Health Equity | michelle ko md phd

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.

Time and space as operations of racism in healthcare

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In this piece, Arianna M. Planey explains how spatial access to healthcare arises from processes of structural racism, and thereby contributing to the impacts of time as a social determinant of health that produces racial inequities in healthcare access and outcomes.

“We discuss the potential for health/medical geography to contribute to a policy-relevant geographical research agenda that remains attentive to social theory debates. We illustrate the importance of time as a social determinant of health, through the case study of racial/ethnic inequities in spatial access to acute hospitals in the U.S. South region amid rural hospital closures, conversions, and mergers, which have decreased the supply of hospitals since 1990. In sum, racial disparities in spatial access were most pronounced for travel distances/times to the nearest alternative hospital, underscoring the importance of both temporal and spatial equity.”

Planey, A. M., Wong, S., Planey, D. A., & Ko, M. J. (2022). (Applied) geography, policy, & time: whither health and medical geography?. Space and Polity, 1-13.

https://doi.org/10.1080/13562576.2022.2098649

Declaring that DEI is important is not enough: We need action

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How to DEI

Three years in the making: a group of PhD students in health services and policy research (HSPR) set out to examine the workplace culture in the profession, with a particular eye to how our field fares with respect to diversity, equity and inclusion.

Bert Chantarat, Taylor Rogers, and Carmen Mitchell surveyed over 900 professionals and students, and conducted focus groups of those from historically and structurally excluded from the profession. In this publication ahead of print from Health Services Research, they report their findings from the survey:

“While the racial and ethnic diversity of the health services and policy research (HSPR) workforce has improved, significant gaps remain for groups historically and structurally excluded from health professions.

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“HSPR workforce members experience non-inclusive, inequitable environments, with those from historically and structurally excluded groups reporting frequent discrimination.

“Those working in HSPR from historically and structurally excluded groups perceive their workplace DEI efforts to lack substance and focus on planning and reporting rather than implementation.”

“The field will not continue to improve toward creating a diverse workforce, and inclusive and equitable workplaces until a critical mass of people, especially leadership, begin working together seriously to address these issues. Declaring that DEI is important is not enough; effective actions must accompany such declarations.”

Check out the full article here:

Chantarat T, Rogers TB, Mitchell CR, Ko MJ. Perceptions of workplace climate and diversity, equity, and inclusion within health services and policy research. Health Serv Res. 2022 Jul 9. doi: 10.1111/1475-6773.14032.