My sister and I speak almost every day. Sometimes we talk about our kids, our husbands, and our jobs. She is an attorney in the military and part of the JAG corps. I am an academic obstetrician/gynecologist (OB/GYN), which means my practice involves education. We are both Black women in majority-white professions. Our morning conversations about our respective jobs are sometimes about the work itself, which we are both passionate about. In fact, we dreamt about doing what we do when we were kids and often vocalize how grateful we are for the chance to live our dreams. But more often than I’d like, we talk about how we, or people who look like us—those we are charged to teach, mentor, or otherwise help—are mistreated.
Our conversations usually start like this:
“Hey girl.”
“Hey.”
“What are you doing?”
“Dropping off [insert kid’s name] at [insert activity].”
“Oh, OK. Hey [kid’s name]. Girl, guess what happened?”
We then describe a scenario that played out a certain way in our professional settings. The stories are often punctuated by lots of “mm-hmms,” “yups,” and “I cannot believe that!” s. But the sad truth is, we can, in fact, believe it. These stories have a unifying thread that is very familiar.
My sister often repeats something like, “These days, people won’t call you the n-word to your face. That’s just not how racism manifests in the workplace.” And what I’ve learned and lived in these scenarios is that ambiguity is the vehicle through which racism is delivered. It’s the nebulous accusation that supervisors take seriously but doesn’t come with any real evidence. It’s the weaponization of the word “professionalism.” It’s a lot of things that fly under the radar.
My sister and I discuss these things so often, we decided to make a list to help others see the unseen. Here’s our top five:
Number 5: Microaggressions
These are the everyday slights and insults that people of color (POC) experience. For example, the inability of coworkers to tell the difference between two Black people in the office who share limited other characteristics besides their race. It’s not so much an inability as it is a refusal of those coworkers to get to know the two Black people enough to learn the difference between them. Another example is the unspoken and sometimes voiced pressure for POC to conform to Eurocentric norms. My sister and I both have natural hair, meaning that it is not chemically processed. One of her senior officers commented that she liked my sister’s hair better straight and that it looked more professional than when she saw it natural. In an extremely hierarchical organization like the military, a senior officer’s opinion really matters. And it’s disconcerting to know that your natural self isn’t palatable to leadership.
Another time, one of my medical students wore braids in her hair. During a patient encounter, the “standardized patient”—a person hired for the learning process—gave feedback that my student’s braids touched him, which made him uncomfortable. He felt this was unprofessional. What’s wrong with this scenario is not only that the standardized patient said it, but that the evaluators decided to put it in the student’s permanent record. When questioned, the school refused to erase the comment, which was completely unrelated to patient care, because, well, “This is real life.” But it wasn’t. It was a standardized, a.k.a. “fake,” patient encounter. People describe microaggressions as “death by a thousand cuts.” This is an apt metaphor to describe how each instance of aggression stings a little, but the collective effect has a huge impact.
Number 4: the inability to follow POC in leadership positions or respect their authority
One of my friends, a Black female leader of her division, was called into her boss’s office for a one-on-one meeting. He proceeded to tell her that, for the last six months, people in her area were dissatisfied with her leadership. There were no explanations given as to why people were upset, so my friend couldn’t get better—assuming there even was a legitimate issue to work on. The ambiguity left my friend upset and questioning every move she made as a leader in the recent past. She had no idea how to change her behavior moving forward to satisfy everyone. Talk about exhausting.
Recently, I interviewed for a job. During my interview, one of my interviewers started discussing another OB/GYN department. He said that he left this other department because the chair exhibited terrible leadership. I knew from being on the interview circuit that this chair was a Black woman. There was a mass exodus of faculty when she was chosen as chair, and the exodus occurred pretty soon after she got there. Firstly, it was inappropriate for this man to be telling me this in the interview—it was definitely an unrelated and disparaging tangent. But, more importantly, his story highlighted his and his colleagues’ inability to handle a Black woman in charge. We expect some turnover in a department when a new chair is named, but not that much and not that soon. Do you know what it takes to change jobs? This very accomplished Black woman must have been a nightmare, right? A POC who currently works under the Black female chair told me that “we all know why they left.”
A Black female colonel came in to lead an office. In the military, it’s standard practice for senior leaders to move around from office to office. That’s why my sister has had to move every two to three years since she’s been in the service. The colonel who led the office before was a white man. A subordinate in the office, another white man, had a great relationship with the previous colonel. This was communicated to the incoming Black female colonel. She was expecting to have great support from this “team player.” But the relationship between this subordinate and the new colonel was starkly different from the previous one. The subordinate constantly undermined his new boss. He even held secret meetings with other coworkers where he instructed them not to listen to her. What a different experience.
These anecdotes are supported by data. There is a paucity of POC in leadership in medicine and in the military. This is true in other arenas such as tech, finance, and higher education. Is it that the so-called “pipeline” is dearth of qualified POC? I think the truth is a harder pill to swallow: white people have a hard time following POC leadership.
Number 3: Policing how POC respond to negative feedback
So here’s the nasty cycle. A POC gets negative feedback from her supervisor. The POC asks for further clarification regarding the feedback. The supervisor interprets the questioning poorly and says the employee was “defensive,” “combative,” and thus “unresponsive” to the feedback. Although upset, the employee doesn’t cry or otherwise show emotion. The supervisor interprets the stoic posture of the employee as aloof, disinterested, and not remorseful, as if an outward demonstration of emotion like tears is proof of remorse. The defensiveness narrative is propagated about the POC employee, who is now in a lose-lose situation. She can’t get clarity on the feedback to get better because questioning is evidence of defensiveness. She can’t provide context about the situation from her perspective because doing so is more evidence of defensiveness. If she keeps her composure to maintain some dignity, she’s aloof.
I remember a time when two nurses disagreed with the plan of care I prescribed for a patient. They confronted me, and I calmly explained my clinical reasoning, but I didn’t change the plan of care. The nurses reported me. I responded to the report with a detailed account of what happened from my perspective. I was required to meet with the head physician who dealt with physician discipline. He said to me that he had never seen such a “detailed response” and used that as evidence of my disruptive behavior. I thought, “What did they expect from me?” I was asked to respond to the nurses’ report, and I did as thoroughly as I could—but now, somehow, that was being used against me. I was flabbergasted. I hadn’t cursed, yelled, or thrown anything (unlike some of my colleagues, who did not find themselves sitting in that seat answering for their behavior). Yet, here I was. I asked if my medical decision-making was wrong. “No,” was the reply. I said, “Well then I can’t help but wonder if I looked different, we wouldn’t be having this conversation.” “What do you mean?” I was asked. I explained that my identities as a Black female likely played a role in (1) how the nurses felt empowered to enact a plan of care without my permission and (2) how they felt compelled to report me solely because I made a decision contrary to what they would have done. News alert: medical decision-making is my whole job as an attending physician. I was then told by this person in power that I needed a professional coach. It was the first time in my whole life that my professionalism was questioned. When I told one of my colleagues, a Black female urologist, what happened, she told me that she gets reported by the nurses “all the time.” She said she just ignores them now.
The problem with policing how POC respond to feedback is that it sends a message of betrayal. Do you really care about my growth, which is what feedback is designed to help me do? Are you really interested in getting to the truth, or are you more concerned with finding someone to blame? Have you already made your decisions about me before even talking to me?
Number 2: flaws of POC are considered fatal
We are all human beings and thus make mistakes. What I’ve observed in the medical education environment is that for POC, these mistakes are fatal. The grace that is given to others because they are “just learning” simply isn’t given to POC. If they make a mistake, they become the mistake, and that reputation follows them everywhere. People talk about them, and the negative reputation precedes them in every new environment. They can’t escape.
“I feel so defeated,” she said in response to my question, “How are you?” This POC resident was on the verge of not graduating on time. She recalled that from early on in her residency, the rules that applied to her didn’t seem to apply to her white counterparts. She tried to get out from under the reputation that she was somehow deficient, but she was unsuccessful. Now it was her senior year, and everything was on the line. I witnessed the unfairness that she experienced personally. When she was late for clinic, she was unprofessional, but the same behavior wasn’t counted against her co-residents. If she didn’t know something, she “wasn’t clinically strong,” but when her classmates didn’t know something, those deficiencies didn’t matter as much or at all. I thought, “If she’s in danger of not graduating, so should everyone else.” To me and to others, her performance was on par with her co-residents. But yet, she was the only one being remediated.
My sister tells me that airmen of color disproportionately make up those disciplined in the Air Force. People have written ad nauseam about the high rates of attrition and dismissals of POC in medical education compared to their representation in the field. POC in professional spaces aren’t given the benefit of the doubt. They are, unfortunately, guilty until proven innocent.
A young Black female JAG described to my sister her experiences thus far. She said she learned through the grapevine that a senior officer wishes she wasn’t working for him. The officer said to another subordinate, “Hey, are you working on case X?” The subordinate replied, “No, it’s lawyer Y”—the Black female. The officer replied, “Oh man, I really wish it was you.” The subordinate, with equal rank to the Black female JAG, told her what the senior officer said. When she told my sister this story, lawyer Y admitted that she knows she has made mistakes as a new lawyer and isn’t perfect. But to hear that the boss told her colleague, behind her back, that she’s deficient was demoralizing.
Number 1: inequities in pay and promotion
What people bring home in salary has an impact on so many things. It affects where they can afford to live, which impacts where their kids go to school, which partially determines the kids’ future. What people make now has an impact on their ability to build generational wealth. Not paying and promoting POC is perhaps the most generationally impactful form of racism in the workplace today. Remember when a Black person was considered three-fifths of a human being in America? The fraction three-fifths equals 0.6 or sixty percent. At some point in the recent past, Black women made sixty cents for each dollar that a white man made for the same work. I wonder if there are parallels here about what and who America values, even today. Pay is often tied to promotion, so the fact that POC do not get promoted at rates on par with their white counterparts is a big deal.
One of my colleagues, a Latina surgeon, is by all accounts an academic rock star. She is impeccably trained, well-published, and internationally known for her surgical expertise. She was very invested in educating the next generation of surgeons, so she wrote curriculum, mentored, and involved learners in her research endeavors. When it came time to name a program director for the fellowship, she was the obvious choice. Except that didn’t materialize. A white woman who was her junior was chosen instead. Interestingly, the junior faculty member was asked to keep the plan a secret. My colleague learned of the plan during a public division meeting. She was completely blindsided. In this case, the argument that “maybe the POC wasn’t qualified” doesn’t hold any weight.
Another Black female colleague of mine was in line to be the clerkship director at her institution. She was serving as the assistant director and was told by the chair that the director position was hers. Except it wasn’t. Another person was named instead, and my colleague found out after the fact. When she confronted her chair, there was no real explanation. After that, she knew she wasn’t valued and had to leave.
These anecdotes are common and are supported by national data. POC in medicine are less likely to occupy professor and associate professor ranks and are less likely to be department chairs. There are only a few POC medical school deans. In the military, POC are less likely to occupy higher ranks proportional to their representation in the workforce. Also, POC tend to engage in a lot of labor that benefits the institution but goes uncompensated. For example, they often participate in activities to increase representation of other POC to “pay it forward” or because they know no one else will do it. They often serve on committees to represent the “diverse” voice. This free labor either creates overwork for POC employees, or they do it at the expense of other things that the institution highly values (i.e., research, more productivity). The tax that POC experience in this regard has been well-described, but few institutions have made systematic changes to address it. The so-called systems of meritocracy, as in medicine and the military, only seem to work if you’re white.
What you can do
This top-five list we wrote represents the hard-to-see places where racism exists in professional spaces today. I think the challenging question is, “What can majority people do to counteract this problem?” I actually don’t think the answer is hard, but it does take courage. If you don’t act, you are complicit in the problem, and you might as well call me the n-word.
There is a difference between equality and equity. Equality says to treat people the same all the time. Equity says to treat people how they need to be treated so that they have the same opportunity as everyone else. We can’t pursue equality until we liberally apply equity. So what does this look like in the workplace?
To address microaggressions, we have to recognize our biases and actively work to counteract them through education, self-reflection, and re-evaluation. We have to own our mistakes and apologize to minimize damage. We have to check and double-check ourselves so that POC don’t bleed to death from the thousand paper cuts.
To address the inability to follow POC in leadership, we have to ask ourselves: Would I be reacting this way if this person were a white man? Am I applying an unreasonable standard to this POC leader? What is it inside me that gets irritated with this POC in charge?
To address policing of POC’s response to feedback, we have to first do the due diligence to determine if the feedback is warranted. Thoroughly investigate the complaint before you bring it up. If it’s not valid, disregard it and don’t put it in any permanent records. If the feedback is worth giving, give it. But if you don’t like the POC’s response, ask yourself why you think the person is being defensive. What about their response triggers you and why? Ask yourself why you think you have the right to control other people’s feelings and expressions. Then ask what your motive is for giving the feedback.
To address the fatal flaws of POC, we have to insert ourselves or people we know into the scenario. Ask, if this were my child who made this same mistake, how would I expect others to treat him? Make it personal.
To address the pay and promotion inequity, be transparent. Look at the data by race and right the wrong. If you think your POC lack the skill to get the opportunity, ask yourself why you think that. If they truly lack what it takes, train them.
My ten-year-old nephew said during one of these conversations between my sister and me one morning, “Why are you guys always talking about this brown stuff?” We both chuckled. This “brown stuff” is real life with real-life consequences for individuals and generations. We will never stop talking about it, and you shouldn’t either.
Tera Frederick Howard is an obstetrics-gynecology physician.
