Throughout the months of 2020, there has been a change in what business as usual looks like in the United States of America. The pandemic has changed how people view healthcare, meetings have shifted from boardrooms to living rooms with virtual capabilities, and educational practices have grown beyond the classroom setting to now include platforms that were formerly unfamiliar to even the most veteran teachers. Yet, a sad realization that much has not changed in one particular area came about when George Floyd was savagely murdered in broad daylight in May on a Monday evening in Minneapolis. This tragedy may have opened many eyes around the country, but for so many others, it was simply business as usual. Business as usual for those who know all too well that stories such as this one have been commonplace long before Mr. Floyd.

It was once again business as usual on February 23, 2020 when another Black man lost his life for what many can delineate as nothing other than the color of his skin. On that sorrowful Tuesday Ahmaud Arbery, an avid runner, was fatally gunned down in Georgia as he literally fought for his life. It was also business as usual that Mr. Arbery would have his last breaths captured on video, similar to George Floyd, for so many to see. Yet those tasked to take action in correcting this wrong still chose to do nothing. It was not until many people decided to do something other than settling for business as usual that corrective actions were taken, and while justice in the overall sense has yet to be realized, many people know there is still so much more that can and should be done. This is why I am and will continue writing.

It should come as no surprise that many healthcare professionals, especially physicians, know that there is an enormous gap between the rising number of healthcare disparities and the dismally low number of physicians of color in positions of leadership and authority within academic or clinical medicine. It should also come as no surprise to many who work within these medical entities that unless there is a drastic and intentional change in how we recruit, retain, and reinforce our students and physicians of color, we will keep seeing the disheartening results of what I call “business as usual healthcare”. I, and countless others like me, know that business as usual healthcare played a part in the untimely death of one of our own on December 20th at an Indiana University hospital. Prior to this day, Dr. Susan Moore recorded a video where she documented her mistreatment while being hospitalized with COVID. In her video, Dr. Moore definitively stated that she was made to feel like a drug addict when asking for medication to treat her uncontrolled pain. Yet, despite the countless reports, studies, and journal articles documenting how minority patients’ pain assessments and treatments are far too often disregarded and not believed, Dr. Moore likely fell victim to the same biases and schools of thought that have plagued the healthcare system and society overall even to this day. Add the December 24th statement from Indiana University Health’s President and CEO to this story—where he concluded that Dr. Moore’s subpar treatment may be due in part to her nurses being “intimidated” by her being knowledgeable and her use of social media to voice her concerns and critiques of the care she received—without hardly any statements from major medical societies or organizations, academic institutions, or hospital entities condemning this language or idea is just another poignant example of business as usual healthcare.

In addition to the many unfortunate examples that end with loss of life, business as usual healthcare equates to less and less Black and Brown students entering into medical school year after year, which eventually leads to more and more Black and Brown communities having higher morbidities and mortalities as a result of many disease states that could have been prevented or treated. Whether it is heart disease, HIV, social determinants of health, COVID-19 or some other category related to poor health outcomes, Black and Brown people more often than not remain at the top of these lists. Yet, when it comes to CEOs, CMOs, department chairs, department leads, board chairs, board members, program directors, associate program directors, chief residents, class presidents, class vice presidents, academic deans, scholarship recipients, top ranked applicants, and medical school acceptees, Black and Brown people are more often near the bottom or left off these lists altogether.

For a moment, I ask that you allow that concept to resonate with you and colleagues of yours who are supposedly some of the smartest and most compassionate people in the country; people who have the ability to take the most complex, pathophysiological diseases and disorders and understand them well enough to treat or eradicate them. However, many of those same colleagues have a palpable indifference to the aforementioned pathology that has been well-documented, well-studied, and long-proven. They also have a willful ignorance to change the long-standing and truly outdated policies and practices of many medical hierarchies that built this system where one particular demographic continues to prosper while the other historically disenfranchised demographics perish.

So the charge levied remains ever present; increase the number of minority physicians while ensuring that we—and others within our field—collectively and continuously call out, stop, and undo the business as usual mentalities, schemes, and strongholds that have become commonplace in medicine. This means calling out the idea that “there are no worthy or qualified applicants of color out there” for your medical school admissions, academic departments, or hospital leaderships. This means stopping the notions and beliefs that all doctors of color are only the best candidates when it comes to leading the diversity and inclusion departments and committees but not elsewhere within your institutions. This means undoing decades, and even centuries’ old ideologies, methods, rules, and structures that should not have any place in the way we teach and practice medicine of today. A simple example of this would be adding images of doctors of color to your hallowed medical school and hospital halls as they have undoubtedly contributed to its success in many ways. Another example would be ensuring that the members of your boards, faculties, and administrations greatly reflect and represent the communities and patients they serve. One might also consider not choosing Black patients to be the first and most frequently drug tested when they have common complaints related to behavioral health, but the last and least often to receive adequate medication to control their pain. Perhaps the most important and timely example would be to begin developing, accessing, and implementing programs and resources that allow the Black people who grow up in your communities to matriculate into your institutions and eventually become contributors and leaders within it.

It is my hope that leaders within medicine will take another moment to understand that what is being asked may not be the easiest nor most popular task to complete. In that same breath I implore you to also understand that there are countless people like Mr. Arbery, Mr. Floyd, Dr. Moore, and an exponential number of Black people who have passed because of COVID-19—whom I do not have an appropriate amount of time to name—whose stories might have ended differently if this went beyond simply being a hope. If we instead had more Black doctors in the most afflicted communities and in positions that set forth policies and practices to address the rising number of disparities, we could change medicine for the better. It has been said that “if you want to change the world, start with the next person who comes to you in need”. Well, the Ahmaud Arberys and Susan Moores of the world, and so many like them, have needed this change for some time; and so many others will also need it when they are eventually faced with similar situations and outcomes in the future. Perhaps you will choose to accept this charge to help eliminate the possibility of that need coming to fruition, thereby preventing the filming of more videos of Black people dying before their time as a result of them being left without the appropriate tools needed for their survival. Or will you choose to simply keep your head down, focus on your next meetings and your bottom lines, and go about your business, as usual?

Sincerely,

Byron Jasper, MD, MPH