Prioritizing Equity video series: Examining physician gender inequity in medicine

This Oct. 2, 2023 edition of the Prioritizing Equity series follows recent policy adopted at the AMA’s House of Delegates meeting in June 2022 as panelists will discuss gender equity in medicine and how COVID-19 has exacerbated experiences for people identifying as women. The episode will also explore both historical and present inequities in medical education, employment and leadership opportunities.

• Deena Shin McRae, MD, associate vice president, Academic Health Sciences, University of California; faculty member, Psychiatry, UC Irvine School of Medicine
• Tania Jenkins, PhD, assistant professor, Sociology, University of North Carolina
• Jasmine Brown, medical student, University of Pennsylvania; Rhodes Scholar and author of Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century

• Aletha Maybank, MD, MPH, chief health equity officer, American Medical Association

Dr. Maybank: Hi everyone. Welcome to our new and next episode of Prioritizing Equity. I am Dr. Aletha Maybank, chief health equity officer and senior vice president for the American Medical Association, and I oversee the Center for Health Equity. And it’s such a pleasure to be here again to host this particular episode on gender equity in medicine.

In 2014, about 1,066 physicians who were recipients of career development awards found that 66% of women and about 10% of men perceived there was personal gender bias, oppression, discrimination—and it demonstrates the substantial impacts that are existing for women. And so, addressing gender inequity in medicine is absolutely crucial as we strive for health equity in professional health care settings. Health care is not anywhere different than any other setting.

And recently and over the years, AMA has had some various policies that relate to gender equity. And in June of 2022 at our Annual Meeting, our House of Delegates, which is a representation of delegates from across the country, adopted policy that actually directs our organization to advocate for research on physician-specific data, analyzing changes in work patterns and employment outcomes among women physicians during, but not limited to, the COVID-19 pandemic.

So as 2022, I mean, we’re still in the pandemic in many ways, but we were very much in the heart of it at that time. So, there was a lot of unearthing of inequities and gaps that exist as it was across the board in many places in which inequities were being exposed. And it also calls for us as AMA to collaborate with organizations to really remove obstacles affecting women physicians and medical students.

And so, today’s panel, we’re going to speak to this policy and discuss with leaders in the field from just their professional leadership, but also their personal experience of what gender inequity in medicine is like and how it was exacerbated by COVID-19, the experiences, but also witnessing challenges with human rights, the disruptions of both reproductive rights and pregnancy care, transgender women rights. We’ll examine some of the historical and present inequities in medical education, employment and leadership opportunities. And then we will cover some policies and system changes that are really needed to address the issues that women have and have faced often in medicine.

So, joining me today are Dr. Tania Jenkins, who is an assistant professor in the department of sociology at the University of North Carolina, Chapel Hill, and a faculty research fellow at UNC’s Cecil Sheps Center for Health Services Research. Welcome, Dr. Jenkins. We next have Jasmine Brown, who is a fourth-year med student at the University of Pennsylvania, a Rhodes Scholar and the author of Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century. Awesome to be in sharing space with you, Jasmine. I’ve been following you.

And Dr. Deena Shin McRae is associate vice president of academic health sciences for the University of California and serves as a faculty member in the department of psychiatry at UC Irvine School of Medicine. Excuse me for miswording. Thank you all for being here. Very honored to be in conversation with all of you. You have fantastic leadership and work that you all have been doing over years, really.

So, I have a question for you all just to kind of open up. I usually like to kind of get a sense of where you’re at, not so much in a physical sense—you can say that—but just kind of how you’re doing as well. But can you connect that to how gender inequity is showing up for you and other health professionals and physicians today in medicine? And I’m going to start with Dr. McRae.

Dr. McRae: Sure. Thank you very much, Dr. Maybank. So, the vast majority of the work that I do in my role at the University of California is working on advancing equity and optimizing our community’s access to opportunities, to education and research and clinical care, as well as ensuring equity and inclusive excellence for our diverse UC training staff and faculty.

We have 20 health professional schools spread across seven campuses. And as we all know, although the public health emergency and pandemic had been declared to be over, the challenges continue. Staff shortages, a political environment that has been tumultuous and impacting our everyday experiences, both in and out of the hospitals and clinics. So, I just thought it’d be helpful to share some data that illustrate the gender disparities that exist in academic medicine.

Although 51% of our medical school graduates identify as female, in California, when you look at the percentage of females with active medical licenses, it drops down to 38%. And when you look across the nation in academic medicine, again, you see 51% of graduates identifying as female, then it drops to 47% in residency, then it goes down to 38% when you’re looking at full-time faculty, and then drops down to 25% as full professors.

And then when you look across the schools and who are in leadership positions, it still remains low, with department chairs and deans being about 18%. And then when you look at the number of women faculty of color over the past decade, it’s only grown by one percentage point. So, this is the landscape that we still are in and looking at, and there still remains a lot of work to do.

Dr. Maybank: Thanks for that. I appreciate that, Dr. McRae, to provide the data. Dr. Jenkins?

Dr. Jenkins: Yeah. So, you asked us how we’re doing, and I would speak as not a physician, but as a professional and as a relatively new mom. I became a mom during the pandemic. I’m exhausted, and it’s certainly a feeling that I’m seeing resonate in clinical spaces. I was collecting data in the field, spending time observing physicians during the pandemic, and what I noticed was that both—two things were happening simultaneously and have, to some extent, continued since COVID.

There’s been an intensification of work norms, intensification of work demands that have been placed on physicians, alongside a simultaneous intensification of expectations and demands on mothers in particular. And so, what I am observing is really just this sense of female physicians feeling like they can’t be good physicians because they can’t give their everything to medicine, and they can’t be good moms because they’re being torn and taken away from being able to give everything to their children. And so, there’s been this intensification. And I think physicians, at least the ones that I’m observing, are exhausted.

Dr. Maybank: I appreciate that. And I recognize the experience of moms, but they’re also the folks who also are caretakers for parents, because that’s what I have experienced during this time as well, and the pressure of just being pulled in so many different ways and trying to figure out how to make it all happen. It’s not easy, right?

Dr. Jenkins: Absolutely.

Dr. Maybank: Yeah. Jasmine?

Brown: Hi, everyone. So, where I’m at right now, I’m actually studying for Step 2, but in generally looking ahead to residency and beyond and working as an advocate along the way. In terms of gender inequity, one of the major things that I’ve seen thus far is wage disparities. I’ve been told an anecdotal story from a mentor of mine, who is a white female physician, and she said that when she was working at a VA hospital in the West Coast, some of the female physicians actually decided to look at the patrons in the hospital, which was only possible because the VA is a government organization—thus was required to make their employees’ wages publicly accessible.

And what they saw was that there was a significant wage gap among the female physicians as compared to the male physicians. They raised this to the hospital administrators, and thankfully they actually tried to remediate it by raising those female physicians’ wage gaps. But this issue raised a few questions for me personally. One, why is the disparity there in the first place? And two, how can similar wage gap issues be addressed at other academic institutions that don’t publish their employees’ wage gaps publicly?

And to look at the issue more broadly, in 2018, there was a study in the Annals of Internal Medicine that found that the mean starting salary for newly graduated male residents was nearly $17,000 higher than the starting salary for newly graduated female residents. And then other research that was conducted at Harvard Medical School and USC’s Schaeffer Center for Health Policy and Economics published a study in The BMJ that showed that physician income disparities, considering both race and gender, and they found that the median annual income for white male physicians was actually $100,000 more than the median annual income for Black female physicians.

Learning these disparities are really startling for me, and something that I would like as a trainee is advice on how to tackle this issue as a future Black female physician to make sure that I’m paid equitably as well as other physicians that are women or people of color.

Dr. Maybank: So, thank you.

Dr. McRae: If I can add to that, Jasmine—

Dr. Maybank: Oh, please do.

Dr. McRae: I’m really glad that you brought this up. A couple of things I want to point out: One, when you brought up the example at the VA, I think that is a good example of how it’s important to have transparency and accountability, and so that way people will respond. And in terms of the pay disparity, people often just assume that women are choosing family over their careers, but often there isn’t a choice. They may be trying to address childcare issues, or when there are two parents who are working, then you have to make a choice about who stays home, who works and then the pay gap may be the deciding factor.

And I’m glad that you brought up the data in terms of male physicians are found to be paid $110,000 more, even when controlling for specialty, location and years of experience, and this is data from 2022. And to your point also, AAMC has an annual Faculty Salary Survey—and yes—gender was the primary factor for driving pay inequities, but Black, Indigenous and people of color faculty also experienced substantial compensation inequities. So, it goes back to transparency and accountability.

Dr. Maybank: Thanks so much for that addition, Dr. McRae. I really appreciate that. And it’s going to lead me in two directions, because you start to bring up … And actually, Jasmine asked the question of, why is it like this? And the why is sometimes really hard for people to talk about, honestly, and that’s the area people like to dance around.

And so, Dr. Jenkins, you have a book out, Doctors’ Orders: The Making of Status Hierarchies in an Elite Profession, and you examine the formation of probably formal and informal status hierarchies, looked at gendered lenses. Can you speak to kind of really the patriarchal origins of where this has come from in medicine?

Dr. Jenkins: Yeah.

Dr. Maybank: Medicine is so steeped in that. It’s really hard to almost separate.

Dr. Jenkins: Medicine is a profession that, you’re absolutely right, has been so deeply molded on a male ideal. So, lots has changed in the last 100 years. Things like duty hours, et cetera, have been introduced. But in other ways, the profession and particularly residency training remains, as I mentioned, firmly molded around this male ideal. And so, it was in, I believe, 1889 that Johns Hopkins University created the first modern residency program.

And that was where a group of highly selected white, wealthy, unmarried men were chosen by hospital leaders, like William Osler and William Halsted. Those were the first chiefs of medicine and surgery, respectively, to come learn and live in the hospital. Right? That’s where the term residence comes from. It’s also worth noting that around the same time, perhaps in the same 20-year period, the Flexner Report had a huge influence on making the profession even more white and male than it was previously at that time.

So back to residency, thinking about what the ideal resident was back at Johns Hopkins, this unmarried, male resident. So first, the ideal resident is untethered. The residents were explicitly discouraged from marrying and bearing children. In fact, it was a stated expectation by Osler and others that they were expected to neglect their families and other obligations for the sake of patient care. Residency also didn’t have a fixed duration. And so, these male residents were expected to just stay as long as it took for them to be deemed fully trained in a particular area.

A second characteristic of the ideal male resident back in the Johns Hopkins era was that he was exceptional insofar as he was expected to be invulnerable to human needs, things like rest, things like needing to eat and drink adequate amounts of fluid. And there’s a lot of beautiful historical writing about how that norm is probably undoubtedly fueled by the first chief of surgery, William Halsted’s notorious cocaine addiction. But I want to point out that this was the expectation, that these male residents were to really always put the patient first and to put their needs aside.

And finally, the third ideal trait, if you will, of the early resident was someone who was imperturbable. That is the precise term that was used by William Osler in a graduation address. It’s now well-known in 1889 at none other than UPenn, where he calls for the importance of equanimity. It’s his Aequanimitas address. And what imperturbability really translates into is stoicism, that physicians, no matter what they’re feeling on the inside, remain impassive on the outside. Stoicism is a trait that’s highly associated with masculinity.

So, this was how the original, ideal resident was formulated. Importantly about the Johns Hopkins model, it was developed as a model of residency with the expressed purpose of being exported, of teaching the teachers so that they could go on and create residency programs that were very similar to the Johns Hopkins model across the country, and they were quite successful at doing that.

And so, in my research, and I’ve been collecting interviews with residents, medical students, attending physicians, as well as observing them in their clinical practice, what I’ve observed is that those expectations of the ideal resident have not changed that significantly since the early days of Johns Hopkins. The ideal resident remains untethered.

And what I mean by that is that it wasn’t until last year, 2022, that the ACGME mandated six paid weeks of parental leave, which is notably, I want to point out, six paid weeks is half of what the American Academy of Pediatrics recommends for all parents. Their recommendation is that parents get 12 weeks of paid leave. The ACGME only requires six paid weeks of leave. And again, that was only formalized in 2022.

And in addition to those formal regulations, many, many women that I’ve spoken with feel that they have to continue to work just as hard during pregnancy and afterwards as they would at any other time. And so, they’re still fighting for accommodations—and they fight against this current—which is a culture that views working less hard, taking rest, getting accommodations in this way as weakness. Right? It’s molded against this highly male ideal.

Dr. Maybank: Absolutely. And then I want to bring in another question, because I think it’s fascinating—first of all—the historical context and thank you for that. And we’re going to come back to policies and kind of where we need to go, but I want to highlight two things. As you were talking, AMA is going through and has launched a truth, racial healing, transformation and reconciliation process.

And we’ve been looking a lot at Flexner. We’ve already issued kind of our acknowledgement of the harm that Flexner caused because of the shutting down of the five of the seven Black med schools, all of the women med schools at that time, and then just really investigating and going through our archives and history. So this is actually really helpful, I think, for us as the AMA as we move forward in this process.

I want to speak to also the context of the intersections that exist, the realities of… The experience of all women is not the same. So as I mentioned, the three women’s schools were shut down. However, white women still have been able to have a certain level of equity in med school presence with white men, where Black women, Indigenous women, as well as Latina women have not had that same parity exist or happen.

And so, Jasmine, I shift to you. You have a book and a work, Twice as Hard: Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century. Can you tell us some of the stories just that … And it may be one story, because we don’t have too much time. But this has now sparked something that I think we need to have a larger conversation, a longer conversation, so I appreciate you all. But can you speak a little bit to that and what you learned and some parallels?

Brown: Yeah. I was really happy when you mentioned the Flexner Report because that was one of the huge policies that I found in my research that shifted or impaired progress and representation within medicine. So, speaking back to when women were first entering medicine in the U.S. in the 19th century, initially women were not allowed to enter medical school or become a physician. And the best that they could do was dress as men and then attend the classes, but they couldn’t graduate. The first woman to change that was Elizabeth Blackwell, a white woman who graduated from medical school at Geneva Medical College in New York in 1849.

And at that time, she was actually admitted. The dean didn’t want to admit her, but he had a relationship with one of her mentors. So, he told the men at the school, “You can vote to decide if she can come here,” which is very funny to me as a medical student trying to imagine, “Do I really have the credentials to decide if somebody else is capable to be a good physician? I’m not even done with my training yet.”

But they admitted her as a joke. They thought it was hilarious that a woman would think that she could become a physician. But afterwards, female medical colleges started to open, and that changed the landscape for white women and women of color. The first Black female physician to train in the U.S. was Dr. Rebecca Crumpler in 1864, and she actually went to the New England Female Medical College.

And in 1900, there were 160 Black female physicians, 3,500 white female physicians, and this is compared to 1,600 Black male physicians and 88,000 white male physicians. But after the Flexner Report and the closing of those female medical colleges and so many of the Black medical colleges, the number of Black women entering the field dropped by more than half. By that point, it was only 65. And then the number of Black physicians as a whole tapered off. The percentage of Black physicians entering medicine from 1910 compared to 2006, almost 100 years later, was approximately the same.

And so then, you think about that bottleneck where the white women, they started entering the predominantly male medical schools more, but then that limited how many Black women could enter the field. Yeah. There’s definitely a lot that I could go into with that. But the intersectionality of when one barrier is added, what extra steps do you need to do to be able to surmount it? And if you have intersecting identities, that path becomes harder.

Dr. Maybank: Thank you for that. And that’s the true kind of definition that Kimberlé Crenshaw in terms of intersectionality, the layers of oppression that exist based on the identity that you have, and really looking at the context of racism and the intersection of gender and the experience of Black women. The intersectionality tends to get kind of co-opted and used for many different things, or at least the history and the origin is not used. So, I thank you for kind of demonstrating the roots of that.

So, for all of you, how has COVID-19, the pandemic, worsened existing gender inequities and the working and learning conditions for both physicians, trainees, clinicians who identify as women? And especially looking at maybe the compensation and workload, and then a little bit on people of color as well. So, Dr. McRae, I’ll start with you first in terms of how has it worsened during the pandemic, the inequity.

Dr. McRae: Sure. Thank you. I think that with the pandemic, the caretaking tax was magnified. And what I mean by the caretaking tax, it’s that women physicians often have the expectation, both at home and in the workplace, to be more of the caretaker. So, at home, they may be the primary caretaker of someone with an illness or disability or have children. And there are some statistics that show that even in a dual-physician household, when there are young children, the women will work 11 fewer hours per week than women without children.

And then another way to look at this, another study revealed that married male physicians spent seven more hours at work and 12 hours less per week on parenting or household tasks than their female counterparts. All of this was magnified during the pandemic. And then also, as we were dealing with staff shortages, women were expected to engage more in administrative tasks. And there’s this expectation that women will spend more time supporting patients’ emotional needs because they’re frequently identified as the caretaker and nurturer.

But I think that this patient-centered care also has its benefits, and there is a lot of literature showing that patient outcomes are actually better when you have a female physician. But the caretaking tax comes with a cost, and you will see it in salary, in retirement benefits, the rate of promotion, opportunities of leadership or research. So, it’s something that all organizations need to be wary of.

Dr. Maybank: Thank you for that. And I also think caretaking, again, because I also think there’s, I think, a rightful consciousness in terms of the experience of mothers, but there’s also a lack of consciousness of the experience of those who may not be mothers, but have still other things that they are taking care of, and especially across race, identity as well, because oftentimes, as a Black physician or another physician of color, you’re taking care of a family in many different ways, and my family is not even in this country.

Dr. McRae: Absolutely.

Dr. Maybank: So, I think I would love to see expansion of the research and the conversation to be inclusive of that as well so that we aren’t excluding women within the context of talking about it.

Dr. McRae: Yes. I absolutely agree. Sorry, real quick. Just when I’m doing my research, we have also included just taking care of anyone who is dependent on you. And like you said, it could be extended family. Absolutely.

Dr. Maybank: Absolutely. Thank you. Jasmine? In terms of just the pandemic and its worsening of inequities during COVID, and especially specifically for you since the nature of your book and the topic of your book for … What are you hearing in your experience as a Black med student, but also from women physicians and attendings that you may be around or exposed to?

Brown: Yeah. One of the big challenges that I personally experienced in the midst of COVID was finding mentors. I actually started med school in 2020, so right in the midst of everything. We didn’t have a lot of the orienting type of events that med students usually have in the beginning. We didn’t even have our white coat ceremony for another year until starting. And so, most of my pre-clerkship classes were virtual, which meant that it was hard to connect with professors or other faculty at the school, ways that are typical of developing mentor-mentee relationships.

And I think that this was an experience that a lot of med students struggled with. And to compensate, some people went to family members that they may know who were physicians. But for me and I think many women of color, people of color in general who don’t have family who were physicians, then that became particularly difficult of finding mentors who could guide them through their journey.

And I would say, once I eventually was able to find mentors, which happened once I went into the hospital and things were less virtual, that had a strong influence on my leanings in terms of specialty-wise and what I was thinking towards my future, and I think a lot of women of color and people of color in general had a similar experience.

Dr. Maybank: Thank you, Jasmine. Dr. Jenkins.

Dr. Jenkins: Yeah. And I just want to underscore what Jasmine mentioned there just about class, right? That’s another layer to all of this, and access to people in one’s family that maybe physicians are not … is all sort of very classed. Yeah. I think what we saw with the pandemic was … And I like to conceptualize COVID as an acute-on-chronic stressor. It exacerbated underlying tensions that already existed but made them on steroids. Right?

And so, on the one hand, we saw this intensification of work expectations of physicians as exceptional, as superheroes, COVID heroes, expecting physicians … There’s a great op-ed by Dr. Sandeep Jauhar about questioning whether even physicians are expected to be martyrs during the pandemic. So, there’s this one, on the one hand, intensification of that expectation as well as an intensification of caregiving responsibilities and, in a similar way, expecting that women give themselves up and put themselves after, put their loved ones, their dependents first.

And so, what I think has happened with COVID, and it’s not clear to me that this has disappeared as the virus has sort of receded, is this expectation that women be doubly superhuman or martyrs in some ways, that women as physicians both put their patients above all else and put their caregiving above all else, which leads to the question, what room does that leave for female physicians?

Dr. Maybank: So, Dr. McRae, just turning to you, as we shift towards kind of the final points of … You’ve done some research, a lot of research actually, and understanding—especially, in light of this historical context, the key drivers of dissatisfaction and career regret. And especially during this time of COVID, it is elevating tremendously for many of us, honestly. Can you just provide some of what your research has shown?

Dr. McRae: Sure. Thanks for asking. And yes, we’ve been dealing with the pandemic, but then again, also this tumultuous political landscape and also an increased number of violence, incidents in our clinical spaces and experiences of discrimination. So, there’s been so much going on, and it just seems elevated in a lot of our spaces. And so, I’ve been involved in research since 2018, looking at career satisfaction and well-being of women physicians of color.

And like you said, the goal was to identify key drivers of career dissatisfaction, regret and what are concrete strategies for health care organizations to implement to retain this important group of clinicians. And so, we looked at experiences of women physicians of color in various practice settings throughout the State of California, and we gathered quantitative as well as qualitative data through focus groups from women physicians in 2018, and then again in the summer of 2022.

So, in terms of the risk factors, it still remains the same in terms of, for all women, low professional fulfillment, having dependent family members, being in primary care, having a low perceived sense of workplace diversity and inclusion. The risk factors that were more prominent for women physicians of color were experiences of discrimination at work, not feeling valued at work, having patients, having colleagues question their competency regularly.

But what is protective? It’s found to be social support, having that sense of community, as well as meaningfulness. And what I mean by that is feeling that the value of your work and the goal is in alignment with the workplace where you are. So, the values, the ideals, the standards are the same. Also, availability of resources. And I don’t just mean the physical resources and the staff, but the physical, emotional and cognitive resources that individuals feel comfortable accessing.

And this leads to psychological safety. Does someone actually feel empowered to show themselves, to share their thoughts without fear or negative consequences to their career or how people view them? And when we asked women physicians, “What would be important changes for you to improve your well-being, to improve your workplace satisfaction that your employer should provide?” And number one, both years, flexible schedule, and then also the ability to work part-time, which goes along with having some more flexibility.

And then also looking at, “How much support staff do I have versus my counterparts?” because there is literature and there’s more evidence showing that because of societal expectations and perhaps institutional expectations, women are expected to be a little bit more responsible and do more administrative work and be okay with that—and pick up some of the other responsibilities and have thus less support staff. And it’s also found that women will spend more time doing services that may not actually generate revenue. They’re more service-oriented, teaching more, so they may lose out on research opportunities or not generate as much revenue through clinical work. So, these were some of the findings that we had.

Dr. Maybank: Wow. Thank you for that great, great work and very helpful. And it’s validating. Many of the context of what you were able to expose and share, we all deeply feel and intimately feel and have a sense of. But I think as what happens always in the space of equity, because we aren’t believed, our stories aren’t valued, our experiences aren’t valued, we have to use numbers as well. Right? And so, thank you for collecting that data.

So, as we move towards the end of this particular program, I want to do two questions, I believe, because I want to get to just the policies that we should be advocating for. And if you could just name … There are probably lots, and there are lots. I won’t even say they probably are. But again, for each of you, just name your number one, if you had a choice that you could actually move forward and through today, in terms of state and federal policy and what we should be advocating for and what you want your colleagues to advocate for, on the medical profession to advocate for. What’s that one policy? And Dr. Jenkins, I’ll start with you.

Dr. Jenkins: Yeah. I mean, I would start with paid leave. We’ve talked a lot about how women, and especially women of color, are disproportionately thrust into caregiver roles, whether it’s for children, for older parents, for relatives, for siblings, whoever it is. Women and people of color are disproportionately doing that work. And so, at the state and federal level, there has to be mechanisms to make it possible for women to engage in that work.

I would add that that would also help with a culture shift potentially within the profession. Dr. McRae mentioned the importance of flexible work policies at the organizational level. But while that flexibility, yes, is absolutely necessary, it may not be necessarily sufficient for changing the perception that taking time off work to care for a child or to care for oneself even is viewed as weakness or reneging on one’s responsibilities or maybe adding more work onto the plates of colleagues. So, I want to stress the importance of not only policy change, but culture change. And particularly, if policies at the state and federal level can change, that might drive the culture change that’s needed.

Dr. Maybank: Absolutely. Thank you. And there has to be work at the culture change, because I also don’t assume, none of us assume, that because policy changes … Because oftentimes, to the point of psychological safety, a policy could change, but if the culture, the attitudes, behaviors around a particular state of being doesn’t change, it is ripe for creating conditions of where people do not feel psychologically safe. Jasmine, one policy.

Brown: Yeah. One policy that I would say is if there can be a way to identify and address discriminatory events and cultures that persist within medical institutions. Dr. McRae mentioned the violence that providers have often experienced, whether it be from colleagues or patients. And as a trainee, I feel like the pain and impact this causes for an individual, whether it be a medical student or a physician, is kind of downplayed.

And similarly, to what Dr. Jenkins was saying of like, “Put the patients’ needs above yourself,” but how can we find a more constructive way to address if a patient is violent towards me or another colleague? And how can we train the profession as a whole, where if you’re not a target to this violence, how can you support your colleague going through this as opposed to silence, which, in some ways, can feel like an added insult to that event?

Dr. Maybank: Absolutely. Thanks for that, Jasmine. Appreciate that. Dr. McRae, you’re going to want to close out with your policy choice?

Dr. McRae: Sure. But I wanted to thank Jasmine for mentioning that, and I think it’s absolutely true that there needs to be more education and there also has to be proactive outreach. We can’t just, to Dr. Jenkins’ point, expect everyone to be stoic throughout all of these events that occur in the clinical environment. We have to acknowledge that the challenging experiences force people to pause, to process, and also give everyone the time and the space to access resources.

In terms of policy, the federal government does have an important role to educate, to set and enforce nondiscrimination standards. And health care does have its own unique set of rules enforced by the Health and Human Services Office of Civil Rights. It needs to be clearly prohibited to discriminate on sexual orientation, gender identity, pregnancy and pregnancy-related conditions, marital, family or parental status.

That being said, again, it goes back to what Jasmine was saying and Dr. Jenkins was saying. It’s critical to make sure that we’re focusing on what individuals are also doing in their own organizations to lead, to effectively change culture in order to create true gender equity across all races and across all professions and levels of careers.

Dr. Maybank: Thank you to the three of you. Wonderful. I learned a lot today, and I very much appreciate it. I know those who are going to view this are going to learn a lot, and this particular episode is going to go pretty far. So, again, just thank you for your time and for your energy, for your leadership and for all that you bring to this space.

In closing, I just want to highlight an upcoming National Health Equity Grand Rounds that will be a virtual webinar on October 10, “Creating Accountability Through Data: From Racism and Neglect to Transparency and Repair,” where you can listen in a conversation with experts to talk about data and repair. So, you could register at healthequitygrandrounds.org. That’s healthequitygrandrounds.org.

And then we also want to highlight our “Rise to Health: A National Coalition for Equity in Healthcare,” and it brings together individuals, but really organizations from across sectors to advance equity and provide a toolkit as well as a community of which people can engage with and in. So risetohealthequity.org. That’s risetohealthequity.org for more information. So, thank you, everyone. And until the next time, take care and be well.

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Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.