Finding My Voice
Authors: Joy Y. Wu
Journal: Annals of Internal Medicine (2021)

On Being a DoctorSeptember 2021Finding My VoiceFREEJoy Y. Wu, MD, PhDJoy Y. Wu, MD, PhDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-1587 Audio Reading - "Finding My Voice" Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Finding My Voice" by Joy Y. Wu, MD, PhD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail According to the U.S. Census Bureau, Asian Americans have been the fastest-growing racial group in the United States over the past two decades, with an estimated 22.9 million Asian Americans comprising 5.7% of the U.S. population in 2019. Asian Americans are a diverse group tracing their roots back to more than 20 countries in East, Southeast, and South Asia. Often considered together with native Hawaiians and other Pacific Islanders, the Asian American and Pacific Islander (AAPI) community in the United States represents many ethnicities, languages, religions, histories, geographies, and cultures.Asian Americans and Pacific Islanders occupy a fraught space in the racial fabric of this country. The "model minority myth" posits that AAPIs in the United States have attained high rates of educational achievement and financial success and implies that they therefore must not be subject to discrimination. However, there is a long history of anti-AAPI racism in this nation, from the 1882 Chinese Exclusion Act barring immigration of Chinese laborers to the forcible internment of Japanese Americans during World War II.Since the start of the COVID-19 pandemic, there has been a rising tide of anti-AAPI racism and xenophobia. Between March 2020 and February 2021, the Stop AAPI Hate reporting center received 3795 reports of hate incidents directed at AAPIs that included verbal harassment, shunning, and physical assault. Sixty-eight percent of these hate incidents were reported by women. In recent weeks, there has been an alarming number of vicious attacks targeting AAPIs in cities across the country. Furthermore, in Atlanta on March 16, 2021, eight persons—including six Asian women—were murdered at three Asian-owned businesses.The following day, I felt compelled to break my silence on my own experiences with racism in a series of tweets. I was especially driven by anguish and fury when initial reports of the Atlanta shootings attributed the suspect's motivation to a "sexual addiction," highlighting how AAPI women can be targeted by both racism and misogyny. As a child, I lived near Detroit during an era of rising tensions against Japanese automakers that led to the 1982 beating death of Vincent Chin, a Chinese American man. I was regularly kicked, punched, and called "Chink" on the way to school. Yet, because I was one of only two AAPI children in the entire elementary school, I believed this was just the price to pay for being different. Media portrayals have often stereotyped AAPI women as submissive and exotic, and as a young adult I endured the leers of men telling me they "like Asian women."I eventually realized that physical and verbal attacks were a common experience among my AAPI peers. However, the fact that these experiences were so common only served to impress upon me that there was no need to discuss this further and no point in doing so. We had all experienced racism, and there was apparently nothing to be done. Only recently, when the National Basketball Association announced it would investigate racism directed at player Jeremy Lin, my own astonishment made me realize how deeply I believe that anti-AAPI racism is ignored and dismissed.Even as I entered the field of medicine, racism persisted. Patients and classmates expressed surprise that I speak English "so well." Professors and attendings told me, "You are too quiet," "You all look the same," and "I can't keep your names straight"—endless reminders that we never quite fully belong. Most AAPIs have been repeatedly asked the question that insinuates exclusion: "Where are you from?" If I respond that I was born in Texas, the inevitable reply is, "No, I mean where are you really from?"When I became an attending myself, I heard in teaching workshops that quiet students are problematic. The perception that AAPI medical students are quiet rather than thoughtful can lead to bias, especially in clinical clerkships when attendings' evaluations are largely subjective. From my personal experience reading letters of recommendation, I can attest that AAPI students are, indeed, frequently described as quiet. Although a growing number of studies is addressing gender and racial/ethnic biases in letters of recommendation, data on AAPI students are lacking.The model minority myth further serves to obscure the reality that many subgroups in the AAPI community face significant barriers to equity in medical education. Asian American and Pacific Islander students represent the second-largest racial group among entering medical students (22.9% of matriculating students in 2020) and are therefore not considered underrepresented in medicine; however, aggregating all AAPIs hides the fact that some AAPI subgroups, particularly those with roots in Southeast Asia, are underrepresented. Laotian, Cambodian, and Indonesian applicants together comprised less than 1% of AAPI applicants to medical school between 2018 and 2019. Burmese, Thai, and Hmong subgroups were not even counted. The model minority myth perpetuates sometimes dangerously high expectations among AAPI students and nullifies individual effort by reducing hard work into a single stereotype that "all Asians receive good grades." This myth can also have the detrimental effect of pitting AAPIs against other minority groups, preventing a united stand for equity regardless of race and ethnicity.As faculty, AAPIs face hurdles to advancement in academic medicine. The Association of American Medical Colleges' 2020 Faculty Roster reveals that AAPIs make up 23.4% of assistant professors, 20.6% of associate professors, and only 14.2% of professors. Asian American and Pacific Islander women in academic medicine face intersecting barriers—the "glass ceiling" and the "bamboo ceiling"—that magnify these disparities. Although the percentage of AAPI women (11.2%) is similar to that of AAPI men (12.1%) at the rank of assistant professor, there are more than 2.5 times as many AAPI men (10.2%) as AAPI women (4.0%) at the rank of professor. Among internal medicine departments, 12.8% of chairs are AAPI men, but only 1.1% are AAPI women.Considering all AAPIs as a monolithic entity also disguises substantial differences in socioeconomic status and access to health care within AAPI subgroups. Several studies have shown that disaggregation of AAPI subgroups reveals striking health disparities, including cardiovascular disease mortality and metabolic risk factors. More research is required to understand the nature of these disparities among AAPI subgroups; yet, between 1992 and 2018, clinical research studies focused on AAPI participants comprised only 0.17% of the budget of the National Institutes of Health. Communities of color have been disproportionately affected during the COVID-19 pandemic, and AAPIs are no exception. In 17 states, the proportion of COVID-19 cases among AAPIs exceeds their representation in the population, and no states are reporting pandemic data on AAPI subgroups. Increasing the diversity of the physician workforce is one important approach to reducing health disparities, because patient–provider concordance in race/ethnicity and language may be linked to improved adherence and satisfaction. In a survey of Asian American adults, 52% of respondents expressed a preference for ethnic concordance with their health care providers, particularly among those with limited English proficiency.I have heard from many AAPI colleagues and trainees that they do not feel comfortable discussing their experiences with racism in medicine. Many Asian cultures place a high priority on obedience and respect for elders, which can translate into reluctance to question authority. Like many, I have long been inclined to keep my head down, work hard, and do my best to assimilate. However, in the days after the Atlanta shootings, I released a statement with fellow AAPI leaders at Stanford; the outpouring of shared frustration in response has shown me that we cannot remain silent. It can feel like the field of medicine favors those who speak first and loudest, but social media has helped me find my voice.For the sake of our patients, our colleagues, and our trainees, we must speak up about the destructive effects of anti-AAPI racism. As individuals, AAPI and non-AAPI alike, we can act. Reach out to AAPI colleagues and trainees to let them know they have your support and that you oppose all forms of racism. Bystander intervention training can provide strategies to intercede when you witness harassment in action. As institutions, we can disaggregate the data on AAPI faculty and students, provide antiracism and unconscious bias training, and support research and initiatives to counter health disparities in AAPI subgroups. Together, we can all stand up to end anti-AAPI racism. Comments0 CommentsSign In to Submit A Comment Carlos julio ApontePremier Physicians25 May 2021 My experience Being an International Medical Graduate and speaking with an accent, I understand xenophobia. In the first hospital I trained most of the residents were IMG's; we had to work extra hard to get attention and receive training. Many times we were dismissed, but we created a support community. My senior residents, were mostly AAPI, and taught me a lot. Many attendants were racists an xenophobic. Author, Article, and Disclosure InformationAffiliations: Stanford University School of Medicine Stanford, CaliforniaCorresponding Author: Joy Y. Wu, MD, PhD, Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, S-025, Stanford, CA 94305; e-mail, [email protected]edu.This article was published at Annals.org on 25 May 2021. PreviousarticleNextarticle Advertisement Audio Reading - "Finding My Voice" Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Finding My Voice" by Joy Y. Wu, MD, PhD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byThe #StopAsianHate Movement on Twitter: A Qualitative Descriptive Study September 2021Volume 174, Issue 9Page: 1327-1328 ePublished: 25 May 2021 Issue Published: September 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. 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