Preventing the Demise of Diversity, Equity, and Inclusion
Authors: Kathie-Ann Joseph, Renee Williams
Journal: JAMA Network Open (2024)

Has the increased presence of leaders in diversity, equity, and inclusion (DEI) since the murder of George Floyd led to a demonstrable change in academic medical institutions?Elsewhere in JAMA Network Open, Esparza and colleagues 1 surveyed 32 DEI leaders across the United States to learn more about their experiences.Their findings confirm what many people who work in this area also know: their work, while challenging and gratifying, comes with challenges their counterparts in other leadership roles do not encounter.These leaders, charged with promoting DEI at their institutions, vary considerably in their roles, responsibilities, budgets, staffing, and authority. 1Of the 32 leaders who agreed to participate in this survey, two-thirds identified as underrepresented in medicine (URIM), and one-third were first generation to college. 1 While many stated they had a high level of independence, they were missing a structure and clear directives from their leadership.This begs the question of whether the surge in DEI leadership in academic medical centers, particularly after 2020, was reactionary in nature or part of a sea change to make substantial efforts to create a medical workforce prepared to treat a more diverse population and advance inclusion excellence.The authors identified 4 themes from their interviews with the DEI leaders.These included wide variability in scope, expectation, and resources; a mismatch between institutional directives and investments that engenders distrust; challenges in use of evidence-based frameworks, theories of change, or standards of expertise; and DEI work that both drives and exhausts. 1It is worth noting that these roles are filled by people who are overwhelmingly URIM themselves (66%), and several hold more than 1 DEI role.Other studies examine the unrewarded, uncompensated work that often does not count toward academic scholarship. 2While metrics for promotion are somewhat variable based on institution, historically, work focused on DEI initiatives has not been afforded academic credit for promotion.Lack of academic credit may contribute negatively to the emotional labor associated with these roles.DEI work, while rewarding in a system that is committed to change, can be equally exhausting.A recent mixed-methods study 3 found that leaders utilize significant energy to maintain a neutral stance while suppressing positive and negative emotions.The consequence of this emotional labor was burnout, manifested as emotional exhaustion, diminished personal accomplishment, and depersonalization. 3The minority tax that tasks URIMs with the job of tackling diversity in academic institutions can be time-consuming, often leads to feelings of isolation and increased discrimination, and is a significant source of inequity in academic medicine. 4ile staffing and resources are important for DEI leaders to succeed, what is not highlighted in this article is the significance of support and commitment from the top academic leadership.Scholars have noted that DEI should be actively supported by the dean and should be part of the school's academic strategic plan.By incorporating DEI in the strategic plan, it becomes woven into all facets of the school's mission. 5URIM physicians make up approximately 12% of the physician workforce and do not adequately reflect the general population. 6Health equity is a public health crisis; however, we cannot achieve health equity until there is a workforce that adequately reflects the population at large.DEI and health equity are closely intertwined; one cannot exist without the other.The ultimate goal of improving patient outcomes in marginalized populations underscores the importance of DEI integration into the departmental goals and strategic plan.For the past 2 years, at our institution, faculty who pursue scholarly work in DEI can include these efforts as a criterion for academic promotion and tenure, thereby reducing the minority tax and burnout experienced by those who choose to integrate DEI into their academic pursuits through research, teaching, or education.