DEI in surgical subspecialties

[Friheten]

As a rising fourth year medical student applying into a competitive surgical subspecialty, I have noticed an increased emphasis on DEI in the field, particularly at historically highly ranking institutions. As an "ORM", I have always felt somewhat conflicted. On one hand, I am grateful for academia's progress in including traditionally marginalized groups. On the other hand, I feel like these movements have never included me or my racial group, who also often faces discrimination, racism, and negative bias. I am also doubtful of the authenticity of these movements from those in positions of power (who are generally not from marginalized groups and are only advocating for them after already achieving success themselves) because I believe these initiatives are for show due to the current popularity of DEI in academia.

I have a strong application (multiple connected mentors in the field, well-published, strong clinicals) but have felt conflicted lately as I heard from a reliable source in my home residency program that they have set demographic quotas for selecting residents. I understand the importance of DEI, however, it's difficult for me to accept that certain minorities are not included under this label of "diversity". Honestly, I'm troubled by the idea of favoring candidates based on their demographics in general. Does anyone else feel conflicted about this?

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[Billiam95]

 

[ChordaEpiphany]

One large divide between liberal and conservative values is fairness to society vs. fairness to the individual.

Liberals tend to value society over the individual. Someone working hard their whole life and being denied their dream is an acceptable sacrifice for an overall improved system. In the liberal mind, the improved system is a diverse one, even if they miss out on some individual talent.

Conservatives tend to value the individual over society. Consistency in the "rules" for success allows individuals to target their efforts accordingly so that hard work actually translates to success. In the conservative mind, each individual's ability to chase their goals allows for maximum buy-in to the system and incentivizes good work.

Then of course there are opportunists who simply support whatever benefits them. When a white man claims unfairness, it's hard to know if he would actually rally in support of URMs if he saw undeniable evidence of discrimination. When a woman or minority claims we need diversity, it's hard to know if they would rally in support of ORMs or white men if they saw undeniable evidence that patients have better outcomes with higher performing students, regardless of race.

I don't think either of the ideologies are wrong. We do need diversity, but we also need a solid basis of meritocracy. What grinds people's gears is that there will always be a smattering of opportunists, and there are tons in every medical school class.

Whether or not you agree with it, DEI is part of the landscape. Just try to understand and improve it according to your own moral leanings.

 

[Friheten]

One large divide between liberal and conservative values is fairness to society vs. fairness to the individual.

Liberals tend to value society over the individual. Someone working hard their whole life and being denied their dream is an acceptable sacrifice for an overall improved system. In the liberal mind, the improved system is a diverse one, even if they miss out on some individual talent.

Conservatives tend to value the individual over society. Consistency in the "rules" for success allows individuals to target their efforts accordingly so that hard work actually translates to success. In the conservative mind, each individual's ability to chase their goals allows for maximum buy-in to the system and incentivizes good work.

Then of course there are opportunists who simply support whatever benefits them. When a white man claims unfairness, it's hard to know if he would actually rally in support of URMs if he saw undeniable evidence of discrimination. When a woman or minority claims we need diversity, it's hard to know if they would rally in support of ORMs or white men if they saw undeniable evidence that patients have better outcomes with higher performing students, regardless of race.

I don't think either of the ideologies are wrong. We do need diversity, but we also need a solid basis of meritocracy. What grinds people's gears is that there will always be a smattering of opportunists, and there are tons in every medical school class.

Whether or not you agree with it, DEI is part of the landscape. Just try to understand and improve it according to your own moral leanings.

Thanks for this thoughtful and focused response. I think the tension between the two ideologies you highlighted is what underlies my own conflicting feelings. I very much aspire to better society through a career in medicine, although I recognize that may be idealistic. But at the same time, I don't think DEI as it is currently implemented in academia is the correct way to achieve that. Why are some minority groups labeled as "diverse" while others are not? Is it not reductive to assume individual privilege based on race and gender? And on top of all that are the "opportunists" you mentioned, who as I see it are those in power implementing such policies usually to benefit their own institutions and political agendas.

 

[throwaway01564]

Thanks for this thoughtful and focused response. I think the tension between the two ideologies you highlighted is what underlies my own conflicting feelings. I very much aspire to better society through a career in medicine, although I recognize that may be idealistic. But at the same time, I don't think DEI as it is currently implemented in academia is the correct way to achieve that. Why are some minority groups labeled as "diverse" while others are not? Is it not reductive to assume individual privilege based on race and gender? And on top of all that are the "opportunists" you mentioned, who as I see it are those in power implementing such policies usually to benefit their own institutions and political agendas.

They aren't doing this "DEI" stuff just for the sake of diversity like colleges dude. Take the example of Hispanic American patients--they are becoming an ever-increasing portion of of the patient populace while the increase in Hispanic physicians, especially in surgical subspecialties, has not been near high enough to keep pace. Like it or not, evidence has shown that patients prefer to be treated, and fare better when treated, by physicians of their or a similar background. This is why there is a push for more URM physicians.

Now, whether this should also be implemented in residencies focused on research vs less research-focused residencies is what I think should be debated. But honestly, it seems like every surgical subspecialty nowadays is hyper research focused anyways so that may be a moot point.

 

[Gilakend]

Thanks for this thoughtful and focused response. I think the tension between the two ideologies you highlighted is what underlies my own conflicting feelings. I very much aspire to better society through a career in medicine, although I recognize that may be idealistic. But at the same time, I don't think DEI as it is currently implemented in academia is the correct way to achieve that. Why are some minority groups labeled as "diverse" while others are not? Is it not reductive to assume individual privilege based on race and gender? And on top of all that are the "opportunists" you mentioned, who as I see it are those in power implementing such policies usually to benefit their own institutions and political agendas.

From my understanding, it is not that some are labeled diverse or not, it is that some are not represented in medicine.

For example, is 2023 there are 96,520 students in US MD schools. 6,542 of them were hispanic/latino or around 6.8%. However, about 18.9% of the US population is hispanic/latino. So in terms of the demographics of the US population, they are heavily underrepresented in medical school.

Now take Asian students. There are 23,294 students who identified as Asian this year, or about 24.1% of students. The portion US population that identified as Asian was 6.1%. So comparative to the US population they are heavily overrepresented in medical school.

Of current medical students, those who identified as Asian are the only racial demographic overrepresented. White-identifying people (which I believe is the next closest racial demographic) are about 45.4% of US MD students and about 59.3% of the US population.

What I think is truly astounding is that more DEI efforts are not focused on economic diversity. Students from the bottom quintile economically (as determined by parental income) are extremely underrepresented and I very rarely if ever see economic diversity championed. SES status is often considered the largest social determinant of health and includes students from all demographics.

Sources:

https://www.aamc.org/media/6116/download

https://www.census.gov/quickfacts/fact/table/US/PST045221

https://www.aamc.org/media/9596/download?attachment

The most powerful social determinant of health

www.ncbi.nlm.nih.gov

 

[Friheten]

They aren't doing this "DEI" stuff just for the sake of diversity like colleges dude. Take the example of Hispanic American patients--they are becoming an ever-increasing portion of of the patient populace while the increase in Hispanic physicians, especially in surgical subspecialties, has not been near high enough to keep pace. Like it or not, evidence has shown that patients prefer to be treated, and fare better when treated, by physicians of their or a similar background. This is why there is a push for more URM physicians.

Now, whether this should also be implemented in residencies focused on research vs less research-focused residencies is what I think should be debated. But honestly, it seems like every surgical subspecialty nowadays is hyper research focused anyways so that may be a moot point.

You are presenting this statement as definitive when the literature on this isn't so clear cut, especially when it comes to something as complex as the impact of race concordance/culture on clinical outcomes. Similarly to my previous point, I think it is reductive to assume outcomes or patient preference are better solely based on race/gender. Gilakend (above) raises an excellent point about why we don't equally prioritize SES which likely has an equal or even greater influence on rapport/outcomes between patients and physicians. I think the reason for this is political.

I also think a utilitarian approach to recruiting physicians is flawed and problematic. For example, medical schools vary by locality and local racial demographics, so should we proportionally select for medical students based on these demographics in respective medical schools? Should we intentionally pair physicians with patients of similar race/gender in order to maximize outcomes? I believe the argument you're making is a very common one in DEI debates, yet it is rarely challenged.

 

[Putkernerinthehall]

Of current medical students, those who identified as Asian are the only racial demographic overrepresented. White-identifying people (which I believe is the next closest racial demographic) are about 45.4% of US MD students and about 75.8% of the US population.

75.8% of US population is white ? You must be including Hispanics in that number. If 19% are Hispanic and 7% Asian, per your own post, then the 75.8% number for "white" (meaning white, non-hispanic) cannot be correct since you're already over 100% and leave no room in your numbers for African American or others.

 

[Gilakend]

75.8% of US population is white ? You must be including Hispanics in that number. If 19% are Hispanic and 7% Asian, per your own post, then the 75.8% number for "white" (meaning white, non-hispanic) cannot be correct since you're already over 100% and leave no room in your numbers for African American or others.

You are correct I used the wrong number from the census data. Thanks for the catch!

 

[throwaway01564]

You are presenting this statement as definitive when the literature on this isn't so clear cut, especially when it comes to something as complex as the impact of race concordance/culture on clinical outcomes. Similarly to my previous point, I think it is reductive to assume outcomes or patient preference are better solely based on race/gender. Gilakend (above) raises an excellent point about why we don't equally prioritize SES which likely has an equal or even greater influence on rapport/outcomes between patients and physicians. I think the reason for this is political.

I also think a utilitarian approach to recruiting physicians is flawed and problematic. For example, medical schools vary by locality and local racial demographics, so should we proportionally select for medical students based on these demographics in respective medical schools? Should we intentionally pair physicians with patients of similar race/gender in order to maximize outcomes? I believe the argument you're making is a very common one in DEI debates, yet it is rarely challenged.

Even the very article you link doesn't seem to support your argument as well as you seem to think: "In contrast, the studies on racial concordance tell a more consistent story. Specifically, racial discordance almost always predicted poorer communication (11 out of 12 studies) in the communication domains of satisfaction, information-giving, partnership building, participatory decision-making, visit length, and supportiveness and respect of conversations. The only communication domain in which racial concordance seemingly has no effect is in quality of communication, with all studies finding no effect of racial concordance on quality of communication. This finding may be due, in part, to the broadness of this category as assessing the general patient-centeredness of communication and patients’ perception that the communication was viewed positively or as “good.” As such, it may be less sensitive to differences according to racial concordance". Ok, no effect on communication quality--what about all the other ones listed?

 

[Friheten]

Even the very article you link doesn't seem to support your argument as well as you seem to think: "In contrast, the studies on racial concordance tell a more consistent story. Specifically, racial discordance almost always predicted poorer communication (11 out of 12 studies) in the communication domains of satisfaction, information-giving, partnership building, participatory decision-making, visit length, and supportiveness and respect of conversations. The only communication domain in which racial concordance seemingly has no effect is in quality of communication, with all studies finding no effect of racial concordance on quality of communication. This finding may be due, in part, to the broadness of this category as assessing the general patient-centeredness of communication and patients’ perception that the communication was viewed positively or as “good.” As such, it may be less sensitive to differences according to racial concordance". Ok, no effect on communication quality--what about all the other ones listed?

What argument do you think I am making? I simply stated that research on this is far from conclusive. I wasn't trying to cherrypick specific articles/points (as you are doing now) to undermine your argument; you also make no mention of the other null findings in the review and do not address my points about consideration of SES or the flaws of a purely utilitarian approach in selecting physicians.

 

[operaman]

I wouldn’t worry about OP. Truth is there aren’t enough super competitive URMs applying to the surgical subs anyhow. The few that are there are aggressively courted and recruited.

Coming from a top program in my own field, we were also probably one of the most diverse. This was mainly because we could get the highly desired URMs to rank us number 1. Their apps were just as strong/stronger than the ORMs and were stellar applicants. Those that matched with us were also stellar residents.

At least at my shop, I never saw anyone moved up the list for DEI reasons. Everyone we interviewed was incredibly strong. The only exceptions I can think of were URM home students, but those were courtesy interviews and they did not match with us.

I think there are too many negatives to matching a weak resident that nobody is going to risk it for a little more DEI cred. This is especially true in the subs where all programs are small relative to IM and the like.

If a URM gets ranked above you, it will be because they were just stronger overall - same reason any ORM will get ranked above you.

 

[Friheten]

I wouldn’t worry about OP. Truth is there aren’t enough super competitive URMs applying to the surgical subs anyhow. The few that are there are aggressively courted and recruited.

Coming from a top program in my own field, we were also probably one of the most diverse. This was mainly because we could get the highly desired URMs to rank us number 1. Their apps were just as strong/stronger than the ORMs and were stellar applicants. Those that matched with us were also stellar residents.

At least at my shop, I never saw anyone moved up the list for DEI reasons. Everyone we interviewed was incredibly strong. The only exceptions I can think of were URM home students, but those were courtesy interviews and they did not match with us.

I think there are too many negatives to matching a weak resident that nobody is going to risk it for a little more DEI cred. This is especially true in the subs where all programs are small relative to IM and the like.

If a URM gets ranked above you, it will be because they were just stronger overall - same reason any ORM will get ranked above you.

Thank you for providing an insider perspective. I have great admiration for the advice and knowledge you share with members of this forum.

I don't want to make this about me, but frankly one factor that motivated me to post is my desire to match at such a top program, which is likely to also be a top choice for URM candidates. I'm also friends with many "URM" classmates, whom I really admire both personally and professionally--so my issue is not with individuals in this system. My conflicted feelings stem from what I see as a flawed system that disregards non-"diverse" minorities, has hidden agendas, and is reductive in its definition of diversity/privilege solely on the basis of demographic characteristics.

 

[operaman]

Thank you for providing an insider perspective. I have great admiration for the advice and knowledge you share with members of this forum.

I don't want to make this about me, but frankly one factor that motivated me to post is my desire to match at such a top program, which is likely to also be a top choice for URM candidates. I'm also friends with many "URM" classmates, whom I really admire both personally and professionally--so my issue is not with individuals in this system. My conflicted feelings stem from what I see as a flawed system that disregards non-"diverse" minorities, has hidden agendas, and is reductive in its definition of diversity/privilege solely on the basis of demographic characteristics.

At least as it stands now, there aren’t enough Uber competitive ones to matter. We’re talking low single digits in my field when I was looking at apps. And probably 1-3 would get ranked in the sure to match range any given year, and those would be great people with stellar apps anyhow that were on par with all the other top ranks. I really don’t think their DEI attributes really mattered much at all in the end.

If you’re truly a top applicant you should have little trouble matching at a top program. I’d worry a lot more about the 20-25 other non-URMs with superstar level apps who are also awesome people!

 

[Friheten]

At least as it stands now, there aren’t enough Uber competitive ones to matter. We’re talking low single digits in my field when I was looking at apps. And probably 1-3 would get ranked in the sure to match range any given year, and those would be great people with stellar apps anyhow that were on par with all the other top ranks. I really don’t think their DEI attributes really mattered much at all in the end.

If you’re truly a top applicant you should have little trouble matching at a top program. I’d worry a lot more about the 20-25 other non-URMs with superstar level apps who are also awesome people!

I must say that's a lower number than I expected. Could you provide an example of what a stellar application to your specialty might look like? I see a top level application as double-digit # of publications, with many as a first author, laudatory letters of recommendation from well-known faculty, excellent clinical year grades (almost all honors or equivalent comments at P/F schools), and capable performance on subI rotations.

Sorry for somewhat derailing the thread, just curious.

 

[operaman]

I must say that's a lower number than I expected. Could you provide an example of what a stellar application to your specialty might look like? I see a top level application as double-digit # of publications, with many as a first author, laudatory letters of recommendation from well-known faculty, excellent clinical year grades (almost all honors or equivalent comments at P/F schools), and capable performance on subI rotations.

Sorry for somewhat derailing the thread, just curious.

Yeah you pretty much nailed it. 260+ s1/s2, all Hs, AOA, extensive research with multiple first author pubs, glowing letters, clearly beloved by their dept, personal calls from well known mentors, and often other background things that stand out like advanced degrees, military service, top schools, success in prior careers, successful startup founder, grant funding, patents, parents who are leaders in our field, etc. The list goes on. There are some ridiculously accomplished people out there. And many of them are also great in person, vibe well with everyone.

Obviously some things you can’t change now, ie if you haven’t already been a professional athlete it’s probably a little late to start. So aim high and do the best you can. There aren’t too many superstars overall and they tend to disperse among the top programs. The closer you get to those ranks, the more options you will have.

 

[Dantes]

At least at my shop, I never saw anyone moved up the list for DEI reasons. Everyone we interviewed was incredibly strong. The only exceptions I can think of were URM home students, but those were courtesy interviews and they did not match with us.

Interesting, why bother giving a courtesy interview then?

 

[Dral]

Interesting, why bother giving a courtesy interview then?

Could be several reasons. One might be that depending on the size of the field, someone from another program could ask about an applicant (as in a PD from another program contacting the PD of the institution where the student is from) and come to find out that they didn’t get an interview at their home program. That could come off as odd and raise a red flag for the other PD.

 

[operaman]

Interesting, why bother giving a courtesy interview then?

I think most programs interview all of their home students. It’s both a courtesy as well as part of the educational mission to help prepare them for their other interviews.

 

[Mr.Smile12]

For what it's worth: "Overrepresented Minorities": A Brief History - SDN

 

[aldol16]

There is nothing that anybody can do about it so there's no use talking about it on here (and it is an issue that has been talked about ad nauseum). At the end of the day, competitive programs have many more applicants than spots and so they can set whatever quota they want when selecting residents. They can even disguise it as a diversity initiative. The point is, there's no use agonizing over what you have no control over and instead control the things that you can control.

 

[Friheten]

There is nothing that anybody can do about it so there's no use talking about it on here (and it is an issue that has been talked about ad nauseum). At the end of the day, competitive programs have many more applicants than spots and so they can set whatever quota they want when selecting residents. They can even disguise it as a diversity initiative. The point is, there's no use agonizing over what you have no control over and instead control the things that you can control.

I disagree that debating the status quo is pointless, even if we are unable to alter it right now. When I am in a leadership position, I absolutely will use my power to improve policies/movements I see as flawed. If my post can convince even one person to do the same and/or reconsider their viewpoints (my own included), then it was valuable.

 

[MateoGM416]

I don't see how this is an issue for competitive specialties as most URM's go into primary care anyway, and also how many times does this debate have to happen on this site. But I do agree with OP's points about racial categories. Some Asian ethnicities like Thai, Hmong, and Filipinos are underrepresented in medicine and academia. But in America, you're either white, black, brown, or Asian

 

[aldol16]

I disagree that debating the status quo is pointless, even if we are unable to alter it right now. When I am in a leadership position, I absolutely will use my power to improve policies/movements I see as flawed. If my post can convince even one person to do the same and/or reconsider their viewpoints (my own included), then it was valuable.

I doubt you're going to convince anybody else of anything in an anonymous online forum, much less convince someone else to do something years into the future.

 

[Friheten]

I doubt you're going to convince anybody else of anything in an anonymous online forum, much less convince someone else to do something years into the future.

Agree to disagree.

 

[aldol16]

Agree to disagree.

Have fun convincing.

 

[ChordaEpiphany]

What I think is truly astounding is that more DEI efforts are not focused on economic diversity. Students from the bottom quintile economically (as determined by parental income) are extremely underrepresented and I very rarely if ever see economic diversity championed. SES status is often considered the largest social determinant of health and includes students from all demographics.

DEI initiatives were basically how the elites from the Silent Generation prevented class-based reform, Boomers have carried that torch, and Gen X never had the sway to move the dial. Wealth inequality was at all-time lows in the 80s, and racism was a much more obvious problem. For the elites, it made so much sense to divert efforts on diversity instead of SES. Minorities were about 20% of the population, but about 90% of the country was underrepresented in elite academic programs by SES.

It's also harder to sus out SES. If your parents made $100K in salary in the 90s, it looks like you grew up upper middle class on paper. If they made $100K as a small business owner, their tax returns could paint them as paupers. I met tons of people in college on generous need-based aid packages whose parents came to pick them up in a luxury car and paid their rent in a luxury apartment near campus.

 

[mrbreakfast]

It's also harder to sus out SES.

It's even harder than in your example, because defining SES based solely on its "E" kind of misses the mark. I grew up around academia, as most of my immediate family, and their circle of friends, were college professors. I can tell you how little a professor of literature makes, and I can tell you how well their children do in school and beyond. It's much simpler to divide things in terms of ethnicity.

 

[catnip12]

@operaman nailed it! For the sake of your own odds, these URMs you’ll encounter on the trail might be extremely hard working individuals with impressive CVs and are just better applicants than you are. But you don’t know that. What’s interesting is that they are aware that some people are looking at their appearance and making sweeping judgements about their competitiveness how deserving they are of an interview purely based on it. And that might have driven them to prove themselves in the first place.

 

[operaman]

I will say that one place where DEI characteristics matter a little is when winnowing the 60-80 strong apps down to the 30-40 who get interviewed.

This is where things like that as well as geographic location, phone calls, etc start to really help. The handful of true superstars get invites nearly everywhere. For the rest who look very similar (and amazing) on paper, soft factors matter. DEI is certainly one of many factors used to pare down the short list.

Even here, the number of URMs on the short list is still low and not worth losing any sleep over. That may change now a little bit with PF step 1, but hard to say until we’ve seen a few cycles. Previously, most schools would dissuade any student, URM or otherwise, from applying to subs with sub par scores because they knew they wouldn’t get any special treatment. I suspect step 2 will just replace s1 in this regard.

The lack of URMs applying in the subs is a big problem, but so far nobody is seriously suggesting lowering standards to fix it. Most programs have turned to aggressively courting the strong URM applicants, and working with the local medical schools to court top students away from other subs. Convince them that their love of bones and joints is misplaced and that the sinuses are calling for them.

 

[aldol16]

LOL. I am 100% with OP.

LOL

 

[Kierkegaard's Bud]

As a rising fourth year medical student applying into a competitive surgical subspecialty, I have noticed an increased emphasis on DEI in the field, particularly at historically highly ranking institutions. As an "ORM", I have always felt somewhat conflicted. On one hand, I am grateful for academia's progress in including traditionally marginalized groups. On the other hand, I feel like these movements have never included me or my racial group, who also often faces discrimination, racism, and negative bias. I am also doubtful of the authenticity of these movements from those in positions of power (who are generally not from marginalized groups and are only advocating for them after already achieving success themselves) because I believe these initiatives are for show due to the current popularity of DEI in academia.

I have a strong application (multiple connected mentors in the field, well-published, strong clinicals) but have felt conflicted lately as I heard from a reliable source in my home residency program that they have set demographic quotas for selecting residents. I understand the importance of DEI, however, it's difficult for me to accept that certain minorities are not included under this label of "diversity". Honestly, I'm troubled by the idea of favoring candidates based on their demographics in general. Does anyone else feel conflicted about this?

I highly doubt someone will entrust a medical student with information about the intricacies of residency selection, such as quotas.

 

[operaman]

I highly doubt someone will entrust a medical student with information about the intricacies of residency selection, such as quotas.

Generally I would agree with this, but I also got a lot of insider info as a Med student from my own mentors. I was a non trad and knew a number of my dept faculty from outside school long before I encountered them as a student. So it does happen, and probably more frequently than you’d think. If I were in a dept that got on a DEI kick, I would definitely let affected mentees know so they could plan accordingly.

Personally, I think such quotas should be publicly disclosed if they’re going to be there, but obviously that isn’t going to happen.

I will also add that rank lists can be funny things and sometimes your best DEI plans get blown away. I remember one of my mentors in Med school telling me how excited she was that they were probably going to match their first all female resident class. Nearly all the entire top 10 ranks were women and they rarely dropped lower, so surely this was going to be the cycle they finally did it. Match day roles around: all white dudes.

So even if OPs program wants to rank on DEI alone, they still have to convince all those students to return the favor. And yet again we come back to the underlying issue: not enough urm students are applying in the subs.

And the good ones who do are very strongly courted by all the top programs. We’re not only talking personal PD and chair phone calls of interest and extra swag, but flying them back for second look weekends, wining and dining, and going above and beyond to convince them they would be happy at that program.

 

[Kierkegaard's Bud]

Generally I would agree with this, but I also got a lot of insider info as a Med student from my own mentors. I was a non trad and knew a number of my dept faculty from outside school long before I encountered them as a student. So it does happen, and probably more frequently than you’d think. If I were in a dept that got on a DEI kick, I would definitely let affected mentees know so they could plan accordingly.

Personally, I think such quotas should be publicly disclosed if they’re going to be there, but obviously that isn’t going to happen.

I'm not sure how telling a student will help them as they do not know other schools' DEI plans, and I am not sure how this could be a net positive to the decision-making process. What quota? Get 1 resident; there aren't enough for quotas.

Thank you for providing an insider perspective. I have great admiration for the advice and knowledge you share with members of this forum.

I don't want to make this about me, but frankly one factor that motivated me to post is my desire to match at such a top program, which is likely to also be a top choice for URM candidates. I'm also friends with many "URM" classmates, whom I really admire both personally and professionally--so my issue is not with individuals in this system. My conflicted feelings stem from what I see as a flawed system that disregards non-"diverse" minorities, has hidden agendas, and is reductive in its definition of diversity/privilege solely on the basis of demographic characteristics.

Some strong words there at the end; I don't think your "URM friends" have heard you say those things out loud, have they?

 

[MateoGM416]

I'm not sure how telling a student will help them as they do not know other schools' DEI plans, and I am not sure how this could be a net positive to the decision-making process. What quota? Get 1 resident; there aren't enough for quotas.


Some strong words there at the end; I don't think your "URM friends" have heard you say those things out loud, have they?

He thinks the URM and ORM experiences in this country are the same- he's definitely not said any of these things to his URM 'friends'

 

[operaman]

I'm not sure how telling a student will help them as they do not know other schools' DEI plans, and I am not sure how this could be a net positive to the decision-making process. What quota? Get 1 resident; there aren't enough for quotas.


Some strong words there at the end; I don't think your "URM friends" have heard you say those things out loud, have they?

Sure excellent question. I think the ethical burden to notify is different whether we are talking insider info to a mentee vs public statements.

For a mentee, I would tell them if we had a DEI or other push that would make them less likely to match so they could plan accordingly. Conversely, if they were more likely to match with us I would convey that too. While most students apply very broadly, some stronger students will limit their apps a bit and I wouldn’t want them counting on a home slot if they weren’t going to be competitive for it. Students will also base away rotation decisions on this as well. I didn’t do any aways since my app was strong and I knew I would match locally; I might have done 1-2 if the local match was unlikely.

Publicly speaking, if a program has a specific mission to a certain group, that should be disclosed. Like if I were to start an ent residency in Montana with the aim of increasing supply of local ents, I might reasonably prefer only to interview and rank students with very strong ties to the area. If so, I wouldn’t want other students wasting their time and money applying if they aren’t going to be considered, so I would put a statement on the info website saying that only applicants from Montana or with very strong ties to the area will be considered.

If a program has a mission to serve a particular group, then that too should be disclosed so others can weigh if it’s worth applying.

In reality it becomes more of a gray area because preferences are rarely that rigidly defined. Probably not worth disclosure if DEI will get you from the short list to the interview list just as not worth disclosing that location will do the same. But if DEI is going to be the major factor in ranking, then that should be disclosed.

 

[Friheten]

I'm not sure how telling a student will help them as they do not know other schools' DEI plans, and I am not sure how this could be a net positive to the decision-making process. What quota? Get 1 resident; there aren't enough for quotas.


Some strong words there at the end; I don't think your "URM friends" have heard you say those things out loud, have they?

See operaman's replies above, which is essentially the same context in which I was informed about quotas/DEI focus at my home institution (mentor involved with residency program helping me plan my applications).

Does whether or not I share my views with my friends have any bearing on their validity? Do you have any actual arguments against the points I made?

He thinks the URM and ORM experiences in this country are the same- he's definitely not said any of these things to his URM 'friends'

The implication of what you are stating is that minorities considered URM categorically face more hardship/discrimination than those considered ORM. As I stated previously, I believe it is reductive to assume this solely based on race and gender. Clearly we have our own biases, as you belong to the former and I the latter group, but I believe we can respect each other's experience without implying that one is lesser or greater than the other.

 

[EmperorK]

As a rising fourth year medical student applying into a competitive surgical subspecialty, I have noticed an increased emphasis on DEI in the field, particularly at historically highly ranking institutions. As an "ORM", I have always felt somewhat conflicted. On one hand, I am grateful for academia's progress in including traditionally marginalized groups. On the other hand, I feel like these movements have never included me or my racial group, who also often faces discrimination, racism, and negative bias. I am also doubtful of the authenticity of these movements from those in positions of power (who are generally not from marginalized groups and are only advocating for them after already achieving success themselves) because I believe these initiatives are for show due to the current popularity of DEI in academia.

I have a strong application (multiple connected mentors in the field, well-published, strong clinicals) but have felt conflicted lately as I heard from a reliable source in my home residency program that they have set demographic quotas for selecting residents. I understand the importance of DEI, however, it's difficult for me to accept that certain minorities are not included under this label of "diversity". Honestly, I'm troubled by the idea of favoring candidates based on their demographics in general. Does anyone else feel conflicted about this?

To be honest there are a few points you're missing. Class Mobility is part of the reason the United States got to the top of the food chain: they spread welfare the best among the western countries. What you're seeing is a straightforward process of that right now, where it's simply Black/Hispanic vs Asian, and as time goes on fine-tuning will occur. An excellent example is if you're Asian/Indian your parents forced you to study hard, if you're from those URM then that doesn't happen as much. Therefore, some of your academic success comes down to having different parents, and this process is hereditary by proxy (as in you'll do the same to your kids). One way to stop the circle is to add incentives where the URM will move up the ladder and hopefully be able to break the circle. I know that it might be hard to hear that your achievements might not be only caused by your hard work, but that is the truth of reality.

In this topic you mention the concept of SES, I would like to propose to you that money is not only a resource, but knowledge and culture, and previous success as well. If you want to know more, read about the prep schools in Asia/Japan and charter schools in the UK. The other issue is that you do live in the US, and it's more of a melting pot than you think. Lastly, you're not competing with URMs, but with your fellow ORM. If you do lose there it is because you couldn't beat your equal.

 

[MateoGM416]

Does whether or not I share my views with my friends have any bearing on their validity? Do you have any actual arguments against the points I made?

You wouldn't share those opinions with them, because either you actually know they're ridiculous or those people are not really your friends, and I assume it's the latter.

The implication of what you are stating is that members of underrepresented minority (URM) groups categorically face more hardship/discrimination than members of overrepresented majority (ORM) groups. As I stated previously, I believe it is reductive to assume this solely based on race and gender.

You're still wrong on the first point, but DEI has more so to do with the fact that URM make up 30% of the population but 12% of practicing physicians in this country.

 

[Friheten]

You wouldn't share those opinions with them, because either you actually know they're ridiculous or those people are not really your friends, and I assume it's the latter.



You're still wrong on the first point, but DEI has more so to do with the fact that URM make up 30% of the population but 12% of practicing physicians in this country.

Classic example of a false dilemma.

Not that it's relevant but yes I have discussed my dissatisfaction with the current system with friends that identify as URM. If there's any reluctance to do so it's due to academia's strong pro-DEI bias. This means that any criticism of DEI, even if well-intended, can have professional repercussions and people are quick to jump to conclusions. Just because a viewpoint is different from the status quo, though I would argue more people agree with my viewpoint than what is visible on the surface for the aforementioned reason, does not make it ridiculous.

I've already addressed your second argument in my reply above to throwaway01564.

 

[Friheten]

To be honest there are a few points you're missing. Class Mobility is part of the reason the United States got to the top of the food chain: they spread welfare the best among the western countries. What you're seeing is a straightforward process of that right now, where it's simply Black/Hispanic vs Asian, and as time goes on fine-tuning will occur. An excellent example is if you're Asian/Indian your parents forced you to study hard, if you're from those URM then that doesn't happen as much. Therefore, some of your academic success comes down to having different parents, and this process is hereditary by proxy (as in you'll do the same to your kids). One way to stop the circle is to add incentives where the URM will move up the ladder and hopefully be able to break the circle. I know that it might be hard to hear that your achievements might not be only caused by your hard work, but that is the truth of reality.

In this topic you mention the concept of SES, I would like to propose to you that money is not only a resource, but knowledge and culture, and previous success as well. If you want to know more, read about the prep schools in Asia/Japan and charter schools in the UK. The other issue is that you do live in the US, and it's more of a melting pot than you think. Lastly, you're not competing with URMs, but with your fellow ORM. If you do lose there it is because you couldn't beat your equal.

Your argument is contradictory. Are you arguing in favor of equality of outcome (that is, equity over equality)? If you think that certain racial groups are not as well-adapted due to their culture rather than racism or discrimination, then you are arguing that we should intervene to make up for this so that all groups have equal results. Or do you think that a racial group's "culture" can be seen as an unfair existing resource/advantage? I agree that culture is a component of SES; however, I do not agree with your conclusion that this should lead to equality of outcomes instead of equality of opportunities and resources.

 

[operaman]

You wouldn't share those opinions with them, because either you actually know they're ridiculous or those people are not really your friends, and I assume it's the latter.



You're still wrong on the first point, but DEI has more so to do with the fact that URM make up 30% of the population but 12% of practicing physicians in this country.

And an even smaller percentage of the highly competitive surgical subs, derm, and the like.

Which is why I think OP needn't worry about it too much unless he's from a home program that's going all in on this DEI stuff and truly willing to risk/endure weaker residents for it. Maybe there are some mid and low tier programs that are willing to overlook some poor stats to bolster their own DEI cred, but it's got to be exceedingly rare. As it is, there are a number of strong URM applicants, and the top programs compete heavily for them.

A quick google of the residents at top programs shows that non-URMs clearly have little to fear for the foreseeable future.

 

[EmperorK]

Your argument is contradictory. Are you arguing in favor of equality of outcome (that is, equity over equality)? If you think that certain racial groups are not as well-adapted due to their culture rather than racism or discrimination, then you are arguing that we should intervene to make up for this so that all groups have equal results. Or do you think that a racial group's "culture" can be seen as an unfair existing resource/advantage? I agree that culture is part of SES but I do not agree with your conclusion that we should have equality of outcomes.

No, that's not what I'm saying. Please reread my arguments (and that also wasn't the only one so please try to reply to the other ones). I'm saying that by doing DEI you're normalizing the field. This is why I told you to read about the topics I mentioned. But I'll use one. In China there's the famous GaoKao exam (a college entrance exam), to put it shortly it decides your fate at a higher level of education. If you live in an urban city (Shanghai, Shenzhen, Beijing) you will have access to strong high-quality prep courses. If someone lives in Xi'an (a province in the top corner of China) they simply do not have the resources or even knowledge to go to the high-quality program (e.g the child's parents, don't know the high-quality prep courses even exist). The Chinese government compensates for this disparity by having different cutoffs depending on which province you form AND adding/subtracting points to the exam scores depending on which province you're from. Why? Because of class mobility, which they learned from the Americans.

I will also point out a more personal thing I'm seeing. A lot of what you're doing right now comes from your anxiety and maybe (I'm speculating) some low self-esteem. I've coached many Asian Americans when it comes to soft skills, and this is quite common to see. What they'll do is logically frame an emotional argument, that they don't even know why it is emotional. Just things to consider.

 

[MateoGM416]

He's already attempting to blame URM (maybe a few dozen in the entire country if even that) and garner sympathy for his potential failure to match a competitive subspecialty, which hasn't even happened yet. He has already accomplished so much in his career up to this point, but his ego is still so fragile that he calls into question the basis of diversity in medicine as to pave a runway for a failure that probably won't even happen. It's one of the most pathetic things I've ever seen on this website.

 

[rulerkk]

He's already attempting to blame URM (maybe a few dozen in the entire country if even that) and garner sympathy for his potential failure to match a competitive subspecialty, which hasn't even happened yet. He has already accomplished so much in his career up to this point, but his ego is still so fragile that he calls into question the basis of diversity in medicine as to pave a runway for a failure that probably won't even happen. It's one of the most pathetic things I've ever seen on this website.

Brutal, but accurate to me. Idk why OP doesn’t focus on beating out the hundreds of white, Asian, and male applicants as opposed to the URMs and women that make up a small portion of the application pool.

Why not get mad at nepotism through family connections instead? Or people who have a below-average application for these fields but network incredibly hard to earn their spot through great LORs and mentors who call programs for them? These common examples seem less justifiable for earning a spot than the few URMs who clawed their way up against historically negative lived experiences in the predominantly white, racist U.S. of A.

Many URM patients would like more URM physicians as an option. As stated, 3-10% of competitive surgical subs attendings are URM right now vs half the country will be a previous minority when we’re mid-career

 

[EmperorK]

He's already attempting to blame URM (maybe a few dozen in the entire country if even that) and garner sympathy for his potential failure to match a competitive subspecialty, which hasn't even happened yet. He has already accomplished so much in his career up to this point, but his ego is still so fragile that he calls into question the basis of diversity in medicine as to pave a runway for a failure that probably won't even happen. It's one of the most pathetic things I've ever seen on this website.

A little bit unnecessary, I get where ur coming from though. Next time, please try to approach it with more grace/softness.

 

[MateoGM416]

A little bit unnecessary, I get where ur coming from though. Next time, please try to approach it with more grace/softness.

The underlying implication behind these arguments is that URM are less deserving of the accomplishments we make in this field. You know it. I know it. Everyone knows it. As if the hard work we did means less than that of our classmates because of the existence of DEI. I'm tired of feeling like we have to justify our existence in medicine, and I have the least empathy in the world for someone who has it all and still finds a way to throw us under the bus.

 

[Friheten]

No, that's not what I'm saying. Please reread my arguments (and that also wasn't the only one so please try to reply to the other ones). I'm saying that by doing DEI you're normalizing the field. This is why I told you to read about the topics I mentioned. But I'll use one. In China there's the famous GaoKao exam (a college entrance exam), to put it shortly it decides your fate at a higher level of education. If you live in an urban city (Shanghai, Shenzhen, Beijing) you will have access to strong high-quality prep courses. If someone lives in Xi'an (a province in the top corner of China) they simply do not have the resources or even knowledge to go to the high-quality program (e.g the child's parents, don't know the high-quality prep courses even exist). The Chinese government compensates for this disparity by having different cutoffs depending on which province you form AND adding/subtracting points to the exam scores depending on which province you're from. Why? Because of class mobility, which they learned from the Americans.

I think we both agree that class mobility is beneficial for society and that everyone should have equal opportunities and resources. Your analogy is an example of SES-based affirmative action, and your argument is that since culture, which is associated with race, is a form of SES, race-based preferences are appropriate.

I understand your argument, but I disagree with your assumption that race is a proxy for SES. For example, would an ORM from a working-class family have a higher SES than a URM from a family of physicians? It's too reductive.

I also disagree that, even if we accept your premise that certain racial groups are more culturally adapted to succeed, this means we should discriminate against them. It is very different to come from a high-income province with access to prep courses than to come from a household which values education and achievement, and that shaping one's aspirations and career path.

I will also point out a more personal thing I'm seeing. A lot of what you're doing right now comes from your anxiety and maybe (I'm speculating) some low self-esteem. I've coached many Asian Americans when it comes to soft skills, and this is quite common to see. What they'll do is logically frame an emotional argument, that they don't even know why it is emotional. Just things to consider.

And I will point out, intentionally or not, this statement is a form of implicit bias/racism--implying that Asian Americans (which is a broad term to begin with) are generally deficient in soft skills. While it would be off-topic to delve into the reasons behind this stereotype, it is telling that the two users liked who liked your post are supposed advocates for diversity equity and inclusion.

 

[Friheten]

The underlying implication behind these arguments is that URM are less deserving of the accomplishments we make in this field. You know it. I know it. Everyone knows it. As if the hard work we did means less than that of our classmates because of the existence of DEI. I'm tired of feeling like we have to justify our existence in medicine, and I have the least empathy in the world for someone who has it all and still finds a way to throw us under the bus.

I'm sorry if I made you feel less deserving/accomplished or if I implied that; that was not my goal. I'm feeling conflicted about the current state of DEI in academia, so I spoke up for my beliefs. I tried to make this discussion impersonal and not about me, but I recognize that people naturally take these discussions personally. I hope we can try to discuss things without personal attacks which was always my intention.

 

[MateoGM416]

I'm sorry if I made you feel less deserving/accomplished or if I implied that; that was not my goal. I'm feeling conflicted about the current state of DEI in academia, so I spoke up for my beliefs. I tried to make this discussion impersonal and not about me, but I recognize that people naturally take these discussions personally. I hope we can try to discuss things without personal attacks which was always my intention.

Reread your own first post and stop being purposely obtuse. You've made yourself out to be a victim as if diversity quotas have somehow slighted you (they haven't and never will). There's nothing to be 'conflicted' about: whether you match whatever specialty you want to do is completely up to you.