STAT’s Usha Lee McFarling had heard whispers for months: Early-career Black doctors were being unjustly ousted from residency training programs for elite surgical specialties at alarming rates. Nobody wanted to talk about it, though, out of shame and fear of dashing their remaining career prospects. McFarling wouldn’t let the story drop. Not in the wake of the Covid pandemic, when every health care leader was pledging to address health disparities and promote diversity. Eventually, over many months, she spoke with more than a dozen Black residents and former residents who said they had been fired, forced out, or withdrawn under duress, often without cause and no recourse. She persuaded four to be named in her story. When the organization that tracks residents’ outcomes by race refused to give her access, she located a PowerPoint presentation with data showing Black residents were dismissed at far higher rates than their white peers. “To many Black doctors in these lucrative specialties, the hemorrhaging of young doctors is a clear sign of systemic racism,” McFarling wrote in the article.
While many news outlets covered racial and ethnic health disparities in the wake of the Covid-19 pandemic, much of that reporting danced around the uncomfortable issue of structural racism, using terms such as “socio-economic status” or “social determinants of health” without confronting the racism that may be the most important factor causing disparities. McFarling’s work stands out because she connected the dots, probing why health disparities are deeply entrenched, why so little has been done to curb them, and what it may take to finally elicit change. Her stories openly explain the many ways in which racism fosters, sometimes subtly, inequitable care. They make the invisible visible.
In addition to her story on the dismissal of Black residents, she examined why pulse oximeters, ubiquitous fingertip devices used to measure oxygen levels, have never been fixed even though they work less well on people with darker skin — a flaw that led to poorer treatment and worse outcomes during the pandemic when the devices were used to triage who would be admitted into overwhelmed hospitals and ICUs and who would be sent home. She traveled to the Rio Grande Valley in south Texas to understand why Hispanic people are excluded from clinical trials for Alzheimer’s disease, though they’re more vulnerable to the illness than other groups, and to explore how a team of Hispanic researchers is testing approaches to diversify studies and make treatment more accessible. Finally, she profiled Abdullah Pratt, an ER physician who grew up in the Black neighborhoods of Chicago’s South Side and now tries to bring more kids like him into medicine while teaching them strategies to stay alive amid an epidemic of gun homicides. It’s an inspiring story, but also one that shows the high toll this work takes on Black physicians like Pratt who are trying to break decades-old cycles and raise themselves and their communities out of poverty, but getting little help from the health care establishment.