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Homing in on Diversity
While the face of academic medicine has remained overwhelmingly white, the long-overdue move toward a more diverse faculty is accelerating, and the imperative is clear: It’s time for everyone to be welcomed in the door.
Illustration by Pep Montserrat
“We outpace many of our institutional peers in URM faculty representation. However, our faculty by no means reflects the numbers found in the overall population, and certainly not here in Baltimore. So we are not satisfied, and we still have a long way to go to improve the experiences of URM faculty at our institution.”
“I remember, when I was in medical school and didn’t have a mentor, I thought the other people around me who had medicine or medical people in their background had inside information on what to do, and I had to find out these things on my own. But when I came here for endocrinology, I remembered looking at the faculty and see who could help me, and I saw Dr. Sherita Golden [professor of medicine and executive vice chair of the Department of Medicine].
Here she was, a black woman working on diabetes, and I was like, ‘Hey … I’m a black woman interested in that work, too!’ I didn’t know her, but I reached out to her to ask if we could talk. We did. That night I went home and told my husband, ‘Oh my goodness, I just found the person I want to be just like!’ because personally and professionally she was exactly that. She became my mentor. It’s been three years now, and she’s so warm, so helpful. It’s so motivating to have someone who can give you such insight. If she hadn’t been around, I don’t think anyone else could have filled that exact role.”
—Estelle Everett, endocrinologist
“Data has shown that when you have minority faculty in medicine, they’re more likely to go out into the community and help those same groups. Anecdotally, I’ve been in Philadelphia and Baltimore; when you walk into a room with a black patient and tell them you’re a medical student or doctor, they often say they’re so proud of you, so happy you’re there. It’s important to them. I don’t think it’s a coincidence that I study a disease [interstitial lung disease, which progressively scars the lungs] that’s much more common and severe in African-Americans. And I know that these patients appreciate that I’m there and focused on helping them. So, clearly, while it’s important for a faculty member to have diverse experience—race, gender, class, etc., it helps—it’s also important for patient care. The kinds of questions women and minorities ask in research, the kinds of patients they’ll study—it brings in more inclusion across the board.”
—Cheilonda Johnson, pulmonologist and critical care medicine specialist
“We set the tone from day one regarding our core values regarding diversity. During orientation, there’s the Levi Watkins Welcome Reception that [was] started 30 years ago, attended by every incoming URM student, resident, post doc and faculty member. That builds community. We have the annual Myron Weisfeldt Distinguished Visiting Professorship in Diversity, which brings in people from backgrounds traditionally underrepresented in science and medicine. These are national and global leaders who can be appreciated as role models of success and achievement. Their work and life journey speaks to the best of what we’re talking about. We’ve all benefited from their academic work and their science, and they provide role models for persons who traditionally are not seeing such role models on a frequent basis. At the same time, it allows our larger community to see the benefits of diversity.”
—Damani Piggott, infectious disease specialist and Assistant Dean for Graduate Biomedical Education
History, noted many a scholar, is often written from the viewpoint of the victors. As for those who didn’t come out on top? Those slights through the generations are never forgotten.
“It’s almost angering, walking down the hallways of Hopkins, all you see are pictures of white doctors until, it seems, the 1990s. It’s only after that that you even begin to see people of other backgrounds,” says a recent African-American fellow at the school of medicine. “This history that Hopkins is so proud of, it’s posted everywhere. And maybe if you’re white, you think that history is good, these pillars of medicine. But as a black person, regarding race and opportunity, I know what was really happening back then. It stays in your mind.”
Indeed, though The Johns Hopkins Hospital treated African-American patients from its founding in 1889, the school of medicine didn’t grant admitting privileges to an African-American physician until 1966: Roland Smoot, who went on to become the first African-American assistant professor in 1974. Robert Lee Gamble, the school of medicine’s first African-American graduate, did not earn his M.D. until 1967. Nationwide, the American Medical Association allowed its state members to practice hiring discrimination without any kind of recrimination until 1966.
Today, half a century after the civil rights era, the “face” of academic medical success has remained, just like that Norman Rockwell painting of the kindly doc giving that kid the shot, overwhelmingly white.
The numbers tell the tale: According to the Association of American Medical Colleges, under-represented minorities (URMs)—people who identify as black/African-American, Hispanic/Latino/Spanish origin, Alaska Native/American Indian or Native Hawaiian/Pacific Islanders—currently comprise just 8.2 percent of medical school faculty members nationwide. That’s just slightly up from 7.5 percent in 2008, making the issue a great concern in a country projected by the U.S. Census Bureau to have a majority-minority population by 2044.
Yet there’s reason to believe that both here and across medicine in the United States, the long-overdue move toward a more diverse faculty is accelerating—driven both by a moral imperative of equal opportunity and a growing body of scientific literature suggesting that a diverse faculty makes for optimal medicine in the clinic, lab and classroom.
“Patients often better connect with doctors with whom they can relate,” notes Janice Clements, vice dean for faculty at the school of medicine. URM researchers are often drawn to investigate diseases and conditions they’ve seen from their own cultural upbringing. And medical students are attracted to institutions where they see mentors from their background in senior and leadership positions.
“We are competing against every academic medical institution to recruit under-represented minorities for our faculty,” adds Clements, noting that currently 9 percent of faculty members are URMs, and three of the school of medicine’s 32 departments are headed by URM faculty members: the Department of Biophysics and Biophysical Chemistry (headed by Mario Amzel), the Department of Surgery (headed by Robert Higgins, who came on in 2015), and Physical Medicine and Rehabilitation (headed by Pablo Celnik ’03, who was promoted to the top spot in 2016).
“If we want Hopkins to thrive and stay competitive as the best place to do medicine and science,” Clements says, “we have to get the best people.”
The future is clear: In the 21st century, it’s time for everyone to be welcomed in the door.
Not Immune from Bias
Transforming an entrenched institutional culture is like turning a supertanker: Change doesn’t happen quickly, and it demands tremendous amounts of sustained energy to set a new course.
“Diversity is a cultural change. It can’t be done overnight,” says James Page, vice president and chief diversity officer for Johns Hopkins Medicine. “It’s an investment in time. It’s an investment in education. It’s an investment in dollars. It’s an investment in understanding each other. If we’re really not invested in those things, the effort will ultimately be superficial.”
Complicating matters for Johns Hopkins is its elite status in medicine—going back to 1910 when the influential Flexner Report essentially pointed to Johns Hopkins as the model worth emulating nationally—and has continued into the new millennium, with The Johns Hopkins Hospital and school of medicine programs consistently ranked at or near the top in the annual U.S. News & World Report’s rankings year after year.
As former Dean/CEO Edward Miller says, “Changing a culture when things are going well is a lot more difficult than when you’re having major problems.”
That didn’t stop Miller and others from trying. For nearly 40 years, faculty members here have been engaged in important URM diversity efforts. These began in an adhoc manner going back to Roland Smoot, and began gaining steam in the late 1980s and onward as African-American faculty members—including Levi Watkins, Neil Powe, Ben Carson, David Nichols, Hoover Adger, Lisa Cooper and other Johns Hopkins pioneers—made their presence known nationally as willing mentors to minority medical students, residents and fellows.
The genesis of institutional awareness and the power to take direct action came in 1997, when The Johns Hopkins Hospital and the school of medicine were formally combined and Miller came in as the first dean/CEO. Previously, the school had no board of trustees and little autonomy to enact diversity programs.
“Shortly after I took over in Baltimore, Dave Nichols really convinced me that a diverse faculty was important,” says Miller today. “[Nichols said], ‘When Hopkins started in 1893, it was East Coast white males who were the intellectuals because that’s where the major educational institutions were, and those people went into medicine. But as time has evolved, the best and brightest may no longer be on the East Coast. They could be on the West Coast. They may be outside the United States. So if we want to stay No. 1, we need to be able to go after the very best and brightest wherever they come from, whatever their racial background might be.’
“That convinced me [diversity] was the right way to go,” says Miller.
Nichols and Watkins brought Miller data in the early 2000s quantifying the nationwide dearth of URM medical school faculty members. Concurrently, those early ad hoc efforts were beginning to take off. In 2002, the Department of Medicine created the school’s first departmental diversity council, modeled in part on the department’s earlier successful effort to better recruit and promote women faculty members.
“Mike Weisfeldt, our chair of medicine at the time, had come from Columbia,” recalls nephrologist Deidra Crews, the current diversity council chair. “When he came in, he would meet minority faculty members and trainees, and felt their careers weren’t advancing in the way that he expected. He and others worried systematic issues were at play that were causing this.
“So first, we needed to know who in our faculty were at what rank, gather data and anecdotally understand the barriers being faced. Then Lisa Cooper, the council’s second chair, and others did a departmentwide survey asking about faculty member experiences. It found minority faculty members were more likely to be planning to leave Hopkins within five years and were more likely to have been harassed or treated unfairly in their position as faculty members.”
While the Department of Medicine’s diversity council planned and began implementing programs to address and eliminate these inequities, Miller urged the Board of Advisors to fund scholarships to recruit 12 minority medical students. “That changed the medical school,” says Clements. “It brought in outstanding students, some of whom later joined the faculty. And it inspired Ed to bring in a group that did diversity training with our leadership and advised us.”
One particular retreat underscored the need to change the way faculty recruiting was conducted. “In the past,” says Miller, “we’d invite an outside expert in to consult with search committees. That expert was often male and white. And he’d often say, ‘Here are the top three people you should look at for this job,’ and they’d all happen to be white and male. [The retreat leader] told us that the outside expert was really influencing the committee. We learned nothing would change unless we researched and reached out to candidates ourselves and asked them to put their names in. That’s how diversity happens. And that’s what we did.”
Clements recalls that same workshop and its impact. “We realized we had to take this on because, as an institution, we were really behind on diversity recruiting,” she says.
The ball started rolling. In October 2006, “diversity and inclusion” was established as one of Johns Hopkins Medicine’s four core values. In 2007, Miller worked to create the Robert E. Meyerhoff Assistant Professorship, which set aside monies specifically targeted to recruit and retain URM faculty members identified as future leaders in their specialties.
Perhaps the most recognizable and ongoing commitment came in 2009. Miller, along with Clements, launched the school of medicine’s Office of Diversity and Cultural Competence. Much like the Office of Women in Science and Medicine, created just a year prior, it offered networking resources, celebrated faculty member promotions and achievements, and shone a light on the emerging field of documenting and addressing health disparities.
Key to both offices was that they had gravitas: They were headed by dean-level hires, guaranteeing a constant voice would be at the table, reminding all departmental leaders to keep diversity issues front and center, and underscoring that progress—or lack of it—would be subject to regular review and reports.
Chiquita Collins took full advantage of this. Hired in 2012 to succeed Brian Gibbs, she had the title, the clout and the full backing of incoming Dean/CEO Paul Rothman to ensure she was part of every senior faculty search committee effort—from search inception to candidate selection.
By all accounts, Collins did an outstanding job finessing discussions of unconscious bias in approaching and evaluating candidates, and how it could be recognized and mitigated during the hiring process.
“I tried to present the material in a way that was not pointing the finger. I was adamant about sharing some of my own personal biases up front. I think that put a different lens on the discussion—here I am, an African-American woman, a person of color, and I’m not immune from biases,” says Collins, who recently left Johns Hopkins to become the first vice dean for diversity and inclusion and chief diversity officer at the Joe R. and Teresa Lozano Long School of Medicine (formerly UT Health San Antonio).
In essence, what Collins and her predecessors did was to plant and nourish the seeds of faculty diversity across the school of medicine’s garden.
Now, it was time to ensure those seeds could establish deep roots and bloom.
Agents for Change
Across the nation, URM faculty members are well aware of medicine’s checkered history in the treatment of both patients and staff members of color. Memories have been passed down through generations of minority communities, along with bitter reminders of the segregated symbols of the times, including at The Johns Hopkins Hospital, where there were separate bathrooms and cafeterias for people of color, and their blood donations were stored on shelves separate from that of white donors.
Given the acute awareness of these historical realities, leaders here know the importance of building trust when recruiting and retaining minority faculty members. The hiring of Assistant Professor Erica Johnson in 2014 offers a blueprint of how true diversity is about an institution walking the talk.
“Hopkins is in my hometown, and I understood the relationship of Hopkins to Baltimore, and my grandparents had stories of distrust with the institution,” says Johnson, who came to Johns Hopkins after an 11-year stint in the Army Medical Corps, where she had been promoted to Major. “I saw the overall residency program and the department of medicine here at Johns Hopkins Bayview specifically as being particularly oriented to repairing some of that distrust,” she says, explaining how her recruitment experience nurtured confidence in the institution.
“‘Token hiring’ is a very real problem in medicine, and I have peers at other academic institutions who very much feel that way,” says Johnson, who now heads Johns Hopkins Bayview’s internal medicine residency program. “But I really have to credit Hopkins; throughout my recruitment and onboarding process, they made it clear they were interested in supporting me and established a mentorship team for me to ensure my success.”
For Johnson, that support includes access to funding dedicated to URM junior faculty career development. Rothman established the Strategic Recruitment and Retention Program in 2014 to increase URM faculty representation. His rationale was simple: “When we have diverse voices around the table, we make better decisions.”
The grants of up to $50,000 each, for up to three years, must be used for the faculty members’ scholarship and academic development. To date, 16 such grants have been awarded to URM faculty members.
Some recipients have said those monies proved Johns Hopkins’ commitment during the recruiting process. “Dr. Clements said to me, ‘That’s for you to use. I don’t want your bosses regulating it. This is for you to launch your career,’” recalls Alejandro Garcia, an assistant professor of surgery, who used the grant to begin research in pediatric irritable bowel disease. “The other universities recruiting me didn’t offer that grant, nor did they say what Bob Higgins [head of surgery] said to me. ‘I’m invested in you. Your career is more important than my own advancement.’”
Similarly, the Meyerhoff grants established back in 2007, of roughly $40,000 a year for five years, have now benefited six URM junior faculty members, including the two current Meyerhoff Professors, Jonathan Chrispin, an assistant professor in cardiology, and Arthur Vaught, an assistant professor of gynecology and obstetrics. As a child growing up in Memphis, Vaught had been encouraged to go into medicine, a field that fascinated him from the moment he visited his grandmother following triple-bypass surgery.
“I met the surgeon—I was about 10—and I said to him, ‘Wow! You held my grandma’s heart in your hand!’” says Vaught. But his dad issued a warning to his son about surviving as a minority in work and academic environments. “He said, ‘Make sure you are always at your best because your rare flaws will be easily noticed.’ But now, with the Meyerhoff award, it’s just the opposite. I’m being noticed for doing positive things. People at Hopkins are rooting for me to function at my maximum capacity and really be an agent for change.”
Part of that change is seeing a diverse faculty as vital to a well-constructed pipeline that runs deep and wide and never stops flowing. Such a pipeline offering affordability, accessibility and opportunity in academic medicine is now more crucial than ever, which is why diversity efforts at Johns Hopkins are also being targeted at the entry point.
“The truth is, today, there are fewer African-American males entering medicine than 10 or 15 years ago,” says Robert Higgins, who became the school of medicine’s first African-American department head in 2015.
“If you are comparing the medicine trajectory to choosing other fields such as law, business, engineering or entrepreneurship, where you can actually get scholarships, that’s a much less tedious and expensive path forward. Layer on the inherent apparent bias and racism for black men in medical fields, and they may wonder if it’s worth the time and effort.
“So what we need are more role models speaking to the positives of this career path, the satisfaction of medicine, the joy and impact on people’s lives, even the homes they’ve built despite an academician’s salary,” he says.
Today, a wide variety of institutional programs—some established a decade ago, others quite new—are connecting school of medicine faculty members with the neighborhoods surrounding The Johns Hopkins Hospital.
The Summer Academic Research Experience and the Johns Hopkins Initiative for Careers in Science and Medicine program are both aimed at young people interested in hands-on experiences in research and medicine. Many participants come from impoverished neighborhoods and desperately need mentors committed to developing their potential.
Other programs, such as Medicine for the Greater Good and Centro SOL—the Center for Salud/Health and Opportunity for Latinos—are wide-reaching efforts addressing the health needs of underserved populations at higher risk for certain chronic and potentially fatal diseases.
This isn’t lost on URM faculty members who’ve seen the impact of these health conditions up close. Research shows they’re often drawn to study such conditions, and their ability to engage personally, clinically and scientifically with these patients can yield more effective treatment protocols. That kind of engagement builds trust and makes Baltimore a place they want to call home.
“I feel like I contribute uniquely to this cohort of patients,” says Centro SOL co-founder Kathleen Page, an associate professor of medicine who was born in Uruguay and raised in Bolivia. “And it’s my job to be the squeaky wheel in meetings around Hopkins and remind other faculty members and leaders: ‘Well … what about your Latino patients? Don’t forget about them!’ That’s the key point of having diverse faculty. It’s not just numbers; it’s point of view. That’s why we need everyone.”
Moving the Needle
Based purely on the numbers, the needle is moving: Crews says salary reviews done by the Department of Medicine show no differences by URM status among faculty members. As for URM faculty representation schoolwide, in 2005, 6.5 percent of school of medicine faculty members were under-represented minorities; today, it’s the aforementioned 9 percent.
Collins noted that 55 URM faculty members came aboard during her five-year tenure, a time that overlapped with two other key diversity initiatives: the hiring of James Page in 2015—he oversees diversity efforts for every employee, patient and contractor who falls under Johns Hopkins Medicine’s umbrella—and the 2015 University President’s Faculty Diversity Initiative (FDI). That five-year, $25 million initiative “supports recruitment and hiring of diversity faculty members universitywide,” says Collins, who launched nine initiatives with FDI funding. These include a school of medicine action plan to implement and measure the effectiveness of new diversity programs.
Janice Clements has found great value in these extramural funds. “I hear from a department probably every other week attempting to recruit a minority faculty member,” she says. “In the last month, I’ve received two Target of Opportunity awards from the university—unrestricted dollars for three years that augment a faculty member’s startup.”
Is there still work to be done? Of course. Currently, just eight of the school of medicine’s 32 departments have a faculty diversity council, and medical school scholarships that other schools offer to URM students currently do not exist at Johns Hopkins.
Still, there is a sense of tempered optimism among under-represented minority faculty leaders.
“We outpace many of our institutional peers in URM faculty representation. There are departments of medicine that have two URM faculty members. We have 40,” says Crews. “However, our faculty by no means reflects the numbers found in the overall population, and certainly not here in Baltimore. So we are not satisfied, and we still have a long way to go to improve the experiences of URM faculty at our institution.”
Higgins agrees but is cautiously optimistic about the future. At this moment, in this place, he says he has the power to do what so many before him were denied: to give those with the best ability a chance to succeed.
“Now that the door is open,” he says, “I can recruit the next generation, who may be black, white, men, women, straight, gay, Latino, whatever. So our health system leadership knows I’m creating an environment of excellence.”
“‘Token hiring’ is a very real problem in medicine, and I have academic peers at other institutions who very much feel that way. But throughout my recruitment and onboarding process [at Hopkins], they made it clear they were interested in supporting me and established a mentorship team for me to ensure my success.”