Next Steps in Derm reached out to dermatologists playing a role in overcoming barriers in equity, diversity and inclusion in dermatology for their insight on the most pressing EDI issues in the field.
Issues of injustice and inequality have come to the forefront in our country in the last year, and dermatology is no exception.
“It’s truly impressive to realize that for some of us, there’s a massive blind spot when it comes to understanding matters of inequality in medicine,” said Dr. Omar Qutub, a dermatologist in Portland, Oregon, and the director of equity, diversity and inclusion (EDI) for the ODAC Dermatology, Aesthetic & Surgical Conference. “We have first to make ourselves aware as physicians that equity is hardly commonplace – in medicine or our daily lives – and that we all have a hand in creating a space for a healthy conversation.”
The dermatologists surveyed for this article listed a lack of racial and ethnic diversity in dermatology as one of the most pressing EDI issues in the field. Only 3% of dermatologists identify as Black or African American, and even fewer identify as Native. Dermatologist Dr. Nada Elbuluk, who has led diversity and inclusion efforts at NYU and USC, said the racial and ethnic makeup of the provider population impacts patient care. “Research shows racial concordant visits can translate into more positive outcomes.”
And, according to Dr. Julia Mhlaba, a Northwestern University dermatologist who was the lead author on a study analyzing the effectiveness of a skin of color residency curriculum, “Data has demonstrated that patients often prefer to seek care from physicians who are the same race as them.”
Evidence currently suggests a similar disparity in dermatologists may exist for some groups within the sexual and gender minority population, according to dermatologist Dr. Klint Peebles, who primarily practices in Washington, D.C. “We cannot hope to serve all who have a need for dermatology unless our workforce mirrors the diversity of our patient population.”
Another EDI issue named was the consideration of skin of color as a specialty. “Skin of color should not be optional,” said Maryland dermatologist Dr. Chesahna Kindred. “This notion sends the signal that dermatologists do not have to learn about such conditions and issues even after residency.”
Dr. Qutub said non-inclusive diagnostic criteria when grading or scoring severity in disease states is one of the most pressing EDI issues since severity scores determine treatment plans and outcomes. He pointed out psoriasis grading, as an example, “The PASI score is well-meaning, but, overall, historically exclusionary when you consider ‘erythema’ for skin types beyond a Fitzpatrick type II or III.”
Dr. Qutub highlighted progress in addressing one EDI issue – paucity of research on conditions that primarily or disproportionately affect minorities and patients of color. “We already see some changes with new research yielding significant results when it comes to the genetic basis of centrifugal cicatricial alopecia (CCCA), which often affects women of African ancestry.”
Other EDI issues named include:
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- Clinical trials for new treatments for diseases that are more common in Black patients, but with few to no Black patients in the study.
- A board exam with few to no questions specific to patients with darker skin.
- A department dress code that requires Black physicians to thermally or chemically straighten their naturally curly hair.
- The only Black resident asked to give all the lectures on skin of color during residency.
With so many issues to address – some at a systemic level – how much impact can one dermatologist make? Dr. Peebles said a single dermatologist can make a profound impact. “One need not drive institutional reform to contribute to EDI efforts. It can start with one’s choices as they interact with patients on a daily basis.”
“I don’t think people should feel helpless,” said Dr. Elbuluk. ”That’s where the solution starts. Try to be mindful of individual issues – realizing the deficits we have with our education and training, and our biases – so that we can be the best providers we can be for our patients and also for our colleagues and the environments we work in.”
Part two of this series provides 10 tips dermatologists can implement right now to make an impact on EDI.
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