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At the inaugural Black Women in Medicine Conference hosted by the Massachusetts Medical Society (MMS) this week, leaders spoke about the challenges of handling racism in the medical field, and gave concrete advice on how to build supportive networks, navigate bias, and support other Black women entering medicine.

The conference was part of a larger put together by the MMS a year ago in the wake of a national reckoning with racism across all medical fields, and was organized by Philomena Asante, MD, MPH, of Boston University Student Health Services and leader of the organization Diva Docs Boston, which facilitates networking and sponsorship for Black women in the Boston area, and Simone Wildes, MD, of Tufts Medical Center in Boston and chair of the MMS Committee on Diversity in Medicine.

The panels centered on mutual support and tackling problems collectively. Bettye Kearse, MD, a retired pediatrician and the original founder of Diva Docs Boston in the early 90s, said her experiences as a Black woman in medicine and a mother felt isolating at first.

"I confronted people who either felt I was not up to the job, or I was the remarkable exception. So I was also in a state of super-womanhood," she said during a panel called, "The Power of the Sisterhood: Ways to Create Bonds between Black Women and other Women in Medicine and Health."

Once Kearse learned she was not alone and that there were other Black women physicians in the Boston area, "I just began trying to seek out these women and bring us together, mostly so we could give each other support."

The panelists brought up common challenges they face as physicians, academics, and leaders of professional organizations, including being the only woman of color in the room, the cumulative effect of microaggressions, a lack of follow-through in inclusivity and equity efforts put forward by institutions, and being overqualified for positions but being told they needed more experience.

"I have five degrees. I've done two residencies. I've done two fellowships. And then I'll still get a notification saying, 'well, we don't really know if you have the knowledge or the expertise,'" said Fatima Cody Stanford, MD, MPH, of Massachusetts General Hospital, during a panel on bias in healthcare. "And you're like, 'well, what else do you want? Do you want 20 degrees? Do you want 20 residencies now?'"

Others talked about work encounters laced with implicit racism, like being told there's a problem with the "tone" of their voice, or explicit racism, like being excluded from break rooms. Panelists were concerned about the backlash to racial equity efforts and the attitude from organizations that they had done enough in response to racism already.

Ranna Parekh, MD, MPH, chief diversity and inclusion officer at the American College of Cardiology, spoke about being asked to do the work of equity and inclusion at an institutional level without substantive support.

"You need to really screen these jobs before you actually take them because so many people are doing this symbolically," Parekh said. "It was reflexive to say, 'hey, we've done something, this George Floyd murder happened and now we have a chief diversity officer,' and, of course, you're the first person to get fired when something happens."

"I think having the support includes a direct line to the CEO, to the Board of Trustees, and having resources and a true budget, not 'okay, once you come in, then you can fundraise for it,'" she added.

Strategies for Black Women in Medicine

In fighting racism, both interpersonal and institutional, panelists spoke about harnessing the power of research, seeking allies in positions of power, discussing salary with mentors and peers, and networking and building a group of supporters both professional and personal.

One panelist cited a report on by the management consulting firm McKinsey & Company, which showed that Black women reported feeling the most excluded in the workplace, and also that their numbers dwindled in higher-level positions, even as the ranks of white men continued to rise disproportionately up the chain of command.

For example, women of color made up 18% of entry-level positions, while only 3% made it to the C-suite. White women made up 29% of entry-level positions and 19% of C-suite positions, and white men accounted for 25% and 66% of these positions, respectively.

Another panelist pointed out that though racial disparities in maternal mortality are front and center, only five Black women in the U.S. chaired obstetrics and gynecology departments at medical schools, compared with 77 white men, according to the .

Because of this stark gap, a number of panelists said, it is important to form allyships with people different from yourself, and also to build informal networks and spend time away from what can be an exhausting balancing act.

While mentorships and coaching can provide emotional support and help women build skills, Wildes, the conference co-organizer, distinguished between these roles and sponsorships, which she said are key to getting ahead in a world where the cards may be stacked against you. "A sponsor is someone that's going to talk about you when you're not in the room," she noted. In other words, someone who will refer you for a new job, position, committee, or award.

To do this, however, Joan Y. Reede, MD, MPH, dean for diversity and community partnership at Harvard Medical School, stressed the importance of making yourself visible and taking strategic risks, something that can be challenging for Black women in particular.

"What I find is that when offers come along, there's a tendency for women, and for people of color, more than others sometimes, for us to see ourselves out. 'I don't have what it takes, I'm not prepared for that, I'm not ready,'" said Reede. "And so how do we ourselves understand what we have to offer? How do we trust our ability? We're smart, we can learn, and we can grow in this position."

Though it's clear Black women are still up against what can seem like insurmountable odds in medicine, an overarching takeaway was the power in numbers. As one panelist pointed out, women make up more than three quarters of the healthcare workforce -- but not the top positions.

"There's a good old boys' network, and I feel like I want to be part of a good old girls' network," said Katherine Sharkey, MD, PhD, of Brown University's Alpert Medical School in Providence, Rhode Island. "Where we're bringing each other up, and connecting people, and working the system to make it the way we want it to be instead of the way it is."

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