For Black people in America, obstacles exist that impede both quality equitable care and the diversity of those providing it. Biases can influence the care that health professionals provide, as well as the ability for people of color to pursue a career in medicine. Amid recent acts of reprehensible racism in the U.S. there’s been a renewed importance in discussing how race is represented in medicine and what health care professionals can do to help bridge the gaps.
At a recent ASTCT Town Hall conversation, three Black members of the ASTCT community shared their stories about growing up in America and how race affects their careers in medicine, and how systemic biases affect the patients they care for.
“You have to recognize that racial biases are here,” said UNC Medical Center Clinical Pharmacist, Maurice Alexander, PharmD, BCOP, CPP. “While they are hidden and often unconscious, they do arise from assumptions that are made about people of color that impact people of color.”
According to the Association of American Medical Colleges, only 5% of active physicians identify as Black. An even smaller portion of those go on to serve in roles related to hematology and oncology. Part of that is because of the small pipeline for young Black people to becoming physicians, and an even smaller pipeline into hematology and oncology.
Having a diverse medical staff that understands specific experiences based on race helps give care to a diversified set of patients more effectively. Rayne Rouce, MD, of Baylor College of Medicine and Texas Children’s Cancer and Hematology Centers, knows that all too well. Many Black patients comment on how they have never had a Black doctor before. Rarely did Rouce herself come across another Black person working in hematology-oncology with whom she could connect with on her experiences.
That is, until she met Melody Smith, MD, of Memorial Sloan Kettering Cancer Center, at the ASTCT Clinical Trials Training Course. They both found they had a similar family history, and felt their colleagues, no matter how well-meaning, didn’t have the same sense of how racial bias impacted medicine and society as a whole.
“The historical segregation, the historical racism in this country has not only shaped the way most African American’s view America today, but it also led Melody and I to embrace our history and move forward and never forget,” Rouce said.
Both Rouce and Smith had family members who were enslaved people. Both were involved in two historical massacres—Rouce’s family survived the Tulsa Race Massacre in 1921 and Smith’s family survived the Wilmington Massacre of 1898. Both experienced explicit and implicit racism throughout their lives.
“In my lifetime, I have tangible memories of racism,” Smith said. “What’s happened in the past few weeks in our country is not new for Black Americans. We’ve been hurting and dealing with racism for a very long time.”
The death of George Floyd—as well as the deaths of many black men and women—is bringing to light for many white people the impact of systemic racism in law enforcement. Alexander said these injustices should also spark conversations within the medical community about how overt racism and implicit bias impact recruiting, patient care and scientific studies. He said training on racial inequities and diversity and inclusion should begin in the classrooms of all medical disciplines, including medicine, pharmacy, nursing and dentistry, as well as be integrated into training programs.
“It’s important to understand that a big part of racial bias is social conditioning—behaviors, events, messages and opinions that surround us every day that ultimately begin to shape our own behaviors and opinions,” Alexander said. “When you understand that, it’s easier to understand that these conditioned or learned responses can be unlearned, but even better, prevented in the first place.”
Smith said it’s critical for organizations like ASTCT to step up and make tangible efforts to move the needle forward. White people within those groups need to be allies in facilitating change. Those in positions of leadership should push for stronger diversity and inclusion programs, identify areas where they can to make their Black colleagues feel seen and heard, and most importantly stand up to racist behaviors, actions and words.
“I think that’s a powerful thing,” Smith said. “When you see something or hear that someone is disparaging someone else because of their race, there is so much power in your voice. If someone who heard it says something—someone who doesn’t look like me and has more power or influence than me—that can make a difference.”
This won’t be a problem that goes away overnight. But if the medical community starts to make changes—even small ones—in how they address race both with their staff and their patients, it might lead to a long-term solution.
“I know that as we talk about the historical context of racism in America It might seem like we’ll never be able to fix this, but individually, professionally, as a society, we need to know we can address this,” Alexander said. “We need to develop plans of actions to incrementally rectify these current and historical injustices, and I think with time we will be able to do it.”
To view the full Town Hall recording, please visit the ASTCT Learning Center.