To be serious about diversity, academic medicine must pay
As I started interviewing for my first post-fellowship position as a neuro-oncologist, I immediately realized that I could work in private practice and earn a good salary or earn a lot less by choosing to work in a teaching hospital where I could do research and help train new doctors. Ultimately, I accepted a job at a teaching hospital that gave me the time, resources, and support to pursue a career in health equity.
But as a first-generation Guyanese doctor, the decision wasn’t easy, especially when it came to salary.
I’m not alone. Every year, thousands of physicians must make this same decision when considering a career in academic medicine. But that weighs heavier on Black, Indigenous and People of Color (BIPOC) doctors, who are less likely to have generational wealth and often struggle with significant student debt. This is reflected in the makeup of today’s physician pool: Black, Latino, and Native American physicians make up 11.1% of the total physician population and 9.3% of medical school professors, though they represent 31.7% of the American population.
Although compensation is not the only barrier to diversity in academic medicine, it is one of the most important.
It is a privilege to be a doctor. It is also a privilege to be financially and professionally secure enough to embark on the path to becoming a doctor, which includes four years of medical school and a minimum of three years of residency, and lasts even longer for those who pursue doctorates or scholarships for some. specialties. And that doesn’t take into account what pre-med students often pursue to become competitive candidates, which can include years of volunteer work or service.
All this preparation costs money. This is not just the direct cost of medical education, but also additional costs for test prep, applications, and exams, not to mention travel costs for medical school interviews and residency.
Then there is the opportunity cost: years of lost income paying exorbitant tuition fees. Investing $300,000, the cost of attending many medical schools, in an index fund mirroring the S&P and achieving a 10.5% annual return would yield over $800,000 in 10 years.
For many, becoming a doctor remains a worthwhile investment. Once you’re in the club, you can make a better living than most Americans, though for many young doctors like me, that goal is long overdue. I used my credit cards to the max to pay for medical school interview travel expenses. The interest accrued until I could use the student loans I got to pay off my credit cards, trading one debt for another. Later, I used my resident and scholarship salary to pay expenses, start paying school loans, pay professional fees, and support my family. Student loans — which I’ll be paying off for another decade — are the most important accounts on my credit report and the biggest obstacle to buying my first home.
It was therefore a difficult decision to join the ranks of university medicine and accept a lower salary. It was a decision I could make because I come from a two income household. But many in my position cannot choose this option.
In recent years, there has been an emphasis on the importance of diversity within medicine, with many academic medical centers expressing sentiments in support of efforts for inclusion, diversity, equity, Anti-Racism and Social Justice (IDEAS).
BIPOC will continue to be underrepresented in this field for years to come, as the pool of future physicians reflects the nation’s current flawed institutions, with many students excluded from consideration for a medical career before the end of high school.
But I believe there are ways to start closing the representation gap between academic medicine and medical school faculty right now.
One solution is to increase the remuneration of university doctors. Although they generate less revenue for hospital systems and medical organizations than physicians who primarily see patients, conducting medical research and training new physicians is important work that deserves fair compensation. An overall increase in compensation would help make this career choice accessible to those without significant resources.
Another option is to target funds and grants to attract first-generation physicians or BIPOCs. This could be done as needed. New faculty hires might complete financial forms to determine their eligibility for this type of funding, or it might be done through a proxy indicator, such as qualifying for federal Pell Grants. Other programs could include strong loan repayment programs that work in addition to federal options, mortgage relief programs, housing subsidies, and signing bonuses.
Pay transparency is also important. I’m not just talking about total compensation, but what’s in it. BIPOC doctors support the “minority tax” and are often asked to take on many unpaid obligations, such as serving on diversity committees and anti-racism task forces. Although this is important work, it takes away time that could be spent on academic productivity or clinical work. The time and effort devoted to these committees and working groups must be remunerated.
Transparent salaries would also help close the gender pay gap. The Association of American Medical Colleges offers access to its faculty salary report for $1,150 for nonmembers; providing this service free of charge to potential and junior members would help to mitigate wage asymmetry.
Where will this money come from? This is where the country’s leading academic medical institutions must lead by example. Mass General Brigham, Mayo Clinic, Cleveland Clinic and Cedars-Sinai all reported hundreds of millions of dollars in operating revenue (profits) last year. More than 40 universities with endowments of more than $1 billion each are associated with medical schools. The combined endowments of Harvard, Yale, Stanford and the University of Pennsylvania total over $120 billion. Institutions like these have the money to invest in programs and initiatives that recruit and retain BIPOC faculty members.
National agencies must also lead by example, particularly in helping academic medical centers which may not have the financial flexibility to invest in support programmes. The National Institutes of Health, which provides a significant portion of research funding in the United States, has a consortium of diversity programs. Increased funding for this program could be used to support researchers from diverse backgrounds in institutions that lack financial resources. For teaching hospitals, the graduate medical education program under Medicare provides salaries for medical residents. Increased funding for this program could be used to support faculty diversity. Both of these suggestions build on the federal government’s ongoing commitment to improving diversity and advancing equity.
While solidarity statements emphasizing IDEAS are helpful, discussions are inexpensive. It’s time to pay.
Joshua A. Budhu is a neuro-oncology researcher at the Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Massachusetts General Hospital, and a Commonwealth Fund Fellow in Minority Health Policy at Harvard University.