Here's a piece referred to in that letter that I may also have imagined.
Black Physicians' Experience with Race: Should We Be Surprised?
Joseph R. Betancourt, MD, MPH, and Andrea E. Reid, MD, MPH
2 January 2007 | Volume 146 Issue 1 | Pages 68-69
Surveys done over the past 3 years show that minorities have drastically different perspectives on race and race relations in the United States than their white counterparts (1). For instance, African Americans are more likely than whites to feel personally discriminated against in public life and at their place of employment, less likely to feel that they have equal job opportunities, and less likely to feel that race relations in the United States are "somewhat good" or "very good." Even as ground is broken in our nation's capital for the new Martin Luther King Jr. memorial, African Americans are less likely than whites to feel that the United States is making significant progress toward achieving King's dream of racial equality.
In this issue of Annals, Nunez-Smith and colleagues (2) present the findings of a small qualitative study that explored how physicians of African descent experience race in the workplace. ... These findings are extremely disappointing and discouraging; however, since they mirror many of the perspectives on race reported by African Americans in society, should we be surprised? We don't think so.
A recent Institute of Medicine (IOM) report titled "In the Nation's Compelling Interest: Achieving Diversity in the Health Care Workforce" (3) highlights that, of the 70.5% of U.S. physicians whose race and ethnicity is known, Hispanics account for 3.5%, African Americans 2.6%, and American Indian and Alaska Natives fewer than 0.5%. ...
Several studies corroborate the corrosive effect of race in the health care workplace (4, 5). Minority faculty, especially African-American faculty, are much less likely than white faculty to hold senior academic rank, even when the data are controlled for self-reported numbers of publications, research grants, and years of service (6); have lower career satisfaction (4, 5, 7); perceive ethnically and racially based disparities in recruitment for training and faculty appointments (8); experience subtle manifestations of bias in the promotion process; and face structural barriers to academic success and professional satisfaction (5,
. Therefore, we should not be surprised that a group that still experiences discrimination in society, is underrepresented and disempowered in medicine, and has negative race-related experiences in the health care workplace would provide the perspectives described by Nunez-Smith and her colleagues. Another influential IOM report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" (9), found no direct evidence of racial profiling in medicine; however, given the persistent evidence of discrimination in our society, it would be naive to think that physicians were incapable of racial prejudice—or at least racial stereotyping—toward their minority patients and professional peers. Both prejudice (the conscious, knowledgeable prejudgment of individuals) and stereotyping (the subconscious process of applying beliefs and expectations about a group to any individual from that group) may lead to disparate treatment. Negative beliefs and expectations about minorities may be subconsciously "learned" from negative images and portrayals in the media or from the entertainment industry. Although there are probably multiple factors that explain the key findings of this study, we have ample reason for concern that prejudice and stereotyping are playing a role. ...
Where do we go from here? Unfortunately, some of the themes identified in the Nunez-Smith study reflect a society where race matters; they are not amenable to simple policy or practice changes. Physicians of color will always be "aware" of their race and know that race-related experiences may shape their interpersonal interactions. However, the perception of these physicians and physicians-in-training (10) that race-related experiences define their institutional climate—that they feel invisible and isolated, lack supportive mentors, feel "cast" when asked to perform certain activities, and are held to higher performance standards than their peers (2, 10)—remains troubling. It is also troubling that these physicians view the health care workplace as silent on issues of race; that issues of race are not openly discussed and policies against discrimination are not discussed, monitored, or enforced; and when faced with difficult situations, they must have a "thick skin." These experiences, which take a personal and professional toll, may be amenable to intervention.
For health care organizations that are truly committed to excellence and equality, several take-home points emerge from this research. First, these organizations should openly acknowledge that race matters as much in the health care workplace as it does in society. Open and honest dialogue, understanding, transparency, and partnership should trump defensiveness and denial when it comes to identifying and addressing the issues raised here. Leaders should create forums and venues for frank, confidential discussions with minority faculty about their experiences in the health care workplace. By unearthing issues that might otherwise fly under the radar, these discussions may serve as a catalyst for change. ...
Nunez-Smith and colleagues' provocative research shows that race matters in the health care workplace, just as it does in all aspects of society. We hope that leaders in the health care workplace are surprised enough by these findings to take tangible steps to ensure that all minority physicians feel respected, valued, and empowered.