The history of racial tensions in the United States is no secret. Even today, racism is still embedded in all US institutions, including medicine.

In a commentary published in Obstetrics and Gynecology, Ashish Premkumar, MD, of the Department of Obstetrics and Gynecology at the Feinberg School of Medicine at Northwestern University in Chicago, and colleagues, described issues pertaining to race and racism that affect clinicians in the healthcare workforce.1 Although their paper focused specifically on professionals in obstetrics and gynecology — the specialty with the largest proportion of underrepresented providers — the issues covered are relevant to healthcare institutions in general.

Dr Premukumar and colleauges noted that race is not a biological category, but rather a social construct based on assumptions about innate differences among various populations, in which certain groups are considered inferior. Race is “created by a confluence of societal variables writ into the perceived differences of skin tone or geographic origin,” and it “has a political relationship with ‘whiteness’ — cultivated through historical institutions, economics, law, and social practices — that ultimately restricts” the status of non-white subjects, the authors wrote.1 “This statement is not to suggest that racism is perpetrated only by white individuals, but that the expression of racism in America entails an understanding of what it means to be white, particularly the relationship among skin color, state power, religion, and gender.”

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Based on 2015 statistics of medical school graduates, an estimated 6% identified as black or African American, and 5% identified as Latina, Latino, or Hispanic.2 These groups each represent only 4% of active physicians and have previously reported high rates of discrimination in their medical careers.1 Such experiences have been linked with lower career satisfaction, higher job turnover, feelings of being unwelcome within their institutions, and contemplation of leaving the medical profession.

Although discrimination or harassment has been reported by nearly 60% of trainees in medicine, trainees of color are unlikely to feel comfortable speaking up in these situations. Fewer than 20% of students who experienced such incidents reported them to their Office of Minority Affairs.1

The paper detailed several key areas in which race and racism affect clinicians in the workplace, such as relationships with patients and lack of support from colleagues and supervisors. Clinicians of color have reported discriminatory experiences with patients, including refusal to receive treatment from a black female doctor, and a black intern being told that she was “really smart for a black person.”1

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When such incidents occur, people not of color often remain silent and fail to take action on behalf of the clinician experiencing racism. This lack of validation and support further compounds the difficulties facing these clinicians and can increase “racial fatigue,” a term used to describe the “emotional and psychologic consequences minority physicians experience in addressing the enduring issues of race and racism.”1

The authors added that people not of color who do not currently have the skills to address racism must take responsibility to learn them: “Allyship is no longer a luxury, but a requisite component of working and training in health care,” the authors wrote. “Fighting racism requires both a philosophical stance that systematic discrimination is wrong and tools that can be used to fight its multifaceted incarnations in everyday life.”

To that end, the authors outlined actions that can be undertaken at various levels. At the institutional level, for instance, policies that explicitly address racial and ethnic discrimination should be created. After a patient’s daughter requested that her father be seen by an “American” doctor instead of the physician of Southeast Asian descent who was treating him at Penn State’s Milton S. Hershey Medical Center, the facility added a statement to their Patient Bill of Rights noting that they will not honor requests to change providers based on race, ethnicity, religion, sexual orientation, or gender identity.

This article originally appeared on Medical Bag