As my loyal readers know, I don't hesitate to brag about BIDMC when I think we are deserving, but I also write about areas where we need to improve. This is one of those latter topics. I can't cover it all in one post, so I will follow up with more in coming days and weeks.
Here's the issue. If you were to look at the mix of patients here, it would feel like a mini-United Nations in terms of the racial mix. But, if you look at the medical staff -- full-fledged physicians, fellows, and residents -- it looks different, with under-represented minorities being a very small percentage of our trainees and attending physicians. (By the way, on the proportion of men and women, the story is better.)
This is a general problem in medicine nationally (with little progress notwithstanding well intentioned efforts). It is a bigger problem in Boston than other places, and I believe it may be a bigger problem at BIDMC compared to some other places in Boston. "Why here?" is the question I'd like to explore with you, and I'll give you real numbers and other facts in future posts, along with how we are trying to do better.
For today, let's start with the beginning of the physician pipeline. Harvard Medical School does quite a good job in recruiting a diverse entering class. Here is an article from a few years ago documenting this, showing about 19% minority admissions. Those students spend a lot of their time in the Harvard hospitals (BIDMC, MGH, Brigham & Women's, etc) doing their clinical rotations. I think it is fair to say that they love the time spent at BIDMC because we have great teachers and give them a great educational experience.
Then the students apply for residency programs. The minority students are in great demand, and they do very well in terms of the "match" process that characterizes the residency selection program. Many HMS graduates want to stay in Boston, but there has always been a tendency among them to seek the residency programs that have greater prestige. MGH in particular has always been viewed that way. But the other thing that happened here from 1996 on was the financial disaster following the merger of the BI and the Deaconess. For years, the local pool of HMS applicants that might have been interested in BIDMC, including the minority applicants, essentially dried up. Simply put, they feared that this hospital would not be around much longer. So the primary source of minority medical students that were most familiar with our hospital and comfortable with our faculty basically disappeared. And since residents serve as a major source of faculty recruits going forward, if this pipeline dries up, you start behind in terms of expanding the number of young minority faculty members.
With the financial recovery of the BIDMC and the reinvigoration of our clinical and education programs, we are back to being seriously considered by HMS graduates as they apply for the residency training. That should help. But it does not address the full range of concerns.
In the next postings, I will cover more of this topic and also will move up the pipeline and successively cover junior faculty, senior faculty, and chief-of-service issues.