THE SOLUTIONS

Medical leadership must begin to recognize and rectify the historical and current impact of anti-Black racism on the health care workforce. It is critical that we acknowledge the full range of manifestations of anti-Black racism in medicine rather than pretend that it does not exist. Bias encountered by Black physicians is increasingly multidimensional and covert. This distinction is important because subtle manifestations of bias will likely necessitate alternative interventions. Accordingly, health care administrators in their role as leaders must be at the forefront of raising awareness of and combatting a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves. Advocacy involves a multitude of components, such as inclusion, representation and access to career advancement as a Black physician or trainee. Non-Black physicians and leaders need to remember that Black physicians experience additional pressures and burdens during their medical training and career and they must be sensitive to the complex ways in which discrimination is manifest in our culture and how this discrimination and concomitant pressure systematically impact Black physicians. 

Understanding the unique workplace experiences of minority physicians is essential to inform strategies to create a diverse and inclusive workforce. Reshaping medicine to make diversity and inclusion an integral part of the institutional fabric is essential to addressing this issue. Part of combating bias includes changing the racial and ethnic makeup of the physician workforce. Many medical institutions use the term “underrepresented in medicine” to encompass a group whose proportion in the physician workforce is less than in the population, and promote efforts to recruit underrepresented students. The burden of Black physicians and residents to promote diversity is one that can be minimized. Larger institutional changes and interventions can enhance the representation of Black individuals in the Canadian medical profession. It is up to medical schools and institutions to train and hire more Black physicians across training programs, to break down current systemic forces that perpetuate racial injustice, and to decide if they will have a zero-tolerance policy for bias. Tools to support a diverse workforce and to provide equitable care to each and every patient should be the goal for the Canadian medical professional community. 

Identifying high-achieving Black individuals is critical in increasing representation. This is easier when there is increased Black representation on admissions committees, in administrative leadership and in teaching positions. Mentorship is important to navigate the medical profession. The presence of Black physicians can have a significant impact amongst Black patients, students, residents, colleagues and support staff.  Having a Black mentor that has volunteered to help guide young Black physicians and students is critical for achieving success. Black physicians may be the best bridge between the medical profession and racial inequality as Black minorities operating within majority landscapes have been forced to creatively learn, observe, flex and adjust in ways that the majority have not. When making systemic changes, reacting to a new situation is the key. Getting the majority to see crucial systemic flaws and obstacles that have personally been encountered can address the inequalities and inequities substantially.

 It is imperative to establish a professional community that allows Black physicians and residents to speak truth to power and have a larger impact to the community at large. Organizational leadership and support are key if institutions are to truly fulfill an antiracist mission, but that leadership and support require a firm commitment from all stakeholders in the organization. A desire to work towards eradicating racism in all its forms must underpin that commitment. It is virtually useless to sponsor yearly cultural competence or diversity trainings, which do little, if anything, to address anti-Black racism, power, and privilege on the interpersonal or institutional levels in the absence of concerted, ongoing organizational commitment. So much effort goes into the medical profession, institutions and medical education organizations should prioritize creating a hospital environment where perpetuating discrimination against either physicians or patients is not acceptable. Otherwise, bias against Black physicians will continue to harm the well-being of both doctors and patients.  

Residency programs should prioritize resource allocation, including administrative support and institutional funding. Residency program leadership ought to regard challenges related to diversity and inclusion as an institutional problem and strive to achieve institutional excellence. The institutional abdication of responsibility by residency programs to promote the efforts of diversity and inclusion may be of interest to the Royal College of Physicians and Surgeons of Canada. Common Program Requirements should be updated to reflect an expectation that all residency programs promote recruitment and retention of a diverse workforce. This approach is should also be in line with accreditation standards at the undergraduate medical education level.

Open and honest discussions on anti-Black racial issues is essential to achieving equality. It’s better to have training for physicians on how to alter the medical environment to stop perpetuating bias against physicians and fellow colleagues, rather than training physicians how to bow their heads in the face of anti-Black racism. There is much to learn about the long history of anti-Black racism in medicine and institutions should receive presentations from those impacted by it on what they think could be improved. Diversity efforts should not be the function of Black trainees, whose principal responsibility is the pursuit of clinical excellence. 

Education is key to progressing the advancement of Black physicians and physician in training. Access to funding to help establish research projects and initiatives should be available for Black physicians and physicians in training. Future studies can examine the differences between varied minority groups to understand common and unique themes and can be extended to multiple facets of the unique experiences that Canadian Black minority physicians and residents face. 

Given the ethical (and legal, in some cases) demands to provide care and not to treat patients against their wishes, zero-tolerance does not mean letting expressions of discrimination slide; rather, it means acknowledging what was said and addressing the anti-Black racist behaviour. The need for organizational policies and guidelines is unequivocally necessary. But without an informed health care work force that is motivated to provide nondiscriminatory care, aware of—and sensitive to—the dynamics of anti-Black racism in myriad settings, and fully capable of holding difficult (patient-clinician or collegial) conversations in the heat of the moment and in the coolness of reflection, policies of respect and zero tolerance are mere moral proclamations.