Diversifying the clinician workforce

There’s a growing awareness that we need to model the diversity of clinicians on the diversity of the United States population. This mirroring could alleviate some aspects of the devastating and growing healthcare disparities that plague our country. At the moment, though we have numerical parity in medical school matriculants of binary genders, numerical parity with respect to other diverse identities including race, ethnicity, sexual orientation, and disability,  remains elusive. The reasons are multifactorial, but the medical profession itself plays an insidious role in this diversity stagnation because it clings to and endorses the status quo. Perhaps because it benefits from this or because inertia is a human default position, leaders in medicine have put forth little meaningful effort, significant resources, or sustainable support to ensuring that people who present as “other” are treated equitably. Yet, as research in gender studies teaches, numerical parity doesn’t translate to equity. We have a number problem with respect to other diverse identities, and yet fixing the numbers may not entirely cure what ails us.

Mitigating the attrition trend
Clinicians who identify or present as something other than white and male carry an increased risk of experiencing harassment, discrimination, and retaliation. Sometimes, these clinicians are scapegoated for upholding ethical principles that benefit patients, like raising issues of quality and safety in medical care or choosing to be an upstander when witnessing an injustice. Though professionalism requires that course, those who are not white males may find themselves at risk of retaliation. Entrenched power doesn’t appreciate disruption of its hierarchy.

The irony is rich: The clinicians who advocate for optimal patient care and bring diversity to the workforce are the very same clinicians who are subjected to harms that lead either to those individuals being pushed out of or leaving the workforce. And then the healthcare system is rendered worse. But some who have power within the system would rather support an injustice than a clinician who brings the injustice to light. That’s a frightening reality, and any workplace in which that paradigm exists must be criticized for its priorities and values.

Medicine should be roundly criticized, perhaps more than other professions, because it’s charged with preserving and optimizing the health of the public. When the “do no harm” profession is guilty of inflicting and perpetuating harms against its diverse constituency to hide its own failings, something is deeply and profoundly wrong. Deliberative and intentional treatment is urgently needed.

Meanwhile, highly educated, ethical, committed, and talented clinicians are being unceremoniously ousted from the profession, many of whom have worked exceptionally hard over decades to attain their skills and achievements in the face of obstacles that the white patriarchy never encountered. Ultimately, many ethical physicians who happen to be women or underrepresented minorities—or both—learn that it’s unsafe to stand up for ethics and/or competence in patient care when retaliation is the risk. That truth marginalizes excellent clinicians, excising them instead of the people that perpetuate harm, because the structure of leadership in medicine has failed. To date, much of medicine’s leadership has been complacent or incompetent on this front, and nothing will change until those people, the ones in power, decide that it’s finally time to be upstanders.

Physician Just Equity
Physician Just Equity (PJE) is a 501(c)3 nonprofit that was founded to support clinicians who are experiencing harassment, discrimination, and retaliation in their workplace due to upholding their professional ethical duty to honor patient rights, advocate for quality and best practices, and/or upstand when witnessing an injustice. Currently, designated institutional offices such as Human Resources (HR), Title IX, and DEI often lack safe reporting processes, oversight to ensure due process, unbiased and transparent investigations, and accountability to just outcomes. These institutional offices have a history of preferentially protecting the institution rather than the reporter, thereby working against the interests and the safety of clinicians and patients.

For patients to stay safe the clinician workforce must feel safe. Clinicians need to be at liberty to express concerns about safety, best practices, quality, equity, and injustices without the fear of retaliation that leads to isolation, loss of one’s professional reputation, job loss, and ultimately loss of a beloved and hard-earned career.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.