To encourage dialogue about race in health care systems, the University of Wisconsin School of Medicine and Public Health (SMPH) offered an inaugural Diversity Summit in early 2018.
The central topic surrounded concerns among academic medical centers nationwide, including the School of Medicine and Public Health and UW Health, which are grappling with recruiting and retaining a diverse workforce.
In his opening remarks, Dean Robert N. Golden, MD, said, “One of the school’s core values is to foster a culture of inclusion and respect among our patients, learners, staff, faculty and the communities we serve as we work to advance health equity via our missions of teaching, research and service.”
He described some of the school’s efforts focused on advancing diversity, including establishing new processes, procedures, and leadership and professional staff positions devoted to multicultural affairs, equity and inclusion. For example:
- The school’s Collaborative Center for Health Equity engages partners throughout the state in collaborative teaching, research and service initiatives to improve health equity in Wisconsin.
- The Native American Center for Health Professions connects the school with the 12 tribes in Wisconsin with the goal of improving the health and wellness of Native American people through community projects and the expansion of the pathway for Native American clinicians.
- The Wisconsin Partnership Program develops community partnerships, including community grants that respond to needs, as identified by community groups, and offers resources and guidance aimed at reducing disparities and advancing population health.
“We have outstanding and dedicated talent in our new leadership positions, including our associate dean for multicultural affairs and diversity and our associate dean for human resources, equity and inclusion — Drs. Tracy Downs and Brian Gittens, respectively,” noted Golden. “Together with seven additional staff members, they are creating novel approaches for the diversification of our students, faculty and staff, and new processes designed to promote a fair and equitable environment. We thank them for organizing this summit.”
He added, "We should be proud of what we’ve accomplished, but at the same time we need to be honest: Clearly we are not yet where we want to be."
'I'm in the 1.5 percent'
Next, Tracy Downs, MD, professor, Department of Urology, presented statistics from the Association of American Medical Colleges (AAMC) News entitled, “Report Shows Decline of Black Males in Medicine” (September 27, 2016). Specifically, the number of African American males applying to U.S. medical schools has remained stagnant for nearly 40 years, declining from 542 African American male medical student matriculants in 1978 to 515 in 2014. He noted that the number of black women entering the medical profession and being promoted is outpacing the number of black men.
While the frequently touted goal is to have the same percent of minorities in the physician workforce as in an area’s population, Downs noted, “The regional percentages do not reflect reality. For instance, in Wisconsin, where we have a population that represents 6.3 percent African Americans, 1.6 percent of our physicians are African American.”
Downs, who earned his medical degree from the University of California-San Diego and completed a residency at Brigham and Women’s Hospital in Boston and a urologic oncology fellowship at the University of California-San Francisco Medical Center, cited other states that have a similar imbalance, including his home state of California (3 percent of physicians who are African American to serve a state population of 5.7 percent African Americans) and Georgia (12 percent of physicians who are African American compared to 30 percent of its population).
Further, Downs said, “I’m in that 1.5 percent of full professors who are of African American descent.”
Putting this in the context of AAMC statistics, he stated, “When you look at black physicians vs. white physicians in the academic medical center workforce, we comprise 3 percent compared to 63 percent. It’s typical to see higher numbers at the assistant professor rank, but then you see a drop in numbers when the rank goes up in terms of those who have persisted in academic medicine and been promoted. We see very different numbers for our white colleagues.”
Reflecting on why the journey into medical school can be so arduous for African American men, Downs noted that persistent economic inequalities between African Americans and other groups can lead to unintended academic challenges in terms of “where you start, your schooling and the expectations people have for you, be they high or low.”
He said, “African Americans may face a greater likelihood of missing out on test preparation and other things that can increase their ACT scores and high-quality advising that could help steer them toward medicine as a career.”
Driven to excel
Sharing these concerns, keynote speaker Feranmi Okanlami, MD, offered observations along with a personal message of resiliency. After earning his undergraduate degree at Stanford University and his medical degree from the University of Michigan, Okanlami is completing a family medicine residency in the face of difficult circumstances: Partway through his medical training, he survived a diving accident that paralyzed him from the chest down. After two surgeries at Yale and several months of intense inpatient rehabilitation in Chicago, he was blessed with some return of motor function and moved back to his parents’ home in Indiana to continue outpatient rehabilitation.
Due to his determination, Okanlami is looking toward a bright future, with an energetic 6-year-old son and an accepted faculty position in family medicine and physical medicine and rehabilitation at Michigan Medicine. There, he also will be the faculty lead for medical student success in the Office for Health Equity and Inclusion.
During his talk, Okanlami described his experiences as an African American man in academic medicine. Immigrating from Nigeria when he was a child, and as the son of two physicians who strongly encouraged him to enter medicine, he was a star athlete on the track team during his undergraduate years. Following medical school, he matched to an orthopedic surgical residency at Yale. Early in his third year of that residency, his accident changed his life and medical career.
Adopting a philosophy of “disabuse disability” — modeling that “disability” doesn’t necessarily mean “inability” — he pursued rehabilitation with tenacity.
Okanlami went on to earn a master’s degree in engineering, science and technology entrepreneurship at the University of Notre Dame. His capstone thesis, in partnership with Cleveland Clinic and Custom Orthopaedic Solutions, involved a patientspecific medical device intended to make pedicle screw placement in spinal surgeries faster and more accurate — equipment that could have enhanced his own surgeries.
Two years after Okanlami’s diving accident, his life held another profound tragedy: He lost his father, a neonatologist, to suicide.
“While my own physical struggles are easy for others to see visibly, this highlighted the fact, to me, that not everyone’s struggles are visible,” said Okanlami. “I have since considered myself a voice for those who don’t have much of one, and an advocate for people with disabilities, visible or otherwise.”
He adds, “My father was an excellent clinician and a compassionate care-giver who left a positive impression on every single patient and family member with whom he interacted, even when, despite his best efforts, the patient didn’t survive. He was a trustworthy, reliable and dedicated coworker, husband, father, brother, uncle, friend and son. My father was an example of what one should aspire to be in medicine — man or woman, black or white.”
Sharing anecdotes, Okanlami discussed the influence of race on a personal level and in the context of society.
“I’ve experienced disparities in the health care system as an African American and as a person with a disability, and as a patient and provider. Like all disparities in society and life, they result from an imbalance in representation.”
The day-to-day pressure of often being the only African American in the room is perceptible, he explained, adding, “On a tilted playing field, any minority has to outperform by orders of magnitude to be considered equal. And while that is a glaring injustice, it is an unfortunate reality. Recognizing this drove me to excellence in the highest ways that I could: in the classroom, in the social and cultural life of my schools, and on the athletic teams for which I played.”
Urging the academic medical community to consider inclusion as a moral imperative, Okanlami stated that diversity of experience cannot be defined by race alone, noting that all people want to be able to connect with their physician, but that can include other elements.
“It is not that every black patient needs a black doctor, nor that every patient with a disability needs a physician with a disability. Every patient deserves an empathetic doctor, but that empathy does not require the same lived experience,” he said, adding, “empathy can be taught and can be caught. My classmates in residency told me that they interacted differently with their African American patients and their patients with spinal cord injuries simply because of my presence in the program.”
Another take-home message focused on the way each person is a composite of multiple communities.
“I represent Africans, I represent Nigerians, I represent African Americans, I represent men, I represent people with spinal cord injuries, I represent people of color, I represent physicians,” said Okanlami. “Every time you leave a good impression on someone, it impacts others in ways you will never know. Someone will mention that wonderful woman physician or that amazing Hispanic EMT, and suddenly someone else’s prejudices will weaken. When you represent those multiple demographics just by being yourself, you shed light that changes the world.”
Okanlami also quoted Martin Luther King, Jr., PhD: “Injustice anywhere is a threat to justice everywhere.”
“Dr. King did not call the nation to do something for African Americans, he called the nation to abandon its oppression and recognize inequality. No one is superior to lift up one who is inferior. We are equal human beings who benefit from each other’s success, and who deserve the tools to achieve our own,” Okanlami stated. “That approach preserves each person’s full dignity and worth, whether their issue is race, ability, some other issue or a combination.”
He concluded: “As an African American man with a disability, I am committed to advancing the quest for equality, not just under the law but in society and in the hearts and minds of my fellow citizens, and in the medical profession that I love.”