June 2021
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In March, the Editor-in-Chief of the Journal of the American Medical Association (JAMA) was placed on leave after a deputy editor's podcast downplayed structural racism in medicine and the journal tweeted ‘No physician is racist, so how can there be structural racism in healthcare?’ Since then the UK's Commission on Race and Ethnic Disparities’ report1 has been challenged, including by the Royal College of Psychiatrists,2 for stating there is no systemic racism in this country. The National Health Service has been noted to have ‘snowy white peaks’ at the top end of senior clinicians and management, and it is clear that we need to get our own houses in order. The key drivers lie in the availability of high-quality data that can be used to inform change; the opinion and discussion reflects the different approaches to the interpretation of that data. Writing in the New England Journal of Medicine, Rotenstein et al highlight the discrepancy between current US medical school entrant ethnicity data – 3.6% Black, 3.3% Hispanic or Latinx and 0.1% American Indian or Alaskan Native – against the broader population representation of 13.4% Black, 18.5% Hispanic or Latinx, and 1.3% American Indian or Alaskan Native.3 They note how women physicians account for just over half graduating classes, but 5.5% of full professors, and White medical students have been shown to hold biased views on, for example, race-based differences in pain perception that have an impact on their treatment recommendations. In addition to being contrary to prevailing principles of morality and equity of care, this is adversely having an impact on patient outcomes and workforce retention. Change is needed, and they propose a quality-improvement framework to address workforce diversity. The authors call for reporting of disaggregated data on workforce diversity and experience to management boards, with an explicit aim of pursuing diversity as a common shared goal across the entire workforce. Examples include looking at existing staff diversity, the number of minority and women candidates interviewed for each position, especially in more senior roles, promotion and retention data, pay equity and job satisfaction. Areas of notable difference or failure to change will need specific attention and drive. It also needs dedicated space for organisations to publish their data publicly (of note, we have recently published author gender differences in accepted manuscripts in the BJPsych).4