Arundhati Dhara: All diversity is not created equal 

The hard truth is that while all physicians from ethnic minorities may experience discrimination, it doesn’t always look the same, says Arundhati Dhara

Medicine has been promoting equity and diversity for years. But in general some people still consider the “normal” physician as white, male, cis-gendered, heterosexual, and able bodied. Everyone outside that image—including me, a brown, South Asian woman—falls into a fuzzy definition of “other.” At the same time, our institutions are congratulating themselves because more and more physicians fit the “diversity” bill. But let’s be clear. This logic allows us to think about diversity in ways that feel comfortable, while we ignore the fact that some people from ethnic minorities continue to be left out. In this moment of global mobilization to finally confront systemic racism, we must consider how the medical establishment is complicit.

The hard truth is that while all physicians from ethnic minorities may experience discrimination, it doesn’t always look the same. For example, Indigenous people face centuries of ongoing colonization and the intergenerational traumas of Canada’s residential schools. By contrast, when my family immigrated to Canada, we were subject to a points-based immigration system which selected for our household privilege in India, where I was born. Navigating the subtleties of distinct kinds of racism in particular communities is difficult work, requiring time and resources—two things in perpetual short supply in medicine. 

While Canadian data aren’t great (reflecting just how uncomfortable we are at dealing with race in medicine), South Asian and East Asian populations are represented in medical training programmes at three times their rate in the Canadian youth population. Black medical students, on the other hand, are represented at less than half their youth rate, and Indigenous students even less than that. Clearly diversity and equity programmes are missing the mark in these populations. 

Part of the problem is in our language, which has become intentionally and increasingly vague. Initially, diversity referred specifically to certain racialized groups, but over the years, its meaning has expanded. The Canadian Federation of Medical Students “defines diversity broadly, encompassing diversity in culture, ethnicity, gender, sexuality, physical ability, geography, religion and socioeconomic status.” In setting up these terms vaguely, we can achieve “diversity” without ever addressing its original intent—to name and address racial inequity. We never have to talk about the racial stereotypes that continue to differentiate between “normal” and “other” physicians, or the under representation of certain groups that fall under the banner of diversity.

Given how uncomfortable it is for us to acknowledge the realities of race in medicine, it’s no wonder institutions look for ways to avoid talking about it altogether, even as they call for more “diversity.” Perhaps the most common pivot away from discussions of race is toward gender. Let me be clear: it is cause for celebration that we have become so much more comfortable talking about women in medicine. But because all “diversity” counts the same, gender is used to gloss over racism in pursuit of inclusion. Indeed, no discussion of equity programmes in Canada is complete without mention of the fact that more than 50% of new medical graduates are now women. The Canadian Medical Association authored a report titled “Addressing Gender Equity and Diversity in Canada’s Medical Profession: A Review citing that very statistic. But despite the same vague definition of “diversity” holding a place in the title, only one paragraph addresses issues of race, sexual orientation, and physical ability. 

As physicians we want to think of ourselves as smart, hardworking, and resilient. In fact, the process of medical socialization is meant to reinforce this identity and eliminate our differences. We are meant to become a “neutral doctor.” By definition, that doctor isn’t “diverse.” We have a lot of work to do, and a lot of really important—and uncomfortable—conversations about race and diversity ahead of us. On the other side, however, is a profession that truly celebrates our differences and hopefully a more just society.

Arundhati Dhara is a community based family doctor in Nova Scotia, Canada with an interest in the social determinants of health. She is also an Assistant Professor with Dalhousie University’s Department of Family Medicine.

Competing interests: none declared.

Twitter: @arunadhara