This is an important discussion to have. Lots of emotion on all sides makes it difficult to look at data, come to our best conclusions, and try to address any issues found without labeling people as "racist" which only amps up the conversation and is unhelpful (and mostly untrue).
Certainly, there are overtly racist people in medicine. But I do hope that they are a very small minority. Is it possible that some programs / geographies have a higher prevalence? Of course. But I doubt this is the primary issue overall.
The interesting discussion here is around difference of outcomes. If we take the ACGME data at face value (there is no way to confirm it, I think it's unlikely that they have massaged it to fit a preferred narrative, and a selection bias is very unlikely as the ACGME collects data on all residents in training), we see that Black residents make up 5% of all residents but make up 20% of all residents dismissed from training. These numbers are in the article but it's all linked to primary data. The data vary by specialty but a larger proportion of Black residents are dismissed from training across all specialties. The data looks solid, I have no reason to think it's not accurate.
The question is why there is this difference. The data only show us the issue, not the reason. Hopefully, we all start with agreement that the answer isn't that minority residents are somehow "worse" than white residents. If we can't agree on that, then any further discussion becomes difficult.
The primary other explanation is "systemic racism". This is a term that often evokes high emotional responses, because it's misunderstood. It's not "everyone is racist". It's that the system / culture we live in has ingrained issues / problems / rules / laws / traditions that impact minorities in a negative way. This includes:
Implicit bias - all of us have implicit biases. I don't like carrot cake. When I go to a celebration and discover that dessert is carrot cake, I get really grumpy. Afterwards if I'm asked how good the party was, I'm likely to give it a lower score. Perhaps a silly example, but we all do this. In Med Ed, the danger is that I may grade a student lower based upon some physical characteristic rather than on their performance -- even if I don't want to. A personal example is students with names I find difficult to pronounce. They tell me their name, it's something I'm not familiar with. In general, I'm not good with names so I find this particularly challenging. The next day, perhaps I can't rmember quite how to pronounce it correctly. So instead, I avoid using their name. There's another student named Steve and I use his name all the time. We work together for a week, and then I need to grade them. Studies show that, on average, I'm likely to grade the student with the name I find difficult to pronounce lower. This is all subconscious -- I'm not punishing them for having their name. It's that I'll think back on our week together and might feel less connected to them. We tend to like people more who are more similar to us, and then this tends to be reflected in subjective assessments. It's insidious and very difficult to account for.
Culture - if the culture of a workplace makes people feel like outsiders / undervalued, that can worsen their performance. In the example above, I could imagine that the student whom I don't use their name will see that, feel less valued than Steve. Their enthusiasm may suffer -- and then that's something that could affect their grade. Perhaps you think they should just power through and ignore this -- but if it's widespread and frequent, that's very difficult to do.
Co-factors / confounders - minority students often come from less affluent backgrounds. This can affect them in many ways -- perhaps they live farther away from the hospital to save money. That would mean a longer commute, which means less sleep / study / personal time. They may get pulled over by the police more frequently while commuting. They may have more trouble affording food and other necessities. They may have less external supports such that when something "goes wrong" in their personal / family life, they can't just have someone else address it and maintain their focus on work. And already mentioned are statements from patients that are interpreted as hurtful -- female residents being assumed to be the nurse, minority residents being told to go get the "real doctor", etc.
The bottom line here is that systemic issues (rather than overtly racist people) may make succeeding as a minority more difficult. Each systemic issue by itself may be relatively small, but they add up over time. And its very clear that once a resident starts to struggle, performance problems tend to mount. When a resident is struggling, programs need to apply more scrutiny to their work. This tends to find more errors, some/many of which they (and others) would have self corrected. This leads to more remediation and more scrutiny. This can create a positive feedback cycle, residents caught in it can become depressed which results in even worse performance, all leading to ultimate termination.
And that's the question raised by the data we see in Med Ed. Do we have an environment that increases the chances that minority residents fail? If so, what parts of that environment can we change to mitigate the issue? The main life lesson that my father repeated to me is that "Life isn't fair". And he's right -- there's no way we can make the world a completely fair place. But we can try to make it as fair as possible, especially the parts we have under our control.
We should definitely not get caught up in individual cases. I know nothing about this resident, her skills, the culture of the program she was in. It's quite possible that she was terminated because her performance was poor and it had nothing to do with her race. She might have been overly outspoken about injustices or had other interpersonal conflicts. She may have been great as an early PGY resident, and then run into performance issues as her responsibilities increased. Or, when her PD left she may have been subject to all of those issues listed above which impaired her ability to perform. I have no idea. But, no matter her story, this doesn't explain the differences we see in termination rates. That does seem to be a problem we should investigate and address.
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