Sue” plays on biases from a long time ago, 1969. A lot of social issues the too. Names create potential biases. If you make a subjective judgment based on a name, you relied on non-actionable information.
That doesn’t make you a bad person, it does make the consequences of less favorable results of your decision your responsibility as well.

by "best possible candidates" you mean "those with most competitive GPAs and MCATs" right?

The biggest issue i can see is at a certain point if you let people in with low enough GPAs and MCATs theyre going to struggle in med school and possibly flunk out. Thats something i wouldnt wish on my greatest enemy. Not sure that has been happening...

[Tim]

“by "best possible candidates" you mean "those with most competitive GPAs and MCATs" right?”
No. That is a cutoff for a smaller pool, interviews.
Actually, you never know ! That is the way how choices work. Each choice has consequences. Best spouse, best college, best portfolio? Hindsight is cloudy too. I am sure choice #1 in any draft in any selective process rarely works out as the “best”. First rounders are valuable.
Do the best you can with available information. Bias is not information, it is not helpful.
MCAT’s and GPA’s are measurements of something. Plenty of people have tons of potential and never master the skill to apply it. Probably a good indicator of the potential to “keep up” in med school. Not an indicator of the best. Thus, the interview. Remove bias from each step as much as possible. Choices have to be made.

[MPMD]

too many people are only familiar with that one speech from MLK. there is much more to him than that. don't cherry pick one speech.

suggesting that MLK was against what we call affirmative action is not accurate.

king encouraged the use of racial quotas in hiring practices.

in his book "why we can't wait" king said...

"Whenever the issue of compensatory treatment for the Negro is raised, some of our friends recoil in horror. The Negro should be granted equality, they agree; but he should ask nothing more. On the surface, this appears reasonable, but it is not realistic."

King also said ""A society that has done something special against the Negro for hundreds of years must now do something special for the Negro."

there are multiple other instances of MLK supporting what would be considered affirmative action and racial quotoas for hiring practices. i could include more but it would be redundant.

if you have truly read up on MLK, his view on these issues we are discussing is pretty clear.

yeah this is correct.

when i see people quoting the i have a dream speech like this i always ask them to name any other text or speech by king, or name any current civil rights leader they admire.

the idea that MLK would have been anywhere close to where people who quote him like this would want him to be is laughable if you know anything about his history.

but it's super comfortable for them and i understand how important it is for them to feel that way at all times.

[resident_1]

There is also the reality that this topic is off the table for discussion by a white person. It can literally cost you your job and career.
Look up what happened to Norman Wang at upmc when there was discussion of affirmative action and training. He was Asian.
In todays environment nothing will change.

[Huggy]

I'd argue that race, ethnicity, and religion would be best removed entirely from one's application to medical school and residency. Yes, this would not be perfect as the reviewer could use publications, jobs, etc. to dig for an applicant's true identity. No, this would not remove all forms of bias from influencing reviewers' perceptions of applicants but it would at least reduce bias partially by increasing the degree of blinding of the reviewers. We all support blinding in RCTs as this reduces bias and leads to more meaningful and true outcomes, no? That is, unless we actually want for there to be bias, just as long as that bias influences outcomes in the direction that we feel is appropriate.

Alternatively, if applicants are expected to continue supplying reviewers with information on race, ethnicity and religion so that reviewers can use an applicant's demographics to, in someway, determine whether an applicant should be accepted, then I feel that there should also be a mandatory section to include information regarding one's socioeconomic status and parents' occupations. This will allow reviewers to have a more comprehensive idea of just how disadvantaged an applicant may actually be. Although certain racial and ethnic groups, as a whole, may be more likely to come from poorer families, I'd truly be shocked if the same correlation applies to those minority students who are accepted to medical school and into competitive residency programs.

[Tangler]

yeah this is correct.

when i see people quoting the i have a dream speech like this i always ask them to name any other text or speech by king, or name any current civil rights leader they admire.

the idea that MLK would have been anywhere close to where people who quote him like this would want him to be is laughable if you know anything about his history.

but it's super comfortable for them and i understand how important it is for them to feel that way at all times.

Favorite speech by Dr king is called: “Loving your enemies”

In a collection called “A knock at midnight”

In that one he says the strong person is the one who
refuses to strike back and tries to find the the good in people.
He describes the different types of love.
He describes the need need to look for the good in others and the need to realize none of us is perfect.

He says: “In the best of us their is some bad, and in the worst of us there is some good.

Look for the good in people you dislike and try to love your enemy.”

In many of his speeches he describes why violence is wrong.

“Violence is wrong: the end does not justify the means…..the end is present within the means”

I am pretty familiar with the texts of his speeches.

Already said I won’t get in a pissing match.

Not getting into a pissing match about that great man.

I probably should have not responded.

We do not agree on what MLK would say/think.

Unfortunately he is not here to clarify.

I think he would say: discrimination against anyone is wrong.

The problem with any type of discrimination based on race / religion /sex / etc. is that it is inherently wrong.

If orange people were treated poorly by green people for years the answer is NOT to treat green people poorly but rather to treat both orange and green people fairly.

Discrimination against anyone is wrong.

Merit and objective scores are the best anyone can do.

Have a good day and a happy holiday!

[resident_1]

I'd argue that race, ethnicity, and religion would be best removed entirely from one's application to medical school and residency.

Current applications (along with list of extracurricular experiences, internships, research, etc) looks more like marriage announcement out of NYT (what prestigious university the bride/groom went to, what jobs parents have, what fancy suburb they are from, etc). This is how american elite keeps its spots in elite jobs, medical residencies, etc for its own pool of elite kids. These extracurriculars/research have nothing to do with a resident learning their field and maturing as a physician. But it does send a message waht social circle they are from Some regular kids (black, hispanic, white, immigrant) do break through, but to have good gpa and good scores from regular school not entirely enough.

[afan]

Alternative take: Smart parents, knowing this, would give their kids normal names, instead of taking the never-been-done-before route.

The world is what it is. It’s not fair, it’s not perfect, and never will be.

You have the opportunity to either help or hurt your child with something as simple as a name. The choice is yours, and so are the consequences.

There are certainly advantages to having parents who think of such things. Hard to credit the kid for their good judgment in choosing parents.

[afan]

There is also the reality that this topic is off the table for discussion by a white person. It can literally cost you your job and career.
Look up what happened to Norman Wang at upmc when there was discussion of affirmative action and training. He was Asian.
In todays environment nothing will change.

I think that overstates the case. Many white people have discussed these issues. The problems arise when they 1. come up with what many would interpret as racists comments and 2. occupy supervisory positions over members of the groups to which they have expressed animosity.
When those two things occur, the institution cannot afford to keep them in the supervisory positions, lest they become law suit bait.
In this way, it is similar to the James Damore case at Google. Had he not had supervisory responsibility, Google could have kept him on for his software skills. As it was, in an industry with few women in engineer positions, he was a law suit threat to the company.
However, as far as I know, Dr. Wang still works at Pitt.

[afan]

In the Wang incident, the paper was retracted and the notice said that he had misquoted and mischaracterized references to distort their meaning.

https://www.ahajournals.org/doi/10.1161/JAHA.119.014602

Wang sued many people and entities, claiming defamation, violation of first amendment rights and other things.

A judge found the descriptions of the misleading citations to be accurate and dismissed those parts of the suit.

A number of other aspects of the suit were also dismissed. Some at least survived that round of legal wrangling.

Taking a step back from the legal case, it strikes me odd that one would claim they can retain their leadership position while working to undermine the policies of the employer. Although there is a state relationship to his medical school , I think his actual employer is a private entity.

Even if it were a state institution, the head of U of Pitt could not expect to publicly disavow its policies and keep their job. For that matter, Janet Yellin could exercise her first amendment right to speak out against Biden's economic policies. However, she could not expect to keep her job if she were to do so.