Livingood Lecture: Unconscious bias keeping dermatology from reflecting the population it serves

Bruce Wintroub, MD: ‘In the last 40 years, dermatology has advanced in spectacular fashion due to the great caliber of people we attracted to the field.'

Bruce Wintroub, MD: ‘In the last 40 years, dermatology has advanced in spectacular fashion due to the great caliber of people we attracted to the field.’

Bruce Wintroub, MD, sees himself in the people business. His business also involves being the interim dean of the University of California, San Francisco, School of Medicine, and professor and chair of the department of dermatology.

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“I look at dermatology through the prism of a medical school department chair. We are in the people business, both training people and caring for people,” Dr. Wintroub said. During his 40-plus years in medicine, dermatology has developed from an overlooked specialty to one that leads the way in development of biologic, genetic-based, and procedural treatments for skin cancer, psoriasis, and other challenging conditions.

How did that happen?

“We attracted and trained the most talented group of young people in American medical schools. When I applied to dermatology, I was accepted with a phone call, unlike the competition that exists now,” Dr. Wintroub said. “In the last 40 years, dermatology has advanced in spectacular fashion due to the great caliber of people we attracted to the field. We have developed outstanding practitioners and leaders across the entire field.”

But those people do not include many from populations that are underrepresented in medicine.

“I believe that our professional workforce should reflect the population that we serve. So, dermatologists should include those who are LGBT, disabled, and underrepresented in medicine. We have not done that,” Dr. Wintroub said during Sunday’s Clarence S. Livingood, MD, Award and Lectureship.

When he was named dean last September, Dr. Wintroub unexpectedly stepped into a hornet’s nest after a distinguished career in medicine. He found that UCSF had been cited for not having an adequate number of African-Americans and Latinos on its faculty. A climate survey of UCSF faculty and students showed that “people who are underrepresented feel uncomfortable and not included,” he said.

Shortly after that, unarmed African-American men were killed by police in Ferguson, Missouri, and New York in seemingly minor incidents that ignited protests that reflected a gulf between races that might best be described as “unconscious bias.”

Last December 9, UCSF medical students reacted to the racial tension that grew in the aftermath of those deaths by organizing a “die-in,” the first of more than 80 that took place on campuses across the U.S.

“All of our medical students, wearing white coats and using the moniker ‘White coats for black lives,’ laid down in the middle of campus,” Dr. Wintroub said. “I found myself in a position I never expected and recalled my own student days when students protested public events, and university administrators responded. Except now the demonstration was about race at UCSF and in America, and I was the dean of the medical school.

“Why do students feel this way? This isn’t just about UCSF. Why is it our climate survey shows that underrepresented minorities feel uncomfortable within our organization? Why are we not attracting more people who are underrepresented in medicine to our faculty? I ask the same questions about dermatology.”

Dr. Wintroub and the UCSF School of Medicine organized a retreat to study the situation. They did not come up with a simple solution, but see unconscious bias as a part of the problem.

“There is no active racism in dermatology,” he said. “However, we haven’t, as a profession, embraced the idea that dermatology needs many more physicians from underserved populations. I think we are a very fair group of people, but our organizations have not taken this on as a mission value as we choose people for the field.

“I don’t have the answers, but I want to shine a light on the questions. I believe that the future of our specialty would be much better if we address and solve this problem. We will be better able to care for patients who are in underserved populations, and we will have a much more satisfying profession.”

The students in American medical schools are much more diverse today than they were 40 years ago, reflecting the population of patients, but the majority of medical school faculties and the leadership of medical societies remain predominantly white, Dr. Wintroub said.

“Race plays a role in how we hire and develop our faculty in ways that we are not conscious of, and it is not just dermatology,” he said. “Medical school students from underrepresented populations generally do not choose dermatology. The question we have to ask is ‘Why?’ What steps must we take so that more students from underserved populations will choose dermatology?

“I hope that 10 years from now this discussion will be unnecessary. I don’t have the answers, but I do think that the Academy, the Dermatology Foundation, and the departments that train young dermatologists should actively examine this problem and develop a set of solutions. Our future as a specialty and our patients depend on it.”

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