Racial fatigue: Minority doctors feeling the pressure

Black physicians say workplace silence can be as demoralizing as open racism.

By Myrle Croasdale, AMNews staff. July 23/30, 2007.

The parents of a pediatric resident's patient asked that she be taken off their child's case. It was not because of her capabilities. They didn't like the color of her skin. The resident, now a practicing physician, still tears up when she revisits the incident.

Marcella Nunez-Smith, MD, MHS, recounts this story and others she heard from black physicians while researching their workplace experiences in 2005. A black physician herself -- and a general internal medicine instructor at Yale University School of Medicine in New Haven, Conn. -- Dr. Nunez-Smith began her investigation after the topic arose repeatedly over coffee with friends.

In her initial research, published in the Jan. 2 Annals of Internal Medicine, she found that the racism black physicians face is often more subtle than being called the "n" word. As she expands this study, Dr. Nunez-Smith is finding that black physicians nationwide experience a general stress related to being black and being a doctor, such as an elusive promotion or a lack of referrals from other physicians.

Call it racism, negative experiences, or, like Dr. Nunez-Smith, call it "racial fatigue." Regardless of the terminology, it undermines careers and erodes job satisfaction, diversity experts said.

"You make it in your career based on how you fit in. When people get disenchanted trying to make that career, they go do something else. It's a tremendous loss," said Daniel J. Wooten, MD, a black physician who has been teaching and researching health care disparities as executive associate dean of academic and faculty affairs at James H. Quillen College of Medicine, East Tennessee State University at Johnson City.