Who’s not at the table? Disparities in healthcare leadership
I remember it as if it just happened yesterday, “this is Dr. Morgan, she is my boss now”. These were the words of the former Chief Medical Officer of the company, a white man, who introduced me for the first time to the group of health care C-Suite executives that I would be working with. His stern introduction appeared to be some sort of rite of passage. As I took my seat at the table surrounded by white men, most at least 20 years my senior, the voices of welcome were drowned out by the daunting realization of loneliness that accompanies leadership as an African American. The certainty of seeing less people who looked like me in these leadership spaces was inevitable. Throughout the years, sadly, this has remained true.
Disparities in diversity of healthcare leadership and governance has largely been attributed to racial discrimination and bias. While African Americans and other non-whites have increasingly gained a seat at the table in diversity & inclusion positions, their presence in top leadership in health care organizations, such as the C-suite, board of directors, and management, is lacking. For the few who gain a seat, they are often alone, and their voices are silenced due to being afraid of unjustifiable backlash that comes from not conforming. African American leaders recount stories of being labeled as “unsociable”, “unfriendly”, or “overly-sensitive” when their participation in this system of inequity, one that has been socialized as being right, is questioned. They have the title without the power and the pressure of having to work twice as hard to be respected.
I had the painful experience of backlash from a trusted mentor after a promotion. The promotion was not worth the daily microaggressions and attempts of sabotage, however, I stood strong. Others have been passed up for justifiable promotions; a phenomenon which has been described by some as “the classic case of training and doing the work for the inexperienced white male colleague who received the promotion instead of the qualified black person.” While certainly this is not always the case, what is indisputable is that white privilege often acts as a pass which grants those that are part of an informal network special access to opportunities that leave others left out. Whether conscious or not, research has shown that years of exposure to structural racialization and privilege perpetuate inequities and harmful biases that foster racial injustice in the workplace. That’s a heavy burden to carry: being judged at a microscopic level based on the color of your skin. This is what white privilege and racism in the workplace looks like.
According to the 2015 study by the American Hospital Association's Institute for Diversity and Health Equity, minorities represented 11% of executive leadership positions at hospitals, compared with 12% in 2013. Boards and hospital C-suites remained predominantly white, and only 14% of hospital board members and 9% of CEOs were minorities. This stark disparity continues to persist even as African Americans and other non-white groups are increasingly becoming a larger part of the patient population these systems serve. In addition to the moral case to end racial discrimination and health disparities, the business case for having leaders from various backgrounds, particularly those that resemble the makeup of the people they serve, has shown promise in reducing bias, promoting trust, compliance, and improved health outcomes.
It’s disheartening to see organizational charts full of faces in leadership who don’t look like you. Pipelines for the recruitment and retention for African Americans and other non-whites in these positions need to be expanded and strengthened. This happens best by intention; policies being put in place and enforced and not left to chance. Like many, I felt confident in my ability to do the job if given the opportunity and the resources to succeed. Sadly, however, this opportunity is not granted for most due to the color of their skin.
Written by: Tamiko Foster, MD, MPH