Is it really a “leaky pipeline” if we actively evict people?

October 05, 2022

5 minute read


Evanie Anglade is a second-year medical study at Rutgers New Jersey Medical School. She can be contacted at [email protected] She wrote this blog post under the guidance of her mentor, Fumiko Chino, MD, radiation oncologist at Memorial Sloan Kettering Cancer Center.

Anglade and Chino do not report any relevant financial information.

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I’m a black doctor in training and sometimes I feel like I’m losing my place.

In 2015, black residents made up about 5% of all residents, but they accounted for nearly 20% of those who were terminated, according to reports from the Accreditation Council for Higher Medical Education.


People from an underrepresented minority (URM) who attempt to pursue a career in medicine exit the “leaky pipeline” at many points in the medical journey (from pre-medical college, medical school, residency , the stock market and beyond) at disproportionately higher rates than their counterparts.

“Unexpected departures”

In my own experience, I can reflect on times when I felt like other URM interns were unfairly targeted and had unexpected departures under murky circumstances.

While working as a medical scribe, I remember overhearing hospital staff discussing how the only black orthopedic resident at the time was fired – yet another RMU resident they had seen being mysteriously fired from their program.

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Evanie Anglade

Just weeks ago, the former director of diversity at the university hospital resigned, later recounting that she had felt singled out, belittled and looked down upon as a black female doctor in a leadership position.

The problem with the “leaky pipeline” analogy is that it portrays the phenomenon as a passive event, as if it were to happen without outside influences. Previous research and my own lived experience would indicate that this is simply not the case; often, the barriers that drive MRUs out of the labor market are factors beyond their control.

Deficits in educational and sponsorship opportunities, as well as elements of structural racism and micro-aggression prevent qualified and motivated individuals in RUM from advancing further in the medical journey, particularly when they obtain leadership positions.

Widespread disparities

We find that racial and ethnic disparities are pervasive in the medical workforce, as the racial and ethnic demographics of the active medical workforce in 2019 did not reflect that of the US population in the 2020 Census.

Less is known about racial and ethnic representation in leadership, particularly in oncology. Our team has previously published about leadership disparities at NCI-designated cancer centers in Open JAMA Network and wanted to better understand the diversity of teams that have created national cancer guidelines.

This summer I worked to evaluate the National Comprehensive Cancer Network and found, unsurprisingly, that there are significant racial and ethnic disparities, with committee members disproportionately white and Asian compared to the U.S. Census and to the active medical workforce.

Even committees creating guidelines for the deadliest cancers in black and Hispanic patients were no more likely to have black and Hispanic members—some committees did not have a single black or Hispanic member. This work serves as important baseline data, which I hope to see improve over the course of my career as I complete my residency, fellowship, and ultimately enter the workforce. medical.

Personal journey

My work with Dr. Chino encouraged me to reflect on my own experiences as a black woman navigating the medical path.

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Chino Fumiko

Mentoring got me to where I am today — it opened doors for me and gave me the opportunity to demonstrate my worth. Many of these crucial mentoring experiences have been possible through programs and initiatives dedicated to supporting URM students.

In college, I participated in the Summer Undergraduate Minority Research Program at the University of Pennsylvania in which I was paired with two research mentors, both anesthesiologists, who took me under their wing to learn more in their field and conduct health services research. This was my first introduction to clinical medicine and research awards. I continued to work with one of my mentors throughout college and into my postgraduate years. This experience was a key part of my application to medical school, helping me secure a spot at Rutgers New Jersey Medical School (NJMS).

While at NJMS, I joined my school’s Student National Medical Association (SNMA) chapter and was paired with a student mentor who had previously participated in the Memorial Sloan Kettering Cancer summer pipeline program. Center. My student mentor encouraged me to apply, which eventually put me in touch with Dr. Chino. The Pipeline program provides funding and a research mentor to URM students, and it has helped me with resources and opportunities to support my success in medicine.

Overall, my experience so far has shown me that pipeline programs can help provide students like me with the ability to navigate both the academic and hidden agendas of medicine.

However, the opportunity started before I even entered medical school. I think about where I would be today if my parents, both Haitian immigrants, had not made the calculated decision and made immense efforts to move our family to a better-resourced area with better access to social opportunities. , economic and educational. They understood the impact of their environment on their future ability to succeed. Thanks to their sacrifice, I was able to attend well-funded public schools, take SAT prep classes, get into an Ivy League college, and ultimately get accepted into medical school.

Growing up, I did not fully realize the importance and impact of my parents’ efforts. I didn’t see them as the registered nurse on an hourly wage and the self-employed taxi driver who worked tirelessly to meet mortgage payments and high property taxes to get my siblings and me to the right places. schools we attended. I now see that without my parents’ efforts, I might not have found the courage to pursue a career as a doctor.

“Everyone should be involved”

With all the opportunities that have been presented to me, I have made it my mission to serve as a resource for those, like me, who are also interested in a career in medicine. I have mentored STEM-interested high school students and pre-med and college-level URM women applying to medical school, in addition to currently serving as SNMA Co-Chair and mentoring first-year medical students. I used my experiences (both successes and failures) to help these students achieve their goals and offer encouragement, making sure they knew they too had a place in the medical field.

Repairing the pipeline should not be the sole responsibility of those affected by it. Everyone should be involved for the betterment of society and to better care for patients. Those in positions of power should advocate for holistic consideration of applications for interns and hires, offer admissions and hiring committee seats to diverse staff (and reward those efforts), increase funding enrichment opportunities for RMU individuals (such as programs that have benefited me) and actively seek to train and diversify their ranks.

Unfortunately, there is always a looming fear that I could be lost to this “leaky pipeline,” like so many other promising black medical trainees. I realized that my merit and the investment of my parents might not yet be enough to propel me forward and enable me to succeed when pervasive societal ills continue to foster inequality and discrimination. After all, all it takes is one biased senior faculty member to boost my career, especially if there are no support people in positions of power to defend me.

My hope is that through all of our collective efforts to change the status quo and support URM interns, we will be able to make the “leaky pipeline” a thing of the past.


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