The Flexner Report of 1910, which disparaged Black medical colleges and led to the closure of a majority of these educational institutions, had a lasting, negative impact on diversity in the U.S. physician workforce. Dr. Blazer said one effect of this report, and other systemic changes in medical education, has been only a 1.4% growth in the number of Black physicians over the past 120 years. No rheumatology fellowship training programs currently exist at historically Black medical institutions.
In this historical context, Dr. Blazer noted that it’s essential the ACR and other organizations commit to increasing diversity and inclusiveness in the field of rheumatology.
Rheumatology Care & Workforce
Andrea Knight, MD, MSCE, pediatric rheumatologist at the Hospital for Sick Children, Philadelphia, and an assistant professor at the University of Toronto, provided a practical model for increasing diversity, equity and inclusion in pediatric rheumatology. She encouraged rheumatologists to:
- Create a culturally safe space for patients and families;
- Integrate patient and family-centered communication in routine practice;
- Hire and train a diverse workforce; and
- Advocate for accessible resources for patients.
She recommended developing a diverse workforce at four stages along the career pipeline: engaging students at an early age, recruiting minority students into training programs, retaining individuals after they have completed their training and providing the resources to sustain and nourish their careers.
We can help build up trainees and colleagues from marginalized groups by providing mentorship, sponsorship and allyship, according to Dr. Knight. She also noted that health equity must continue to grow as an important topic in rheumatology research. Partnering for systemic change will require engagement, advocacy and policy making from community leaders, patient foundations, schools and educational organizations, and local, state and federal governments.
It’s clear we have a long way to go to achieve diversity, equity and inclusion in rheumatology, but it’s possible with such trailblazers as Dr. Rubinstein, Dr. Blazer and Dr. Knight leading the way.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Ringold S, Beukelman T, Nigrovic PA, et al. Race, ethnicity and disease outcomes in juvenile idiopathic arthritis: A cross-sectional analysis of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol. 2013 Jun;40(6):936–942. Epub 2013 Apr 15.
- Chang JC, Xiao R, Burnham JM, et al. Longitudinal assessment of racial disparities in juvenile idiopathic arthritis disease activity in a treat-to-target intervention. Pediatr Rheumatol Online J. 2020 Nov 13;18(1):88.
- Yen EY, Singh RR. Brief Report: Lupus—an unrecognized leading cause of death in young females: A population-based study using nationwide death certificates, 2000–2015. Arthritis Rheumatol. 2018 Aug;70(8):1251–1255. Epub 2018 Jun 27.
- Hoffman KM, Trawalter S, Axt JR, et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016 Apr 19;113(16):4296–4301. Epub 2016 Apr 4.
