White Privilege in a White Coat: How Racism Shaped my Medical Education

I have just finished reading Dr. Romano's essay "White Privilege in a White Coat..." Since the racial trope of "white privilege" has permeated every other institution of society I suppose it was only a matter of time until it made its appearance in essays in our professional literature. Dr. Romano attributes his lack of moral courage in not challenging the gallows humor of his colleagues about the shooting death of a young black man as reinforcing his "implicit racism" as a medical student. He further maintains he has benefited over his career from the "deeply ingrained racism of our medical system". He then goes on to list 17 bullet points as a mia culpa relating to a biological fact that neither he, nor any other white person has any control: genetic make-up. He claims that "white physicians seldom ask how their own racial privilege reinforces a white supremacist culture." Effectively then he asserts all white physicians, regardless of their character or their belief system foster white supremacy on the basis of their "racial privilege". This essay very nearly approaches an exercise in self-flagellation and Dr. Romano is inviting every white physician to join him. I decline.

No white person asked to be white; none of us lied, cheated or otherwise committed a nefarious act to be born white. Concerning white privilege, per se: I, as a white man, do not feel guilty about my skin color. I harbor none of the white racial self-loathing which seems to be so fashionable right now. I reject the assumption that whiteness alone is sufficient to assure an individual's success in our society (an implicit assertion of "white privilege"). In the same way many other physical characteristics confer advantage to the individual possessing them (e.g., height, strength, speed, physical attractiveness) I do acknowledge there is a certain natural advantage to me with being a white man. But physical characteristics alone does not guarantee success

Our country's social, political, and economic institutions has historically arisen from white origins but to maintain that other racial groups are entirely excluded from participation in these is to deny a significant amount of evidence to the contrary. Many non-white persons of considerable talent and ability actively participate in, contribute substantially to, and have demonstrated success in virtually every segment of our society - including in medicine.

Despite Dr. Romano's (and others) opinion to the contrary, being of the white race only gets you so far (as is true with any "advantage" an individual may have). Our modern society is increasingly technology-oriented and competitive and ability and merit is fast becoming the coin of the realm. You have to have ability to achieve no matter what racial or ethnic group you come from. I submit that medicine is distinctly one profession where ability counts. An incompetent physician, regardless of racial or ethnic background will find it difficult to succeed. Moreover, one does not have to search hard to find physician leaders in every medical discipline of a wide range of racial and ethnic origins.

Dr. Romano makes much of the declining rates of black males in medicine. He ignores the fact that at the same time there has been a decline of black men matriculating college and medical school that the rates for black women has accelerated - and this has nothing to do with "white privilege". While the numbers for black medical school students do lag behind those for whites and Hispanics they continue to increase. A report from the American Association of Medical Colleges states that in 2015, women represented 65.3% of all African Americans matriculating into medical school.1 The "barriers" for black men to fuller participation in medical education are reported as biases and lower expectations for black men; poor quality education at K-12 level; and lack of black mentors in medical education - but interestingly none of the barriers seem to daunt black women. The attractiveness of lucrative careers for well qualified black men in other STEM fields that do not require as much training as a career in medicine is also an often ignored factor in the lower number of male physicians. More black men are entering college but fewer are selecting medical careers. I certainly can unequivocally state that as a medical educator I interview far more black women physicians as applicants for residency training than their male counterparts.

Darrell R. Over, MD, MSc, FAAFP

1. AAMC Facts and Figures 2016. Current Trends in Medical Education. www.aamcdiversityfactsandfigures2016.org/report-section/section-3/#figure-19A. Accessed May 14,2018.

Competing interests: None declared