Deeply entrenched racism, rooted in the foundation of white supremacy, has had a stronghold in medicine for hundreds of years. Its legacy of harm against Black, Indigenous, and people of color (BIPOC) communities, particularly its atrocities against Black Americans, is undeniable. Yet significant change eludes us. For decades, these communities have borne the disproportionate burden of public health short-comings from police brutality, gun violence, infant and maternal mortality, and most recently — the COVID-19 pandemic. The degree to which explicit and implicit racial bias still affects our nation is undeniable. The mortality and morbidity of structural and systemic racism leave no institution unaffected, and its harmful effects are seen nowhere more clearly than in medicine. The House of Medicine itself has acknowledged this, and both the American College of Physicians (ACP) and the American Medical Association (AMA) have policy declaring racism a threat to public health and stated their commitment to confront racism, end health care disparities, and improve health equity.
Upon this backdrop, we are horrified to read of yet another act of racial and gender discrimination towards a Black doctor, Dr. Princess Dennar. Dr. Dennar was a trailblazer as the first Black female Program Director at Tulane. However, her position as program director of the medicine-pediatrics residency program at the Tulane School of Medicine was terminated after a barrage of discriminatory and abusive behavior spanning several years came to light in her court case.
The repeated acts of race and gender discrimination alleged at the Tulane School of Medicine are deeply disturbing. ACGME reports from a 2018 site visit at Tulane indicate that they were unable to exclude race or gender discrimination, but despite this, Dr. Dennar continued to experience harm until her recent termination. Dr. Dennar’s court case details a pattern of denigration, harassment, retaliation, and professional abuse despite the accomplishments she was able to achieve for the medicine-pediatrics program. Additionally, the case alleges that actions were taken by institutional leadership that jeopardized the training and wellbeing of her medicine-pediatrics program and the residents in her charge (particularly minority females). Amidst all this, we specifically want to highlight that, during a global pandemic, her health and safety were put at additional risk by removing some of her personal protective equipment (PPE). The entirety of her experience and that of other women and particularly women of color at Tulane School of Medicine is inexcusable.
We have repeatedly seen Black doctors, particularly Black women faculty, be treated with reprehensible behavior by their medical institutions, behavior that violates our oaths and duties as physicians and healers. Dr. Aysha Khoury’s firing from the Kaiser Permanente School of Medicine and Dr. Susan Moore’s death from COVID-19 are two recent instances of how racism and sexism have harmed Black women in medicine. Dr. Moore’s death showed us the devastating reach that racism has on our patients – even a physician was not spared its fatal effects. Dr. Lesley Saketkoo’s court case further highlights the gender discrimination at Tulane School of Medicine. This harm becomes amplified when it intersects with racial discrimination in Black, Indigenous, and people of color (BIPOC).
The house of medicine is long overdue to confront the racism, sexism, and other discrimination that forms its foundations and pervades its halls. This culture is not one of safety; rather, it is one of the entrenched norms of oppression and is upheld by the pillars of white male supremacy. Academic medicine’s hierarchical power structures are both grounded in and reinforce this foundation. Our medical institutions continue to marginalize, disenfranchise and harm women, BIPOC communities, and underrepresented in medicine (URiM) learners, faculty, and staff. Dr. Dennar was a program director of a combined medicine-pediatrics program that was providing training to racial minority physicians, who take care of a New Orleans community that is predominantly Black.
We have clear data that racial minority patients have better health care experiences when they share racial concordance with their physicians. Addressing the massive health care disparities and health and health care inequity in the United States firmly relies upon increasing the representation of BIPOC physicians.
Dr. Dennar was not only a positive role model, mentor, and advocate for her trainees, but she also provided vital care to her patient population, and by advancing the diversity of our physician population, it is immeasurable how many patients’ lives she has positively impacted.
Each time we lose any doctor in our system, we harm our patients. Each time we lose a Black doctor, our harm is magnified in that we add to an already wide chasm of inequity. Our “leaky pipeline” data clearly shows that race and gender’s intersection adversely affects Black women in academic medicine. Diverse representation at all levels of academic medicine along with a culture of safety, inclusivity, transparency, and void of discimination of any kind is crucial to combating structural racism and improving health equity.
We, a body of physicians who are entrusted with the care of patients and the training of present and future physicians, will not tolerate, neither in words nor actions, racism or discrimination of any kind, whether it be racial, ethnic, gender, based on sexual orientation, physical ability, religion, or socioeconomic status. Our professional responsibility is to speak out against the harm that we are witnessing and we will not remain complicit with silence.
As leaders and educators within academic institutions, we are deeply concerned about the institutional abuse and harm that has come to light from Dr. Dennar’s case. We demand transparency and accountability of the actions allegedly taken by the Tulane School of Medicine and every employee that engaged and/or was complicit in said conduct.
We ask the ACGME and The Joint Commission to bring justice to our Black colleagues and all BIPOC faculty, trainees, and staff at Tulane. We specifically demand a full and transparent review by the ACGME of all of Tulane’s residency programs, as well as a review by The Joint Commission of Tulane’s health care institutions. We also support an independent and external review of the ACGME itself to ascertain if this regulatory body can effectively perform a full and transparent review of the Tulane School of Medicine, or any other academic medical institution with alleged discrimination.
Our concerns extend to all academic medical centers and health care institutions, many of whom may be perpetuating a culture of toxicity, systemic oppression, and harm that have impacted women and BIPOC learners, faculty, and staff for far too long. In accordance with the policy statements put forth by the ACP and the AMA, we ask the ACGME and The Joint Commission to do the necessary work to investigate racism and discrimination at all academic medical centers and health care institutions and send the clear message that discimination of any kind will not be tolerated or condoned.
Sacharitha Bowers is a dermatologist and can be reached on Twitter @SBowersMD. Eve Bloomgarden is an endocrinologist and can be reached on Twitter @evebmd. Regina Royan is an emergency medicine resident and can be reached on Twitter @ReginaRoyan. Angela Weyand is a pediatric hematology-oncology physician. Shikha Jain is a hematology-oncology physician who blogs at her self-titled site, Dr. Shikha Jain. She can be reached on Twitter @ShikhaJainMD.
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