Are We Nearly There Yet?

“Change is happening, but it is far too slow. We need pressure from people in all industries – and not just people like me. For many years, the doors to ophthalmology were closed to underrepresented minorities; now they are opening, let’s keep it that way.” So writes Daniel Laroche, one of the authors of our cover feature, which is based on the story of Black ophthalmologist David Kearney McDonogh. 

McDonogh, born an enslaved person in 1821 in New Orleans, Louisiana, trained at Columbia University, New York, and went on to practice at the New York Eye and Ear Infirmary. Medical education was closed to non-white people at the time, but McDonogh managed to study medicine as part of a movement dedicated to send African Americans to Liberia. As McDonogh decided to stay in the US, he was not awarded a medical degree – something Columbia University attempted to rectify 170 years later (1). 

Times have changed, but how far has the door opened? A recent paper exploring racial diversity in the ophthalmology workforce noted that the 6 percent of practicing ophthalmologists from underrepresented minority backgrounds is much lower than the percentage of minority-background physicians practicing in the US – 11.2 percent (2). And neither of these statistics reflects demographics of the entire nation, where 33 percent of people are from minority backgrounds (3). 

Why does this matter? Representation at all levels helps address the wider issue of racial disparity in medicine; health professionals from minority ethnic backgrounds are more likely to practice in underserved communities, and have better communication and satisfaction rates among underrepresented minority patients (4). They are also more likely to speak their ethnic minority patients’ language, whether figuratively or literally, in the case of multilingual physicians.

Much has been said about various health conditions (including, most recently, COVID-19) disproportionately affecting non-white patients. Although there are some biological factors responsible for this disproportion, inequality in access to care needs to be clearly acknowledged and acted upon. In the US, the two main factors independently associated with inconsistent glaucoma follow-up visits were being Black or of Latino ethnicity, according to one study (5), which also noted that insurance status, ability to pay for medication, and transport inconvenience were not predictive of follow-up patterns. 

What can we all do? A good start might be the list of steps towards eradicating racial injustice in medicine prepared by Randy A. Vince, Jr (6). As Laroche concludes, “Look at your leadership; does it reflect the diversity of your community, the country, the world? We all have a role to play when it comes to proposing solutions to these problems.”