In January, we published “Diversity in Recent Leadership Positions,” which highlighted the recent accomplishments and honors of Leon L. Haley Jr., MD, MHSA, FACEP, CPE, Marcus L. Martin, MD, FACEP, and Lynne D. Richardson, MD, FACEP. Dr. Haley, Dr. Martin, and Dr. Richardson have landed roles that reach way beyond emergency medicine alone. Announcements are one thing, but how great leaders achieve success is quite another. The road to leadership is shaped by many experiences and many people, both positive and not so positive. In an interview with ACEP Now’s Medical Editor in Chief Kevin Klauer, DO, EJD, FACEP, these three emergency medicine icons talk about their career paths, influences, and experiences. Here is Part 2 of that conversation; Part 1 appeared in the November issue.

KK: It seems like being first sometimes has additional challenges because you are breaking down barriers while also trying to do your job. Would that be a fair statement?

MM: I agree 100 percent. It’s isolation; often we’re singled out, easily seen, placed under the microscope. Higher expectations are demanded of us. But we don’t have time to cry or to fold or to appear weak. We have to rely on our inner strengths. In my case, I’ve always relied on having conversations with my wife when I go home, and I try to make sure that I’ve built consensus with as many of the faculty, students, and staff.

LH: I think all of us, in many respects, embrace being first because somebody had to be first to help get us where we are, but at the same time, there are those unique challenges. There’s the “under the gun,” the high expectations. There’s the feeling that you’re carrying the weight of people on your back. I think those are unique challenges that the average, quite frankly, white male doesn’t have to carry into a role.

KK: Do we think we’ve lost good leaders because of this?

LR: Absolutely. I think one of the most heinous consequences of the disparities in opportunities that still exist in this country is the loss of talent and all of the leaders, scientists, and researchers who never get the chance to make the kind of contributions we’ve been able to make because they aren’t strong enough or don’t get the support they need to overcome the barriers that all of us have faced. I know I can speak certainly for Marcus and Leon in saying all of us are very focused on spending a lot of time and energy in making it easier for the ones coming behind us than it was for us.

KK: Leon, what are your thoughts on leadership and limitations that you’ve overcome but maybe others haven’t?

LH: I think there’s a challenge for people because there are people who don’t want the extra burden they may have to deal with because there are, when you become an administrative leader or clinical leader, a lot of tasks that come with those roles. I think the art of mentorship has gone away for many folks. There aren’t as many mentors out there that are available to spend the time necessary. I think trying to find enough people who want to be mentors, particularly to women, African-Americans, and underrepresented minorities, is harder.

KK: I read an article that was very intriguing to me in JAMA.¹ The concept was the minority tax. Your thoughts?

LR: I think there’s a psychological burden in terms of this tax, and I think that it is carrying the hopes and expectations of a whole people with you and knowing that, if you fail, the failure will be blamed upon your inferiority as a member of an inferior race. That does add a lot of pressure. There’s also a very tangible aspect to this black/minority tax thing. It is that very well-intentioned people who have a genuine desire to have diversity in various situations will seek out those few of us who actually are of a certain rank in a certain field. This is something that I talk about very explicitly to minority faculty that I mentor because you’re really torn. When you get invited to sit on the admissions committee, you know how important it is that an admissions committee has diverse faculty on it. There’s tension between doing what you know is important, doing what you want to do, and really staying on track to make sure those things don’t derail your career goals.

KK: I assume these “well-intentioned people” believe they are providing opportunity that you and others want, but it may be more of an obligation than an opportunity because if you’re more interested in faculty development or ultrasound or EMS, now you may not pursue those things because you are the appointed diversity and inclusion person at your facility.

LR: For some people, it is a wonderful opportunity, but does that then marginalize you in ways that pursuing other avenues might not? Every individual has to struggle with lots of choices, and there are lots of things to weigh as you make these professional decisions.

KK: Marcus, do you have any response to Lynne’s comments?

MM: Considering the minority tax, if you have a minority in a position of leadership and there was a white person, particularly a white male, in that position prior, and everything else is constant, the black person is expected to raise the bar or increase the diversity of the medical school class or do something totally different just because he’s black—and that’s the minority tax. Regarding getting into a position like chief diversity officer, I feel that should be something that someone truly wants to do. Some people get pigeonholed into it because there’s nobody else to do it; in my case, there was a desire to do it.

KK: Do you have any advice for emergency physicians who do experience diversity and inclusion challenges?

LR: I do want to add one thing since I was the only one that, in fact, had a whole additional set of challenges because I built my career while being an essentially single parent to my two daughters. I often reflect on the sacrifices not only that I had to make but that my children made or I arranged for them to have to make in order for me to do some of the things that I’ve done in my career. I say that not seeking praise but so that women who are facing that same set of challenges know that it can be done and that I don’t think you have to make a choice between having a successful career and being a dedicated parent.

My message to colleagues who are from the majority group is that I think it’s really important that they understand the damage that is done by discrimination and racism, not just to those who are victimized by it but by the perpetrators of it. And being pro diversity and inclusion should be motivated not just for social justice reasons and ethical reasons and humanitarian reasons but for very practical reasons. Diverse teams are actually higher-performing than homogeneous teams. My message is that diversity and inclusion is good for everyone, and it should be embraced by everyone.

KK: Leon, your final thoughts on guidance to others?

LH: I think I would agree with Lynne. I think, obviously, identifying mentors early in your career is always important. I think having a good career plan—what it is you want to do in your life—is critical. Making sure you know your pathway and who are the people who can help you, regardless of whether they’re black, white, male, or female, is critically important.

MM: Emergency physicians must practice the art of medicine not permitting interference of duty to the patient regardless of human variations inclusive of religion, nationality, race/ethnicity, social standing, sexual orientation, veteran status, ability/disability, or any other diverse factor. I encourage experienced emergency physicians to take under their wings and mentor one or more budding health care providers, especially from underserved or disadvantaged backgrounds. Our communities and our nation will be better served in the long run, and hopefully health care disparities will further narrow.

Reference

1. Cyrus KD. A piece of my mind: medical education and the minority tax. JAMA. 2017;317(18):1833-1834.