See It to Be It: Diversity and Inclusion in Academic Pediatrics Starts at the Top.

Abstract

Over the last several years, academic pediatrics has made a concerted effort to address diversity and inclusion, certainly accelerated by the heightened national discourse and activism in the wake of the May 2020 murder of George Floyd.1 The Academic Pediatric Association (APA), the American Academy of Pediatrics, the American Pediatric Society (APS), and the Society for Pediatric Research, the partner organizations that comprise the Pediatric Academic Societies, have taken notable steps in promoting diverse and inclusive environments as part of strategic commitments to address equity and health equity broadly.2–5In this issue of Pediatrics, Omoruyi et al6 detail the trends of pediatric faculty underrepresented in medicine (URiM) over the last 2 decades. Despite overall growth in URiM pediatric faculty at all academic ranks, these increases have notably failed to keep pace with the rapidly diversifying population of children <18 years old in the United States. Dramatically discordant with the percentage of people of color in the general population at baseline, the authors point out the importance of growing a diverse and culturally competent physician workforce to effectively address the systemic inequities and health disparities that disproportionately impact vulnerable and historically marginalized communities. Structural barriers that contribute to noninclusive professional environments, including feelings of isolation, perceived lack of academic opportunity, and microaggressions and outright racism, have all been cited by URiM faculty as contributing factors to negative and less than satisfactory experiences.7,8 Additionally, the authors specifically highlight stagnation of African American male representation among pediatric faculty, reflective of the overall decline of this demographic among medical school matriculants since 1978.9 Complicating the multifactorial challenges at the entry point, the career pipeline for African American men in academic medicine is particularly leaky, beset by retention challenges including lack of scholarly advancement and relatively higher rates of attrition.6The value of exposure of early career URiM trainees and junior faculty to programs that emphasize academic scholarship and focus on successful navigation of the academic landscape has been recognized and supported by academic pediatric organizations.10,11 Specifically included as part of the curricular content of one such program (the APA’s “New Century Scholars”) is concordant alignment of participants with both a junior and a senior faculty mentor. This triad model is designed to not only support the participants’ scholarship, but also to promote career and leadership development through the important experiential lens of “if I can see it, I can be it.” URiM trainees have identified the opportunity to develop such relationships as a positive influence in choosing academic pediatrics.12 Therefore, the task of aligning, supporting, and ultimately growing the relatively small pool of URiM pediatric faculty to serve in mentorship or sponsorship capacities is a key element of diverse and inclusive workforce development.The American Academy of Pediatrics policy statement Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making emphasizes the need to advance diversity in leadership roles.13 The current constellation of leadership across the Pediatric Academic Societies serves as a perfect example. The APA and Society for Pediatric Research presidents-elect are both from URiM groups as are both the current APS president and president-elect.14–17 Additionally, 2 of the leaders in this cohort are men of color. The intra- and interorganizational energy across the Pediatric Academic Societies is palpable as these leaders chart the course for advancing diversity, equity and inclusion in their respective organizations. The collective talent and unique lived experience perspectives of these individuals will provide valuable synergy and “see it to be it” visibility for members as all pediatric providers engage in this necessary work. Transformative change in any profession, sector, or domain starts with leadership at the top; addressing diversity and inclusion in academic pediatrics is no different.To be clear, the work of diversifying the pediatric workforce should not be limited to URiM leaders and practitioners. In a 2020 commentary,18 Reddick analogizes the onerous labor of African American leaders in dismantling workplace racism to the work of the folklore hero John Henry. Henry, an African American “steel-driving man” ultimately defeats a machine in a race to bore an underground coal mining tunnel. However, he dies at the end of the narrative tale of heart failure. The so-called “minority tax”19,20 borne by URiM physicians in addressing issues of bias and racism in patient care, policy, and faculty development is deleterious to personal physical and mental health, clinical performance, and professional advancement. URiM and non-URIM practitioners must evenly disseminate diversity, equity, and inclusion work to ensure that all academic pediatricians positively contribute to the reframing of our institutional and professional environments.