Raised in East Tennessee, I vividly recall seeing signs for “white” and “colored” on restroom doors, or “no colored served” in store windows. My parents taught me to respect all people, regardless of background, skin color, or socioeconomic status, and reminded me that my educational opportunities were, in part, the accident of my birth as a white child of college-educated parents. We went only to stores and restaurants that served all people; we did not frequent segregated companies or services. My father was an experimental pathologist who hired excellent people from diverse backgrounds, and his chief laboratory scientist was a black woman.
When I started medical school in 1975, women comprised about 15 percent of the students in my class. It was not uncommon to hear some faculty members make sexist jokes, include pin-up photos when discussing women’s health, discuss “hysterical” (women) patients’ complaints and concerns, or call women patients and students “honey” or “sweetheart” on rounds. What allowed me to succeed, even thrive, in that setting were the many sensitive, caring, and thoughtful teachers, most of whom were men, who treated women with respect, encouraged us to assert our opinions and interpretations, and provided superb career mentoring and advice. I can say from my own experience that resilience, success, and growth are best fostered when there are supportive mentors and colleagues who strive to build inclusive training and work experiences in which colleagues and students of all ethnic and religious backgrounds, gender identities, and ages are treated with respect, encouragement, and appreciation. I felt scrutinized and pressured to prove myself, feeling the burden that access to medical education and career advancement for other women depended in part on my academic and clinical success. These pressures fostered an atmosphere in which I avoided confrontation. Even when a crude joke or disparaging sexist statement was directed at me, I kept my head down and sublimated my fear and anger by working harder, so that I could ultimately show that I deserved to be there. Crude teasing and sexist comments could escalate into more aggressive bullying or marginalization (“She is not tough enough to be a doctor”) if I or other women did not “laugh off” the insults and hurts.
Now women comprise more than half of the pathologist workforce and the majority of the laboratory professionals in the U.S. Our current challenges relate to empowerment, pay inequity, and disparities in advancement into leadership positions compared to men. One factor that contributes to the inappropriately low salaries for laboratory professionals is gender, because historically laboratory professionals were predominantly women working for men. Addressing salary inequities requires us to acknowledge historical inequities, while advocating for public and payor recognition of the professional status and the high level of care provided by laboratory professionals and pathologists.
Dr. Valerie Fitzhugh’s article “Through My Eyes” in The Pathologist (pp 18-23, Issue #50, January 2019) about the challenges of being a black woman in pathology was painful to read, especially given my own experiences as a woman. It gave me a sense of urgency to raise the issues of diversity, inclusion, and empowerment to a high priority for ASCP and our profession. Dr. Fitzhugh’s descriptions of being mistaken for a janitorial worker when wearing scrubs and of being told by colleagues that “you can be our token” are emblematic of the insensitivity and bias still faced by people of color. Blacks, indigenous people, Latin Americans, people with gender nonconformity and those from other minorities feel continuous pressure to prove themselves, as well as additional stress compounded by isolation. Dr. Fitzhugh noted that blacks and indigenous people are so under-represented in pathology that there were too few respondents to capture salary data in the 2017 and 2018 Medscape Pathology Compensation reports.
A recent editorial in New England Journal of Medicine (Volume 380, No. 16, p 1489, April 18, 2019) highlighted the personal and population toll of breast cancer outcomes in Chicago that reflect “structural racism.” Because only two of 12 hospitals on the predominantly black South Side area have achieved American College of Surgeons Commission on Cancer Designation, most women in this area lack access to radiological specialists in mammography, diagnostic needle biopsies, and timely evaluation and care. The consequence is a gap in breast-cancer related mortality between whites and blacks that is wide and growing wider. Similar or worse disparities in mortality and morbidity are seen when comparing whites to indigenous people in the U.S., and when comparing outcomes for people from lower socioeconomic status in cities and, especially, in rural areas, to wealthier populations. Population health also reflects disparities in educational opportunity for students who grow up in underserved areas, and it reflects the low numbers of these students who enter health professions.
The January 2019 issue of The Pathologistalso includes a piece by Angelina Knott, Dr. Robin Suggs, and Dr. Timothy Craig Allen of University of Mississippi (“The Dream of Diversity”, pp 24-29) regarding the critical importance of pipeline efforts to bring underserved students into our training programs. Students need connections to committed mentors who can help foster better preparation for, and knowledge about, careers in health. In the U.S., most school systems are supported by real estate taxes. Communities with lower rates of home ownership and lower property values have gaps in resources for education, compared to wealthier communities. These are reflected in the lower rates of students taking algebra in 8th grade, which is a benchmark of a skill accomplishment that prepares students for STEM fields and for college entry, few or no AP courses, weaker science courses, and less rigorous language preparation essential for academic success. Pipeline efforts must provide support for the learners, their parents, and their community to assist with making the dreams of higher education into actual successes, providing maps for each step along the educational and career ladder, including information about financial aid, educational programs, and academic support. Long-term connections and relationships can build trust, and pathologists and laboratory professionals can invite students to consider coming to work with us, as well as honoring and celebrating their academic progress along the way.
What can ASCP and our profession do to address disparities and inequities, and how can we build and strengthen pipeline efforts? We can:
Please join me in committing to honesty with ourselves and each other about the work that we need to do to confront these painful subjects and to overcome gaps in access, opportunity, and empowerment. We owe this to our patients, our profession, and ourselves, and this work will make us even STRONGER TOGETHER.