‘Inequity is a public health crisis’: new article finds Canadian medical leadership lacking in diversity

Intentional action by institutions is required to end the lack of diversity in medical leadership. That’s one of the findings in a new article in the British Medical Journal (BMJ), written by Drs. Shannon Ruzycki, MD, and Allison Brown, PhD — members of the O’Brien Institute for Public Health at the Cumming School of Medicine (CSM) — along with their University of Calgary colleague Dr. Susan Franceschet, PhD.

The authors analyzed the low proportion of women compared to men in leadership positions, but add that other minority groups, including ethnic minorities, people with disabilities, and members of the LGBTQ2S+ community are also presumed to be underrepresented in medical leadership positions in many countries, including Canada.

“When you don't have a diverse and inclusive leadership, they're not aware of the barriers in the same way,” says Ruzycki, adding that a lack of diverse leadership allows barriers to continue.

Despite equal numbers of men and women in medical school, women are still underrepresented in leadership and decision-making positions — and harassment continues to be more common among minority and female physicians, while female physicians are paid less than male colleagues for the same work, says Ruzycki. She says this gap is expected to be even larger for women of colour.

“Why this issue is really urgent in 2021 is that we now have had 25 years in Canada where there have been more women in medical school than men, yet we know that most medical society leadership is male, we know that most journal editors are men,” says Ruzycki, “even though there are technically now more women to choose from.”

A lack of representation can also lead to worse health outcomes for patients, says Ruzycki, as data accumulates that shows that patients who have experienced marginalization have worse health outcomes when treated by a physician who doesn't have that shared experience.

People are dying because of these unconscious or conscious biases against our patients. I think we need to represent the population that we serve so we can start to improve health outcomes for our patients.

In the midst of the COVID-19 pandemic, and as conversations about racial justice and inequities continue one year following the death of George Floyd in the U.S., it's time for medical and public health leadership to think about the disproportionate effects inequity and injustice has on marginalized communities, says article co-author Brown. She says an equity lens needs to be put at the forefront of everything in public health.

“Inequities are a public health crisis. Public health without equity and diversity and inclusion is not public health,” she says.

Affecting change

To create change, doctors from underrepresented minorities must be present in increased numbers in leadership and decision-making roles, says Brown, adding that one way to increase representation among medical leadership is to implement evidence-based quota policies and for organizations to work toward more inclusive hiring.

“At the end of the day, it would just create a much better system and structure. We need to be more intersectional and inclusive in our approach. This is not just about gender, our well-intended gender equity efforts often further marginalize and oppress people in medicine,” says Brown.

Government quota policies exist in more than 130 countries, and corporate quotas have expanded considerably in Europe and the U.S.

Brown says the term quota can often be misconstrued as unfair hiring, but the opposite is true.

She says quotas can involve policies to interview at least one person from a minority group, and voluntary quotas, which provide individual or organizational rewards for voluntarily meeting diversity targets, and can include education on diversity or barriers faced by under-represented groups.

The BMJ article is an important study — and part of a bigger picture, says Dr. Aliya Kassam, PhD, lead of the O’Brien Institute’s Equity, Diversity and Inclusion portfolio.

“Gender equity for women is only one intersection of social justice in Canadian medical leadership. Other intersections from equity-deserving groups must also be examined in order for Canadian medical leadership to be truly equitable, diverse and inclusive,” she says.

“It’s time to think beyond gender equity and think intersectionality and have the data to ensure that medical leadership and health-care leadership, more broadly, not only talks the talk but also walks the walk.”