Diversity and inclusion are critical foci for ACEP and our specialty and should include all aspects of our organization. ACEP’s work should represent and benefit our membership and should be representative of our membership. To that end, our educational programs are best served by making certain that the perspectives and opinions shared reflect our diverse membership. The importance of this concept is highlighted in the experiences of Tina Wu, MD, MBA, associate chief of service and director of quality improvement for the Ronald O. Perelman Center for Emergency Services for NYU Langone Medical Center, assistant professor at NYU School of Medicine, and a physician at Bellevue Hospital Center and the Hospital for Joint Diseases, all in New York City.
Dr. Wu recently sat down with ACEP Now Medical Editor in Chief Kevin Klauer, DO, EJD, FACEP, to discuss her experience at ACEP’s Emergency Department Directors Academy Phase 1 meeting held Nov. 14–18, 2016, in Dallas.
KK: You noticed something that concerned you regarding the Directors Academy Phase 1. Tell me about that concern.
TW: I do want to mention that I think the ED Directors Academy was very well-run. I do encourage people who are interested in leadership to attend. I noticed on the first day that there were no women or minority speakers. Some of the names of the future speakers could have been female, so I waited until day three when it became evident that there were no speakers who were women or minorities. We’d just received a lecture that was specifically on diversity with legally interviewing, hiring, and terminating, and so I found it striking to have five days, six to eight hours a day, of speakers talking about inclusion, diversity, and non-hostile environments and to not have a diverse speaker panel.
KK: That makes sense, and you’re raising an important topic. Let’s step back for just a moment if we can. I wanted to ask you in general your feelings about diversity and inclusion in emergency medicine. Do you feel your opportunities have been limited despite the great experiences you’ve had?
TW: It’s less about limitations per se but more about perception. One of the questions that someone asked at the ED Directors Academy was, “If I have two candidates and one is a minority but less qualified, what should I do?” The way that people frame these questions and the way that people say, “Oh, we should give people a chance,” is already putting them at a disadvantage. The reality is when you look at all sorts of leadership papers and one book, The Leadership Machine, they note that motivation and behavioral competency make up about 70 percent of the major factors that contribute to success in a job, whereas 20 percent is experience and 10 percent is functional or technical competencies. So when people say, “Oh, this person wasn’t qualified,” that doctor is usually interviewing them for only 30 minutes or an hour after looking at their CV.
KK: Do you think when people make these statements this displays their subconscious bias?
TW: I completely agree. We all have subconscious biases when we look at patients. That’s how the world works. Our mind works in stereotyping people, and that’s how we survive.
KK: I think if people are open to considering other people’s perspectives, and you bring it to their attention that there is a gap between what they are thinking or saying and what others are thinking or saying, then they have an intellectual choice to decide how to conduct themselves. However, when there is subconscious bias, there is not awareness of any choice to be made. First, we need to recognize subconscious biases exist and then make certain that those biases do not impact the way we interact with others.
TW: Right, absolutely. Diversity and inclusion are not just a numbers game or to make a politically correct workplace. I think that women and minorities are able to bring diversity to the table and treat patients, maybe, in a way that a homogeneous group could not.
KK: In your professional roles, can you give me a sense, on average on a daily basis, how often you experience some sort of issue with diversity and inclusion? That could be either an insensitive comment, a decision made that is not representative of a population you are working with, or other examples.
TW: I don’t think it’s necessarily about outward discrimination or outward biases, but it does happen. I was in the pediatric ED and I introduced myself to a 3-year-old and I said, “Hi, my name is Dr. Wu. What is your name?” He said, “You can’t be a doctor. You’re a girl.” You speak to any female or a lot of young doctors, and you’ll find that they may be mistaken for a patient care assistant, nurse, or registration clerk. Every day I’m aware of it in everything that I say and everything that I do. The way that I dress, the way that I carry myself, my hand motions, how I speak, whether I’m too aggressive or not aggressive enough, whether I’m smiling or not smiling, my type of shoes—it’s everything.
KK: You’re obviously a strong, successful female emergency physician who seems unaffected by such influences, but look at all the things you do. Is it possible that over time you develop a certain acceptance and tolerance of this issue because you have no other choice?
TW: That’s a good question. I think it’s unfair. There are a lot of things unfair in this world. I was reading a book, The Well-Spoken Woman, and one of the things that struck me was that when women speak, people look and then listen, but when men speak, they listen. Such bias is reflected, for instance, in the number of times that people comment on what a woman is wearing or their hair. Women do the same thing. Women comment on women’s hair and makeup, so we do have to try to mitigate that and acknowledge that this exists. There are biases in the world that exist, and as much as people and I would like to kick and scream about promotions being on merit and success and being purely on functional and technical competency, it’s not the way the world works.
KK: Your comments really help illustrate how many of us see our colleagues, like you, who manage it well, thus we don’t realize some of the accommodations you’ve had to make for others in the world who may impose subconscious biases on others. I’m looking forward to the day when you don’t have to pay such close attention to your hand gestures or exactly what outfit you choose for that day or if you’re being too assertive or not assertive enough. Why can’t you just be you?
TW: It speaks to the point of the importance of having a more diverse leadership group that is nationally recognized because then you start to break down those barriers. It’s not just about putting a female out there and making us talk; it’s actually about the audience seeing different types of leaders. There are different types of leadership out there, but when you’re only used to seeing one type of leader, it may bias everything you do.
KK: Let’s go back to the ED Directors Academy for a minute. At what moment did you say, “I need to say something to somebody,” and what prompted you to do that?
TW: I think what prompted me to do that was I felt like I could change things. I really did. I really did think that my voice made a difference. That was what prompted me to speak up about it. I didn’t think it was outright racism or anything that was malicious at all. I thought it was just an oversight. When you point out these oversights, people say, “Oh my goodness, we’ll change this for next time.” I don’t complain without doing something about it. I hear complaints, as medical directors hear a lot of complaints about the ED, and I use that as an opportunity to do something about it.
KK: So you went to Robert Strauss Jr., MD, FACEP, who’s a great guy and who’s been running that program since its inception, and he was pretty receptive to your concerns?
TW: Absolutely. I think he was very, very receptive. He wasn’t defensive at all, and I was very, very glad about that reception. He didn’t try to make excuses; he was just very open to changing it for the future.
KK: This has been discussed at the ACEP Board level, and the ACEP Education Committee is actively engaged in evaluating and addressing this issue. I think it was wonderful that you brought this up in a constructive way. There have even been changes made for this course and for all future educational offerings.