Underrepresented Minorities in Surgery

Underrepresented Minorities in Surgery

Erika Adams Newman

David J. Brown



Medical school enrollment of ethnic minority groups continues to decline, and underrepresented minorities (URMs: African American, Mexican American, mainland Puerto Rican Hispanic, American Indian, and Alaskan Native)—make up only 4% of full-time medical faculty.1 This underrepresentation in academic medicine is important to address because disproportionate representation is thought to account for major disparities in health care. Inclusion of URM faculty improves the ability of US medical schools to fulfill their missions of providing high-quality health care to multicultural populations.2 Diversity within academic medicine also propels all aspects of medical education and research.

Underrepresented minorities are more likely to leave academic medicine, are less satisfied with their career trajectories, and advance more slowly compared with majority groups. These are large long-standing racial and ethnic inequities in career
success of URMs in medicine. In a landmark study, Palepu and colleagues found that minority faculty were less likely than white faculty to hold senior academic rank.3 The authors concluded that this discrepancy was not explained by potential confounders like number of years on faculty or academic productivity. Faculty of color, particularly women faculty, are absent from department chair, medical school executive positions, and decanal roles.

Underrepresented faculty experience unique identity-related barriers that impair success. Although many constraints are the same as those faced by majority groups, there are critical environmental and cultural barriers that account for large achievement gaps for ethnic minorities. Faculty of color report that they experience explicit and implicit racism, bias, devaluing of work, and a complex social isolation (being the “only one”) within academic medical centers.4 Nearly half of URM faculty report personally experiencing racial discrimination by a peer or superior compared with 7% of majority faculty.4 Many also report encountering racial or disparaging ethnic remarks at work. Beyond self-reported analyses, little else is known about faculty of color experiences within predominantly white academic medical centers.

Social isolation, exclusion, and subtle unequal treatment are known barriers that URMs navigate in academic medical centers that cannot be understated. Unequal treatment is complex and multifactorial because inequities may not be clear or can be easily reasoned away. In fact, few URMs report or openly discuss instances in which they may have been socially isolated or treated unequally because of fear of retaliation or career derailment. It may also be difficult to pinpoint covert racism and discrimination, and URMs may not be empowered to address topics such as these in the workplace.

To overcome these constraints, it is the responsibility of department leaders to acknowledge and maintain awareness of the unique experiences of URMs. It is important for leaders to develop a skill set that enables them to identify and counter subtle acts of bias and unequal treatment. This includes being able to recognize and address racial achievement gaps, acknowledging that unique barriers exist, and putting systemic processes into place that eliminate inequities. Success is not appropriately achieved by lowering metrics or performance expectations but by recognizing and working to eliminate the unique barriers that URMs face in academic fields and in medical education.


Although progress has been made in providing an inclusive culture for URMs in Academic Medicine, professional identity is often at odds with cultural, social, and personal identities and with traditions of the academy. Recently, education researchers have begun to understand more about the connection between professional identity and academic success.5 Specifically, URMs that develop a positive professional identity may buffer negative stereotypes associated with their social identities. For example, a woman scientist struggling with negative stereotypes about women in Science, Technology, Engineering, and Mathematics (STEM) may try to minimize her social identity in science classes by developing a strong professional identify as an excellent scientist and in turn tend to perform higher on science examinations and be more accepted by her peers.5 A similar line of research found that the development of strong professional identity predicted success for first-generation college women.6 Professional identity
may be difficult to develop because social norms of academic medicine do not align URMs with positions of leadership or with successful rank advancement:

I am struck by my lived contradiction: To be a professor is to be an anglo; to be a latina is not to be an anglo. So how can I be both a Latina and a professor? To be a Latina professor, I conclude, means to be unlike and like me. Que locura! What madness! … As Latina professors, we are newcomers to a world defined and controlled by discourses that do not address our realities, that do not affirm our intellectual contributions, that do not seriously examine our worlds. Can I be both Latina and professor without compromise?

–(Ana M. Martinez Aleman in Padilla & Chavez, The Leaning Ivory Tower; 1995:74-75).

It is beneficial for URMs to develop professional identities that are recognized and supported by peers and department leaders. This will require insight into the impact of negative social norms and how URMs in the academy are initially perceived and placed into categories based on these norms. For example, stereotyping and images that ethnic minorities generally represent, men with dark skin may not initially be considered honest and upstanding, based on current national police-related events or the environment in the US criminal justice system. It is up to mentors, sponsors, and department leaders to facilitate URMs in developing professional identities based on individual talent, passion, and strengths and not based on societal norms or historical standards. This requires an intentionality that is prioritized by2:

  • acknowledging that societal norms highly impact professional identities

  • helping URM faculty determine and develop a positive professional identity matching their clinical, research, and educational passions and interests

  • ushering an open culture in which professional paths are not outlined or driven by social norms and common ethnic stereotypes

Another important aspect of professional identity is the avoidance of labeling research focused on underserved populations, health equity, or community-based activities as “soft” research.2 URMs in academic medicine report that a career that is community-based is not valued or highly promoted among their peers in the same supportive ways as traditional laboratory or clinical research. This is a significant threat to the success of research programs focused on eliminating health disparities or tackling social determinants of health, many of which are driven by and led by URM researchers. On the other hand, if departments are able to maintain a broad slate of diverse research goals, particularly for underserved populations, URMs may perceive the environment as more favorable and are likely to succeed. Academic departments that value community-based research as “real science” will have improved opportunities to develop and maintain URM faculty.


The underlying causes for the achievement gap in URMs in medical education and at the faculty level are unclear and not explained by discrimination alone. Organizational science and medical educators have determined that there are multifaceted and complex reasons for disparities between URMs and majority peers. An example of this is “stereotype threat,” which suggests that work achievements are
impaired by societal expectations of performance. Because certain societal expectations of URMs are negative, studies have suggested that this results in a constant awareness that affects URM performance and underachievement.7 Another study found that rather than stereotype threat, lack of social interventions that bolster self-affirmation and debunk negative stereotypes accounts for achievement gaps.8

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May 5, 2022 | Posted by in GENERAL SURGERY | Comments Off on Underrepresented Minorities in Surgery

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