The hidden toll of racism in medicine: a doctor's perspective

It felt like a monumental moment when I started my career in medicine. I grew up largely on the borderline of poverty; my parents lived check to check with my sister and me. Neither of them had gotten a college education, and they sacrificed much of their lives to support my ambitions. So to see their son realize his dream was a proud moment for them. But as a Hispanic queer doctor, this field has slowly been killing me—a silent death through a thousand cuts.

It started when I landed in residency and asked about opportunities to be involved in diversity, equity, and inclusion (DEI) related research projects at the resident level. Because I grew up in a poorer town, I wasn’t afforded great opportunities to learn how to be a stellar student. I spent much of undergrad and medical school ensuring my grades matched those of my white peers. I also often worked to help pay for various things my parents couldn’t afford. It left little space for me to pursue things like research during those time frames, and as it’s been described in the literature, it’s hard for historically marginalized scientists to break out. White neighborhoods have better resources and are often taught a different skill set that helps them excel in the research realm – the cycle feeds itself.

“No one is doing that kind of research around here. You’d be better off just joining an ongoing project or doing some literature review in the field you’re interested in.”

I could feel that first cut, but I’ve always known never to let my smile falter, so it stayed on my face as I thanked that person and walked outside. That was the moment I felt isolated at this institution. A feeling so intense I cried on the way home, wondering if I had made a mistake in coming here. Then I questioned if other residents felt this way. So I designed my project around understanding historically marginalized residents’ feelings. I found a mentor and executed my project with some success. Publishing has been hard, but I haven’t given up getting my work out there.

That project gave me purpose. On the days when patients and attendings microaggressed me. When fellows macroaggressed me by questioning why the program would ever choose me as a chief resident. And even as a chief, I’ve been made to feel invisible at the tables I was invited to. It gave me hope, and I had the strength to endure the endless barrage of cuts. Until I applied for a fellowship and found that I had matched—into racism.

I interviewed all over the country, excited at the prospect of pursuing a field I had grown to love so much. A field where Hispanic fellows only made up 5.8 percent and Black fellows 3.8 percent of the pool in 20223. I was ready to pursue DEI in this field and contribute to the advancement of increasing our representation. When it came down to priorities, I chose only to rank my home institution.

I opened the email to find that I hadn’t matched—a major cut. That wound would be deepened when I later discovered that the fellows who did match were all White appearing, some of whom I had met on the interview trail. At that moment, I realized that I didn’t matter to this program. People who look like me, talk like me, sound like me, achieve like me—we are invisible. My final cut would come when the program director emailed me.

“I’m sorry the match didn’t work out. The silver lining is that this is the best match we’ve ever had.”

Again I lose to whiteness. I believe that because medicine is still a white, heteronormative, cis-gendered, male-centric field, my voice is silenced. I think that doctors feel that racial barriers are not as prominent as they used to be and that intra-institutional racism is rapidly disappearing. But personal experience, experiences of other historically marginalized doctors, and most importantly, data would suggest otherwise—even now.

How can I find meaning in this field when all I’ve been able to glean is that it hates me? I used to think I could find joy and meaning in medicine. And I brought what Brown Queer joy I found to medicine—and I found joy. But it just put that joy in the bottom of its shoe and it walked off with all of my stuff. I didn’t cross the border; the border crossed me.

So we suffer silent, invisible deaths. No one talks about when these things happen. Across the country, historically marginalized residents and fellows are asked to thrive in spaces where we can barely survive. There is no programming to uplift me. Few faculty members share my identity to help me through these painful experiences. I was told to do more research, be better, and work harder. Little do they know that I’m already working twice as hard to get half of what they have.

When I was a resident, I worked moonlighting shifts to help pay for things my family couldn’t afford. My youngest sister’s prom dresses and a computer so she could go to college. My parent’s cable and our cellphone bills. I paid bill collectors thousands of dollars to break them out of debt. But I suppose all it would have taken for me to match is to have worked harder.

This field is killing me, and in some ways, I worry people see it happening and feel inclined to do nothing about it. I know something has to change but will it?