Editor’s note: The following interviews were conducted and edited by AAMCNews Managing Editor Gabrielle Redford, Senior Staff Writer Stacy Weiner, Staff Writer Patrick Boyle, and Staff Writer Bridget Balch.
The killings of George Floyd, Breonna Taylor, and Ahmaud Arbery in recent weeks have exposed deep wounds inflicted by the nation’s long legacy of racism. They have also triggered protests across the country against police brutality and long-standing policies and attitudes that have marginalized Black and other communities of color.
The AAMC invited 13 leaders and learners in academic medicine to share their thoughts on the events of the past week, the complicity of medicine in perpetuating inequities, and the role of students, physicians, and academic medical institutions in helping to heal the nation. The conversations have been condensed for space.
Black men, police brutality
M. Roy Wilson, MD
President of Wayne State University; member of the Michigan Coronavirus Task Force on Racial Disparities; former chair of the AAMC Board of Directors
Here's an astonishing statistic. A Black man today has a 1 in 1,000 chance of being killed by law enforcement. That’s 10,000 out of 10 million. The reason I use 10 million is that's the population of Michigan. Michigan had a little over 5,000 deaths from COVID-19, and it has been one of the hardest hit states during the pandemic. But that's still only half the number of Black boys who will die if nothing is done to address this issue of police brutality against Black men.
To be honest, as a young man, I probably had a bit of a chip on my shoulder, and any Black man my age has had numerous encounters with law enforcement. So, the fact that I'm here now, I feel like I'm a survivor, because these encounters definitely could have gone in a different direction.
[At Wayne State], we just created a National De-escalation Training Center for law enforcement. When the Dallas Police Department, for example, did de-escalation training, they had an 18% decrease in excessive use of force in one year and an 80% decrease over seven years, so that’s hugely positive.
I've been looking at these pictures of these protests, and in some cities, there are more White people protesting than Black. This hit a nerve with all kinds of people. They are out there saying they don't want this kind of “justice” anymore, they really want to see a change in this country. That gives me a lot of hope.
Addressing perceptions of human value
Selwyn Vickers, MD
Senior vice president for medicine and dean of the University of Alabama School of Medicine
In Alabama, we uniquely face this moment, feeling that although there have been some areas of progress, there are also glaring and persistent inequities and perceptions of value. The most seminal document highlighting these inequities was Dr. Martin Luther King’s “Letter from a Birmingham Jail” because of its message that peaceful protest is essential to change and that the change must come from all elements of our society.
Having [this latest incidence of police brutality] occur in Minneapolis in 2020 magnifies that this is not a Southern problem, a Western problem, a Northern problem, or an Eastern problem. It’s an American problem. The attitude that perpetuates the lethality that we see connected with people of color by those who are sworn to protect them is very much connected to the reality that our society values one race over another.
That is paramount for us to understand as we try to move our country to a sense of healing and honest reconciliation.
I think academic medicine needs to recommit to the idea that when every part of our society is operating at its highest capacity, this is good for everybody. It lifts the bucket and the boat for the majority and the minority. First, we have to be highly intentional. When we have problems that have been inherently created by racial bias, we try to solve them in a color-blind fashion. The fact is, this is a huge misnomer. The reason we’re in this position is because people have not been color blind. If we’re going to move forward, there has to be reaction and counteraction. We have to be comfortable and committed to being intentional.
Then we have to listen. We have to be willing, whether we are White or Black, to try to understand the full pain that people who are vulnerable are experiencing. As we do that, we have a better chance at understanding and overcoming our biases and prejudices.
Understanding our history of racism
Christle Nwora, MD
Resident at Johns Hopkins Medicine; member of the class of 2020 at McGovern Medical School at the University of Texas Health Science Center at Houston; past chair of the AAMC Organization of Student Representatives
I don't speak for my school, but I would like medical students, and residents as well, to be taught that racism was central to the creation of this country and that it has long-lasting generational effects. Although we may not feel like we are responsible for the ills of the past, there are problems in the present that are our responsibility to address.
I shouldn’t learn about asthma without learning about Black children who have higher rates of asthma due to where they live and that where they live is a result of redlining. This is all connected — which can be overwhelming — but it gives us space to think about the different ways that we can have an impact in our communities.
We need to think about whether students and faculty are able to speak up about racism. Do we create space for these kinds of conversations? We need to recognize that none of us knows all the answers, that we need to not have a fixed mindset when thinking about racism in medicine, that there's always more to learn about anti-racism.
What’s going on now is heartbreaking. It's frustrating. I feel this fatigue, this heaviness, that this just keeps happening. I remember Tamir Rice being shot [in Cleveland], I remember so many other instances, and each time this happens I think, “Okay, this is the moment when people actually will take this seriously.”
[I get hope] talking to first-year medical students at my school. I see their energy and their recognition that things cannot stay the way they've been and that medicine is capable of doing much more. So, as long as we have students like this who will continue to keep our feet to the fire, then I believe medicine can make progress.
The role of physicians in addressing inequities
Dowin Boatright, MD
Assistant professor of emergency medicine at Yale School of Medicine
I’ve been thinking about how we, as physicians, have allowed this to go on for so long and how we’ve managed to become so sophisticated in the way we’re able to treat an individual as a person, but we’ve been relatively ineffective in bringing about societal change, especially in terms of structural inequities.
I think there needs to be more of an emphasis among medical schools training and educating a cohort of future physicians who are change agents and do want to address social justice.
Every year, I feel like I see a new paper that documents the disparities in pay, disparities in promotion — I recently published a piece that looked at the experience of discrimination among medical students, and over 20% of medical students of color, women, and sexual gender minorities all reported experiencing at least one instance of discrimination while in medical school.
As we begin addressing more the social determinants of health, I’d like to see more medical schools make it a part of their mission, and correlated to that part of their mission, more emphasis in their educational curricula on how we can actually start to address these social injustices as physicians, so not only would we be experts in treating disease, but we can actually start treating illness in society overall.
Now, with COVID, many hospitals and medical schools are losing money, and my fear is that the budgets for these diversity initiatives are going to be the first things cut.
And I think the murder of George Floyd brings back into focus the importance of diversity, equity, and inclusion and, hopefully, can be a reminder to leaders in academic medicine that these issues of bias and discrimination and so forth are not luxuries we can address at our leisure, but are necessities that we need to be looking at right now.
Supporting our learners
David Kountz, MD, MBA
Associate dean of diversity and equity at Hackensack-Meridian School of Medicine at Seton Hall University; vice president of academic diversity and co-chief academic officer at Hackensack Meridian Health
I‘m worried about our African American residents and fellows — making sure we’re reaching out to them, giving them an opportunity to talk about their feelings and concerns. There is a greater risk for African Americans to develop maladaptive behaviors to this kind of stress than other members of the population. What can we do to create an environment for African American residents to feel that they’re not alone, and that it's understandable to feel depressed, angry? They might need to take a little time away from patient care to reflect on current events.
Traditionally, medicine is a field where physicians in training were encouraged to be stoic and not necessarily share their feelings. We are looking to create more venues to support a culture which encourages this type of sharing and promote more conversations.
Many residents are angry. Others may feel angry but may feel that it is not appropriate to express it. My job, and others’ in leadership, is to listen and give them safe spaces to express their emotions.
Wayne Frederick, MD, MBA
Surgeon and president of Howard University
Many of our students were born right after 9/11 and they’ve grown up in an America that has seen significant changes. They’ve seen a Black President. They’ve seen our country go to war. And they’ve seen a war taking place in their local society because of police brutality and the color of their skin.
Right now, they’re experiencing a mixture of emotions, everything from anger to frustration to disappointment. Equally as important, we’re also hearing from students about hope and their willingness to be part of the solution. They want to get involved.
[At Howard University], we talk about disparities all the time. The pandemic has really been shining a light on those disparities in terms of the types of diseases that affect African Americans. I lived those disparities today. This morning, I operated on a man with esophageal cancer. All of the factors that made him more at risk for that disease were there — the diet he’s been exposed to and the environment he’s been exposed to. And then this afternoon, we opened a COVID-19 testing site at the Pennsylvania Avenue Baptist Church in Southeast D.C. In D.C., 46% of the population is Black, but 77% of the COVID deaths so far have been in the Black community.
Without a doubt, there is a risk [of the virus spreading] with the protests and that many people. I’m pleased to see people with masks but it’s not easy to social distance while you’re protesting. That’s the reality. Having said that, people are weighing what’s most important. They want to get their message out.
Reframing the narrative
LaShyra “Lash” Nolen
Rising second-year medical student and Student Council president at Harvard Medical School
One of the biggest challenges of this time as a medical student is that we are not on campus. Usually when something like this happens, we come together as a community and have a dinner and give each other a warm embrace. That lack of human connection is missing, since we’re all in quarantine.
We were already dealing with disparities exposed by COVID-19, and now we are also coping with the murder of George Floyd and so many others. I am still taking classes and it wasn’t until recently that professors really started discussing what’s happening in our society. It’s easier to just focus on the medicine. I’m glad we’re finally having the tough conversations, but it shouldn’t take a week of protests across the country for our humanity to be recognized. That’s why these past few weeks have been really isolating and lonely for me as a Black woman.
It’s so important to have Black faculty members. We need to have professors who can relate to our lived experiences. Until then, we must have anti-racism training in medical education. Then hopefully professors will become privy to the fact that these things are happening in our society and they can reach out to students and make sure they validate their experiences.
But I’m hopeful. For the first time, we’re talking about racism. Before, it’s been unconscious bias. It’s been diversity and inclusion. We’ve really been tiptoeing around the real issue of structural racism. I’m most hopeful that the AAMC and some of the other major health organizations have come out and said that police brutality is a national public health crisis. We can no longer pretend that this is not our lane. If we start to change the way we frame these issues, then maybe the next generation of healers will have the power to shift the narrative.
Following talk with action
Rising third-year medical student at University of Washington School of Medicine
I feel like I’ve been failed by my educators, my colleagues, the school administration. We’re having a town hall meeting, where the onus is placed on Black people to speak about their experiences, to tell the administration what they want to have done — when these issues have been brought up for years. It almost seems performative. You get a room of predominantly non-Black people, the Black people get to be emotional and upset, and everyone gets to pat themselves on the back and say, “We hear you.” It almost feels like we have to put out our trauma and have it validated.
Town halls are a good way to have a discussion, but if they’re not met with action then I don’t see the purpose. You’ve said all these things. You cried. People said they listened. But there are no next steps.
The people who are most affected — our voices aren’t the ones at the table in those meetings where changes are made. To make medical institutions less racist toward Black people, there needs to be more Black people at the table to contribute to drafting policies.
I’ve shared so many of my own experiences with racism, I feel like I’ve kind of exhausted that capacity. The message we get is, “We’re impressed by your resilience, impressed by your grit.” Instead of lauding us for our resilience and grit, why don’t you make changes so we don’t have to develop those skills more than other people just to survive?
Oluwaferanmi Okanlami, MD
Assistant professor of family medicine and physical medicine & rehabilitation at the University of Michigan Medical School; director of adaptive sports at the Michigan Center for Human Athletic Medicine and Performance
Meaningful change requires a mutual understanding of what the problem is in the first place.
We’ll have these meetings. We’ll have these conversations. Every institution in the country — every academic medical center in the country — is having town halls and panels and discussions, which is great, but there are many people that are very tired of having the same conversation without seeing any meaningful action. And that action is going to require some accountability by every individual. Every single individual needs to see that this is something that impacts them.
I do think that, within academic medical systems, there will be those that are hesitant to want to take on a new social justice angle. They’re not going to want to talk about police brutality or racism. They’re going to say, “These are big things. This is not my responsibility. I didn’t go into medicine to be a social justice warrior; I just want to take care of people.”
That is something that we can then address and say, “If you want to take care of people, we must first acknowledge that certain people are not valued in the same way. We also don’t see them in the same numbers in our ranks. If you look at academic medical systems, these individuals are not represented in adequate numbers. So why don’t we make a better attempt at supporting them from early on in the pipeline? From elementary school, high school, college, medical school, residency — create programs that actually have a longitudinal ability to support people.” And in order to do so, we need to put our money where our mouth is.
We need to acknowledge that this is not new and connect it to every other underrepresented and marginalized group. For example, women are also not seen in adequate numbers in leadership in academic medicine and face their own barriers and mistreatment. That is also important, so I don’t want us to just focus on Black people today and forget about women tomorrow. While we must absolutely call out the racism that exists and has existed, with a focus on the immediacy of addressing its impacts on Black Americans, this is also an opportunity to support all other marginalized groups. I’m from Nigeria and have a funny first and last name. People get discriminated against because their hair looks funny, people think their food smells bad, or their accent sounds different — these are things that are created because the system we’re in allows it … this isn’t about this one group alone. This is about the systems of power and privilege that allowed this to occur, and we will need to get to the people in positions of power and ask them, “What are you going to do?”
Investing in health care, divesting from law enforcement
Carl Suddler, PhD
Assistant professor in the Department of History at Emory University; author of Presumed Criminal: Black Youth and the Justice System in Postwar New York
If anyone ever thought inadequate health care in the Black community needed to be unveiled, the COVID-19 pandemic has done that. We find ourselves addressing police brutality and inadequate health care at the same time.
For years, Black communities have called for defunding or divesting [from] police and utilizing those resources elsewhere: in education, employment, health care. Many are seeing in a new light how underserved, medically, these communities have been, while continuing to see the dramatic response of police and military, whose resources seem to be abundant. Some organizers have taken to juxtaposing pictures of doctors in hospitals in trash bags [as personal protective equipment], and police officers, even in small towns and cities, in riot gear. They’re having conversations around protective equipment — what that means in the hospital versus what that means in these uprisings.
Two of the big moments have been the University of Minnesota president issuing a statement that they’re going to severe ties with the police department and the school board voting that public schools are also severing ties with the police department. This is the type of divestment it’s going to take to begin to make a change.
Moving forward from atrocity
Jeffrey Druck, MD
President of the Academy for Diversity and Inclusion in Emergency Medicine; professor of emergency medicine at the University of Colorado School of Medicine
My 10-year-old watched a portion of the video of George Floyd and said, “Why would someone do that?” I couldn’t answer him.
I am so sad that I live in a world where something like this happens. Why would anyone do this? How can we talk about equity when blatant racism plays out on the national stage on a daily basis? How could anyone say to someone who is Black, “You should trust the authorities”? I don’t. How can anyone? I know it is impossible to paint things with a broad brush. Most cops are wonderful people.
Then I think of all the wonderful things I have seen in the past few weeks: Students reaching out to both support and congratulate each other; faculty willing to go not only the extra mile, but the extra marathon, to help students; people in the grocery store waiting for each other, respecting personal space; and the feeling of, “We are all in this together.”
So, after crying for George Floyd, and the now innumerable number of people unfairly treated due to their skin color, and wondering how we move forward from yet another atrocity, I am positive of one thing: We can get there. It will be a long road, and that road starts with recognition of our biases and trying to work against them. There will be ups and downs, but I know the trajectory will be in the right direction.
Taking care of patients as a form of social justice
Andre Churchwell, MD
Chief diversity officer for Vanderbilt University Medical Center; senior associate dean for diversity affairs and professor of medicine at Vanderbilt University School of Medicine
There's a whole body of literature about the effects of chronic stress, which leads to cloudy thinking and cardiac issues and other medical problems. Racism is a driving catalyst in stress. Then there’s a lethal brew of social determinants of health in low-income neighborhoods such as unfortunate housing circumstances, a lack of fruits and vegetables, and a lack of safe places to play. These all also influence your ability to have an education that could allow you to springboard yourself out of these circumstances.
Trainees and faculty from underrepresented backgrounds may feel like they aren't doing as much as they should because they're not out holding signs all the time. I try to make the case that taking care of everybody that comes through the hospital’s door, poor or marginalized or otherwise, is social justice. If you do research to understand health disparities, that's another form of social justice. Teaching about and advocating for evidence-based policies and practices to take care of marginalized patients is doing social justice.
With the pandemic and the untoward violence against Mr. George Floyd and others, it feels like one thing on top of another. Now you have clusters of people protesting instead of practicing social distancing. I worry we're going to see spikes in COVID-19 and, unfortunately, more deaths in the marginalized populations that are often doing the marching.
Creating a safe environment for patients and staff
President of Barnes-Jewish Hospital and group president of BJC HealthCare; board member of the AAMC Council of Teaching Hospitals and Health Systems
As we watched the events unfold in Ferguson, Missouri, following the death of Michael Brown in 2014, leaders at Barnes-Jewish and our academic partner, Washington University School of Medicine in St. Louis, recognized the need to take a new approach to understand the underlying racial and social issues affecting St. Louis.
We looked beyond the walls of our hospital to engage community partners. We hosted listening sessions to hear firsthand about generational mistrust for health care institutions. This led to new insights about social determinants of health and the resulting disparities in life expectancy that are based on nothing more than your zip code.
We also looked inward, knowing our staff live in the same neighborhoods upended by the civil unrest. Nearly all of our leaders have completed unconscious bias training, as well as half of our employees. We also organized community health tours for all of our leaders to see how institutionalized racism shaped neighborhoods, and why that continues to have an impact today.
Institutions can lead change, but only if it is a true priority. Academic medical centers benefit from resources that can help us focus on the underlying conditions of poverty, inequality, and health disparities, which include working with the schools of public health and social work. We have bedside programs to break the cycle of gun violence and provide trauma-informed care. And we leverage our legislative relationships to advocate for the underserved through policy, as we are doing to support Medicaid expansion in Missouri.
Change comes when you truly embrace your organization’s values. For us, it means caring with compassion, listening with respect, and working together to create a physically and emotionally safe environment for our patients, families, and staff.