Asian Americans and racial justice in medicine

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AAPI Heritage Month Logo

“I don’t see how that’s relevant to healthcare.”

At the end of March 2021, an (non-Asian American) Associate Dean for Equity, Diversity and Inclusion at a prominent U.S. medical school asked the Dean if they could plan a statement and educational activity about the Atlanta shootings in which 8 people were murdered, 6 of whom were Asian women. At this time, American rhetoric around the COVID-19 pandemic, including language from the former U.S. president, had spawned an exponential growth in anti-Asian hate since 2020. Asian American healthcare workers were experiencing discrimination, harassment, rejection and even violence, from patients, staff and colleagues.

The renewed racial justice movement following the murders of Brianna Taylor Ahmad Arbery and Breonna Taylor had also ushered a wave of discussion about racism in the nation- including in medicine. Medical schools set up anti-racism initiatives, doubled-down on anti-racism commitments, and announced new positions and offices of equity, diversity and inclusion.

The Dean did not see the event- a tragic signifier of the broader issue of anti-Asian American racism in the country- as relevant to the community in their school of medicine.

The continued erasure of Asian Americans within medicine, who make up approximately one-fifth of all medical students, trainees and physicians, and constitute the largest racially minoritized group, will block overall progress on racial justice.

Holding up Asian Americans as a “model minority,” allows for white dominant narratives to deny the existence of racism within the profession. Simultaneously, ignoring Asian American concerns and perpetuating ongoing discrimination will continue to those in healthcare more broadly (not just physicians).

With this commentary in NEJM, we hoped to start a more nuanced conversation about the positionality of Asian Americans in medicine and in the larger movement for racial justice.

Asian Americans and Racial Justice in Medicine

Medical school admissions and institutional racism

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Large boulder in desert sands with clear blue skies and sandy brush in the background

Grant Marek/SFGATE The purported largest freestanding boulder in the world, Giant Rock, in the California Mojave Desert.

Nearly 25 years ago, during my lit review for my med school research thesis on diversity and medical education programs, I found many prior articles had already been published about the lack of diversity in medicine. 1985. 1996. and so on. In 2013, a physician fellow contacted me for advice on her brief research letter documenting the lack of diversity in medicine.

So, when the news cycle had once again “discovered” the dearth of Black men in medicine in 2018 (or was it 2016?), it felt like time to get back into workforce research. And instead of yet another quantitative paper, it also felt like time to ask, what is going on?

Some failed grant applications, a modicum support from UCD Center for a Diverse Health Workforce (not the Center’s fault- there has been barely any money for workforce research until last year), and a *lot* of team effort, and we managed to conduct key informant interviews with 39 deans and directors of 37 MD-granting medical schools, asking them about admissions in general. Then zeroing in on diversity.

We plugged away through the onset of the pandemic to finish the interviews. Coding and analysis, reading, more analysis, more reading, and the final writing-as-analysis phase were a real bear, even more so than usual. But finally this came out:

US Medical School Admissions Leaders’ Experiences With Barriers to and Advancements in Diversity, Equity, and Inclusion

It’s hard to pick a favorite quote so please read the paper if you can. As a teaser, here’s one:

“After our white coat ceremony, [my dean] received a lot of questions [from alumni and faculty], ‘Whatever happened to the six-foot-two blonde, white boys we used to have in our medical school, where did they all go?'”

Key takeaways:

Racism has wormed its way into so many places, small and large, throughout the entire admissions cycle and school of medicine.
This means there are many opportunities, from small process changes to large institutional system-wide transformations, to conduct anti-racist change (see the Supplement!)
Med schools, get out of US News and World Report already. It doesn’t matter as much if the Harvards of the world do it- but you can make a difference if the mid-tier schools do.