“I’m sure they will want to work with you because, well, you know…you’re black.”
I (K.M.D.) heard these words in 2016, at an interview for a faculty position at a highly ranked academic medical center. The “they” in question were a respected group of researchers affiliated with the institution. I was meeting with more than one senior department member, and I’d asked about research and mentorship resources at the institution.
I entered the interview proud of my accomplishments. I was bursting with enthusiasm about all the possibilities available in academic medicine and carried my detailed, color-coded 5-year plan, complete with budget projections, in my folio. But in that moment, I was reminded of the common no-win lens through which I would be viewed: my potential success was undermined by the implication that my race, not by ability, was my real qualification. And if I was not successful, I would simply validate the “diversity-hire” stereotype, proving that I never really deserved my position to begin with. As in many times that would follow in my career and those of my peers, I was reminded that people I liked, respected, and looked up to would hear such comments — and say nothing.
Such experiences are real phenomena that can affect all physician faculty from racial and ethnic minority groups that are underrepresented in medicine (URM), and they are more common and severe in specialties in which extreme underrepresentation is the norm. To reach their positions, URM faculty in highly specialized areas are often ultra-achievers who have managed to overcome both the competition involved in entering a subspecialty field and the structural racism inherent in a medical education system that perpetuates societal devaluation of people of color.
This achievement often paradoxically results in significant isolation. Isolation, in turn, leads to some adaptive behaviors, including “code-switching,” or adjusting one’s style of speech, physical appearance, behavior, and facial expressions in ways that will optimize the comfort of the (nonminority) people with whom one interacts, in exchange for fair treatment, high-quality service, and career opportunities. Former President Barack Obama made an art form of this survival technique, but code-switching can deplete cognitive resources, impede performance, and ultimately result in further isolation.
At the same time, URM faculty are hypervisible, both because they stand out physically and because their institutions often try to showcase them in marketing or recruitment materials in order to demonstrate the diversity of their workforce. A consequence of this hypervisibility, however, is an intensification of “stereotype threat” — whereby URM faculty experience the added pressure of representing their entire community, and thus any failures carry an additional consequence of confirming negative stereotypes in the eyes of the majority, resulting in a narrow margin of error in career pursuits. For people who have defied the odds by succeeding, this narrow margin of error can create an incremental, risk-averse approach to both research and career-building — a limiting strategy that can unfortunately serve as evidence of the very stereotype of limited potential that URM faculty seek to avoid.