Black History Month: A conversation about representation in medicine

Black Americans have been shaping the delivery of health care in the U.S. and across the world for generations through the development of lifesaving vaccines, surgical innovations and more.

Yet despite the ongoing contributions of Black changemakers in medicine, there aren’t enough Black medical professionals in the United States. For example, Black Americans make up approximately 14 percent of the U.S. population, yet only about 5 percent of physicians and surgeons are Black. This lack of representation holds true across other medical professions as well, including physician assistants (PAs) and advanced registered nurse practitioners (ARNPs).

We spoke with five members representing MultiCare Health System’s Belonging Advisory Council and Center for Health Equity & Wellness about diverse representation in medicine and what we can do to improve it. The council consists of employees across all levels of MultiCare who serve as champions for diversity, equity, inclusion and belonging (DEI-B).

Participants in this discussion include:

• Genesis Flynn, surgery scheduling coordinator, MultiCare Neurosciences Center of Washington
• Shareka Fortier, MSML, chief belonging officer at MultiCare
• Kristi Martin, MBA, professional outreach director, MultiCare Good Samaritan Hospital
• Sheri Mitchell, community outreach program manager, MultiCare Center for Health Equity and Wellness
• Martha Raymond, JD, vice president and chief risk & compliance officer at MultiCare

How does lack of representation in medicine affect patient care?

Flynn:  My grandma, who was a Black woman from the South, had difficulty trusting her doctors. I feel if she had seen a doctor that looked like her, she would have been more willing to accept what they were saying about her care.

Martin: A lack of diversity and representation in health care has been linked to poor health outcomes, decreased utilization of health care by higher-risk communities and safety issues due to miscommunication between patients and providers.

Raymond: The conversations you have with your clinician are some of the most private and important you will have in your life. With whom are you the most comfortable having such conversations? It’s with someone that you believe gets you. Many patients feel they are less likely to be judged and more likely to be taken seriously when being cared for by a clinician from the same background or who looks like them.

What do we as a society stand to gain by improving the diversity of the health care profession?

Mitchell: Representation matters in all facets of life. To achieve better health outcomes and improve safety, we need to ensure our health care professionals are representative of the populations we serve.

Additionally, the need to prioritize and address social determinants of health* and the alarmingly high maternal and infant mortality rates among Black, Indigenous and Alaska Natives continues to be an issue nationwide. For the U.S. to continuously see increasingly high maternal and infant death rates among these races compared to other countries is unacceptable! These rates are attributed to a lack of representation and implicit bias in medicine.

Martin: Having diverse representation of the many socioeconomic backgrounds, races, ethnicities, cultures, sexual orientations, religions and genders in medicine has many benefits — improving health outcomes, fostering a sense of belonging and community connection, increasing patient trust, and supporting a broader understanding of the challenges many populations face when accessing health care.

*Note: Social determinants of health are the nonmedical factors that shape a person’s overall health and wellness. They include the conditions in which people live, learn, work, play, age and more.

What barriers exist to improving diversity in medicine and retaining providers of color in the health care workforce — and what can we do about those barriers?

Flynn: I think bias plays a part in maintaining providers in the workplace, both conscious and unconscious. We need to be able to understand our own biases and teach others to do the same.

Martin: People in BIPOC* communities have historically faced increased challenges entering the health care field due to lack of educational opportunities and social support. These groups are disproportionately represented in health care professional education and training programs.

*Note: BIPOC stands for Black, Indigenous and people of color

Fortier:  Inequities are often perpetuated in medicine, which can reinforce mistrust and hesitancy in seeking and staying employed within the health care industry. This is why it is so important to be intentional in how we recruit, hire and retain employees — showing genuine support, with regard to professional development and economic stability, moving beyond celebrations and standing in solidarity alone, committing to action and being accountable to ourselves, employees, patients and community.

What is MultiCare doing specifically to improve diverse representation among its providers and employees — and what more could it be doing?

Raymond: We still have a lot of education to do about what unconscious bias is and how we can counteract it so that we are welcoming rather than just tolerating differences. That starts with acknowledging that you can’t grow up in society without being biased. The Belonging Advisory Council and chief belonging officer are working hard to build a pipeline of diverse professionals and create welcoming spaces for all, but we cannot do this work alone.

Mitchell: MultiCare’s Academy for Students in Healthcare (M.A.S.H. Camp) encourages, inspires and supports students considering nursing or other allied health professions. We have been intentional about ensuring students from diverse backgrounds have an opportunity to participate.

I would like to see M.A.S.H. Camp evolve into an actual pipeline program, where we can pay students as they learn about health care professions — offering paid internships, for example. If we as an organization could invest more in this program, it would be a win-win.

Fortier: MultiCare is developing a strategy to address workforce diversity and belonging. Some of the internal initiatives will include intentionally recruiting, hiring and retaining a diverse workforce, reflective of the communities we serve.

The intent is to foster and leverage relationships with community-based organizations that serve diverse populations, to initiate inclusive hiring practices, to increase support for BIPOC businesses, to establish spaces and networking opportunities for employees so they can build affinity, and to make informed decisions using data. Developing data standards can help us identify DEI-B barriers, measure progress and be accountable for promoting equitable practices and performance.