By Alyson Myers, M.D.
Associate Chair of Diversity, Equity, and Inclusion
Department of Medicine, Montefiore Einstein
Jay-Z once rapped: “This is anti auto-tune, death of the ringtone. This ain’t for iTunes, this ain’t for sing-alongs.” The same can be said for the pending death of diversity, equity, and inclusion (DEI). Recently, the Florida House of Representatives proposed bill HR 999. The March 2024 version of the bill states: “A Florida College System institution, state university, Florida College System institution direct-support organization, or state university direct-support organization may not expend any state or federal funds to promote, support, or maintain any programs or campus activities that: advocate for diversity, equity, and inclusion.
![Alyson Myers, M.D.]()
Alyson Myers, M.D.
Faculty ProfileResearch Profile
Florida is not alone in their attempted burial of DEI. Texas has HB 1006, filed by State Representative Carl Tepper, which prohibits higher education institutions from using state funding for anything related to DEI. Mr. Tepper views DEI as “division, inequity, and indoctrination.” HSB 218 has been introduced in Iowa, which prohibits institutes of higher learning “from expending monies to fund diversity, equity, and inclusion offices or to hire individuals to serve as diversity, equity, and inclusion officers, creating a private cause of action, and including effective date provisions.” There is also the Protect Students First bill in Georgia. A DEI colleague in that state is now unable to use the terms racism, anti-racist, or inclusivity when teaching. They were also unable to provide a prayer space to those who needed to pray during the month of Ramadan.
The current DEI movement is a reawakening of the civil rights movements of the 1960s and 1970s, a time when segregation, sexism, racism, trans/homophobia, disability discrimination, and anti-immigration stances were legal in American society. In 2020, there was a reemergence of this movement after the murder of George Floyd, as well as the disproportionate number of deaths of marginalized communities from COVID-19.
Why diversity? Diversity is actually good for health care, as it can improve health outcomes. People often link diversity with race, ethnicity, or gender, but it is more than that. Having a workforce of people with different skills and backgrounds promotes diversity of thought. I saw this clearly during a case vignette competition at the annual meeting of the Association of Medicine and Psychiatry in 2022. A resident presented the story of a Honduran woman who had been admitted after swallowing a toothbrush. For eight months she kept coming back to the ED with unintentional weight loss and was deemed as having psychiatric issues. She noted that when she vomited, she felt better. When her finger could no longer be used to induce vomiting, she started to use her toothbrush. Her care was further complicated by the fact that she did not speak English. The swallowed toothbrush led to an EKG that showed heart block, and eventually she was finally diagnosed with Chagas disease. After the presentation, a Brazilian resident commented that she would have had that in her differential from the beginning as Chagas disease is endemic in Brazil. Imagine the reduction in length of stay and improved patient satisfaction had this woman been diagnosed sooner!
Why do we need health equity? Albert Einstein attached his name to our medical school because he was committed to helping the underserved, based on his lived experience as a Jewish man growing up in Nazi Germany. He saw similarities in the maltreatment of his people by the Nazis with the maltreatment of Black persons in America. Some of these injustices are still seen in health care, where Black women are three times as likely to die in the peripartum period regardless of socio-economic status or education compared to white women. These inequities of mortality can also be seen in diseases such as breast cancer or cardiovascular disease.
Closing these health care disparity gaps should be the goal of all medical practitioners as we took a Hippocratic oath to do no harm. The 2022 Department of Medicine Health Equity Challenge had the divisions of nephrology and general internal medicine come out on top mostly due to their numerous health equity grants. Other notable efforts within the department of medicine are critical care’s monthly health equity journal clubs accompanied by quarterly lectures on topics of health equity. For those who did not win or participate, I would challenge you to figure out how you can integrate health equity into your curriculum, grant writing or patient care.
The department of medicine has sponsored the Bronx bus tour, which has been a part of orientation for our residents but not our fellows. In September 2022, we changed that by offering the tour to the fellows as well. The Bronx bus tour gives trainees a bird’s eye view of how our patients live by going into their neighborhoods. I attended with the second-year endocrinology fellows, and they all agreed that they wish they had done it as first years. The tour allowed them to visualize the disparities that their patients face daily such as poor transportation options and limited access to grocery stores. The feedback was similar from the other fellows who attended the September 2022 bus tour from the divisions of geriatrics, critical care, and cardiology. I look forward to having even more fellows join us this July, including those from the divisions of endocrinology, infectious disease, addiction medicine, cardiology, pulmonology, and critical care. I hope to garner more participation in 2024.
Why do we need inclusion? Back when we were kids you never wanted to be the kid who was picked last for a sports team. The same holds true in adulthood. Last weekend while serving as an exhibitor at the Student National Medical Association, a young lady asked me: How will I feel supported at your institution if I am the only one at your program? This was a fair question as it can be daunting to be the only one of your race, gender, sexual orientation, religion, or disability status. It creates a feeling of exclusion rather than inclusion.
Inclusion starts with understanding that we all have different identities. Looking at someone’s visage or their name does not tell their story. Instead, we have to listen and learn what allows people to work most effectively. At a March 27 session for medicine leadership entitled Increasing Inclusive Leadership, moderator Dr. Richard Orbe-Austin noted that “inclusive leaders need to let go of their own egos and sharing power.” This was best demonstrated by employers who tried to enforce in-office work five-days per week, despite the fact that studies have shown that people are more productive when they have the remote option. For some of us we enjoy the convenience, the avoidance of traffic, the cost savings on gas and tolls, or the extra hour of sleep. For others, working from home is better because they are living with social anxiety, sensory issues from office lighting or chairs, or have the option of using a gender-neutral bathroom.
Inclusion begins with an individual but continues to the system level. Dr. Orbe-Austin gave several suggestions on how leadership can implement inclusion by:
- Providing consistent DEI training/coaching
- Developing a DEI committee with leadership engagement
- Seeking feedback about inclusive practices
- Evaluating the formal and informal processes for training diverse leaders
- Expanding the medicine pipeline
- Use a blinding process when interviewing applicants
Our department has done a good job with suggestions 1-3 and can continue to improve upon suggestions 4-6.
Posted on: Friday, May 05, 2023