Race, Disadvantage and Faculty Experiences
in Academic Medicine
Linda Pololi, MBBS, MRCP1, Lisa A. Cooper, MD, MPH2, and Phyllis Carr, MD3
1Women’s Studies Research Center, National Initiative on Gender, Culture and Leadership in Medicine: C - Change( Brandeis University,
Waltham, MA, USA;2Johns Hopkins Medical Institutions, Baltimore, MD, USA;3Boston University School of Medicine, Boston, MA, USA.
BACKGROUND: Despite compelling reasons to draw on
the contributions of under-represented minority (URM)
faculty members, US medical schools lack these faculty,
particularly in leadership and senior roles.
OBJECTIVE: The study’s purpose was to document
URM faculty perceptions and experience of the culture
of academic medicine in the US and to raise awareness
of obstacles to achieving the goal of having people of
color in positions of leadership in academic medicine.
DESIGN: The authors conducted a qualitative interview
study in 2006–2007 of faculty in five US medical
schools chosen for their diverse regional and organiza-
PARTICIPANTS: Using purposeful sampling of medical
faculty, 96 faculty were interviewed from four different
career stages (early, plateaued, leaders and left academic
medicine) and diverse specialties with an oversampling of
APPROACH: We identified patterns and themes emer-
gent in the coded data. Analysis was inductive and data
RESULTS: Predominant themes underscored during
analyses regarding the experience of URM faculty were:
difficulty of cross-cultural relationships; isolation and
feeling invisible; lack of mentoring, role models and
social capital; disrespect, overt and covert bias/
to race/ethnicity; devaluing of research on community
health care and health disparities; the unfair burden of
being identified with affirmative action and responsibility
for diversity efforts; leadership’s role in diversity goals;
and financial hardship.
CONCLUSIONS: Achieving an inclusive culture for
diverse medical school faculty would help meet the
mission of academic medicine to train a physician and
research workforce that meets the disparate needs of
our multicultural society. Medical school leaders need
to value the inclusion of URM faculty. Failure to fully
engage the skills and insights of URM faculty impairs
our ability to provide the best science, education or
KEY WORDS: medical faculty; underrepresented minorities; race.
J Gen Intern Med 25(12):1363–9
© Society of General Internal Medicine 2010
Medical schools hold a social mission to educate physicians
who will care for the entire population.1,2Diversity among
faculty enhances the ability of academic medicine to fulfill its
educational, research and patient-care missions.3Inclusion of
under-represented minority faculty members (URM) in medical
schools promotes more effective health care delivery to a
diverse population; improves the quality of medical education,4
and may stimulate research attentive to the needs and
concerns of minority groups.5
Despite these compelling reasons to draw on the perspec-
tives and contributions of URM faculty members, there is an
alarming dearth of these faculty in US medical schools and a
serious paucity in leadership or senior roles6–8(Table 1).
Studies have shown that URM faculty are less satisfied and
more likely to leave academic medicine, advance more slowly
and are less likely to be in the basic sciences.9–12,17,18
Additionally, minority faculty report experiences of ethnic
harassment, biased treatment and racial “fatigue.”11,13–16They
spend more time in patient care and less in research than their
non-minority colleagues. Efforts have increased the enrollment
of URM medical students,19–22but the environment or culture
for URM faculty has received much less attention.
Out of concern regarding the failure of academic medicine to
adequately recruit, retain and advance diverse faculty, we
formed a national collaborative, the National Initiative on
Gender, Culture and Leadership in Medicine (“C - Change”)23to
engage five US medical schools in action research to facilitate
culture change in academic medicine. In this partnership, we
conducted an in-depth interview study of faculty to deepen our
understanding of factors underlying the lack of URM faculty in
the nation’s medical schools.
As part of the larger C - Change initiative, we selected five
schools representing organizational characteristics of all US
medical schools, [i.e., public (two)/private (three), NIH research
intensive (two), primary care orientation/community orienta-
Received January 29, 2010
Revised May 26, 2010
Accepted July 22, 2010
Published online August 10, 2010
tion (one)]. The sample represented all designated Association
of American Medical Colleges (AAMC) regions. Sex and URM
faculty demographics in these five schools were almost identical
to national statistics.
Using purposeful and chain referral sampling,24we inter-
viewed equal numbers of faculty from each school stratified
by sex, race/ethnicity, department/discipline and career stage.
Participants were research scientists, medical and surgical
subspecialists, and generalist faculty holding doctoral degrees
(84% MD/MBBS, 16% PhD) and represented 26 disciplines. The
96 faculty members interviewed in 2006–2007 represented
(almost equally) four career stages: (1) early career (initial
faculty appointment for 2 to 5 years), (2) “plateaued,” (faculty
for≥10 years and who had not advanced as expected), (3)
faculty in leadership roles such as deans, department chairs
and center directors, and (4) former faculty who had left
academic medicine. We oversampled women (55%) and URM.
The 17% African American/Black, 4% Hispanic/Latino
respondents represented 11 specialties/disciplines.
Data Collection and Analysis
A multidisciplinary research team (2 MDs, 2 PhDs) conducted
in-depth, semistructured interviews—15% in person and 85%
by telephone for convenience. Interviews (typically 1 h) were
audio-recorded and transcribed verbatim. The interview guide
(developed from pilot interviews) consisted of open-ended
questions on aspirations of faculty, energizing aspects of their
careers, barriers to advancement, collaboration, leadership,
power, values alignment and work-family integration (Table 2).
We concluded interviewing when we no longer obtained new
After deletion of all identifying information, transcribed data
were coded and organized using Atlas.ti software. Inductive
analysis25,26identified patterns and themes as they emerged
from the coded data. The secondary analysis reported here
utilized all coded data related to URM faculty and discrimination,
and the entire interviews of URM faculty. We verified our findings
using a consensus process. Brandeis Institutional Review Board
approved the project. The example quotations illustrate themes
Male and female URM faculty experienced: difficulty in cross-
cultural communication; feeling isolated and invisible; lack of
mentoring, role models and social capital; disrespect, overt
and covert bias and racism; devaluing of professional interests;
being identified with affirmative action programs and diversity
responsibilities; and financial hardship.
Many URM faculty described problems with conversation and
relationship formation with Caucasian colleagues, e.g., “Maybe
they don’t know how to talk to me because I’m an African
American person.” They ascribed this to having different profes-
sional and social frames of reference. URM faculty didn’t feel
included and perceived that they caused Caucasians to be
uncomfortable in conversing with them. This lack of connection
created a barrier to collaborating with other faculty.
It makes me feel like they're so uncomfortable. We don't
have the same frames of reference. And it doesn't feel
comfortable on either side of the conversation. I feel like
I'm making people think about things they don't want to
think about and so why bother? (URM female, plateaued)
Some described academic medicine as feeling like a foreign
So academic medicine is a foreign culture that isn’t
friendly to American Indians and Latinos. You’re not
going to attract Latinos, American Indians who have a
community bent, who want to change social systems,
who have a sense of family and community. It's very
hard for us to fit in academic institutions, where that's
about the individual. (URM male, early career)
Table 1. Representation of Faculty Members of African-American/Hispanic/Latino and Native American Groups is Far Below the
Demographics of These Groups In the US Population and US Medical Students.6–8
Medical faculty instructors/
assistant professors 20078
Medical faculty associate/
full professors 20078
Table 2. Interview Guide Questions
What is it about your work that energizes you?
When have you felt most successful in your work?
What’s been your sense of being a part of your institution?
What has been difficult or frustrating in your work?
Can you talk about some experiences you’ve had related to the
advancement of your own career in academic medicine?
What do you see as valued at your institution?
What does it take to get into a position of power or leadership in your
Is leadership something you’ve wanted or want for yourself?
How has power affected you/your career in academic medicine?
How do your personal values align or conflict with what you experience
in academic medicine?
Why do you think there are so few women in the upper reaches of
What about underrepresented ethnic groups or people of color?
Tell me about the relationship between your work and family or
How are your aspirations for yourself in academic medicine being
Pololi et al.: Minority Faculty Disadvantage
Isolation due to the scarcity of colleagues of color was cited
frequently. This was especially prominent for female faculty.
Early on, there were just no women and certainly, no
faculty of color, and so you're just there by yourself.
(URM female, leader)
Some URM faculty remarked that people of color need other
supportive relationships from family, church or community
outside medicine to survive the professional isolation.
The sense of isolation was compounded by feeling invisible in
the institution and at national professional meetings.
What I struggled with for a long time here was my being
an African-American woman, in a male, white male-
dominated institution and the feeling that I was
invisible. My opinion didn’t matter, what I was feeling
didn’t matter. There were people who I passed every
single day, who were chairmen of departments, and I
mean, good God, after 5 years you’ve got to see a
person… I would really hate to go to national meetings.
Because I wouldn’t see very many people who looked
like me and even though I had met people the year
before or 2 years before, they always acted as if they’d
never seen me before. (URM female, plateaued)
Lack of Mentoring, Role Models and Social Capital
Many commented on the lack of support and mentoring and
the paucity of URM role models in academic medicine. This
was especially significant as many African American and
Hispanic faculty came from backgrounds where they had little
exposure to academia or the systems of higher education.
When you're the first person in your family to reach this
point, you are clueless. I was not receiving any
counseling at all about what the next move was… A
lot of people of color don't know that. (URM female,
Programs for URM students and resident were available, but
faculty believed it “pretty well peters out at the faculty level.”
Many faculty of color acknowledged that they lacked role
models for themselves, but still felt responsible for serving in
leadership roles and being role models for other URM faculty.
The other reason that leadership is important for me is
because you want your family, other people of color to
say, “Okay, I can do this too, I can do it.” Academics is
not an area that people think about. (URM female,
I'm at a point in my career where I have to decide
whether to stay or go, and if I go, where’s the role model
for the ones coming behind me? Then they have a
similar experience like I did. (URM female, plateaued)
Disrespect, Prejudice, Bias and Racism
We heard numerous accounts of experiencing racist remarks
and bias. Minority faculty described being stereotyped; some-
times being viewed as similar to uneducated minority patients
or other people of color in service roles.
If the majority of the patients that you’re treating are
African American and very poor and uneducated, and
I’m African American, well, people are sometimes not
able to make the distinction between some of those
patients and you. (URM female, early career)
So I showed up at the meeting last year, and one of the
Division Directors asked me to take his luggage to his
room…I was just puzzled. And he said, “You are at this
meeting aren’t you?” And then it became clear to me
that he thought I was one of the organizers of the
meeting. I said, “Well, yes I am at the meeting.” And
then he very sharply said, “Well then can you take care
of this?” And I said: “Sir, I believe I’m at the meeting for
the same reason you are.” (URM female, leader)
Another minority physician remembered an incident as an
I was on call and one of the nurses interrupted me and
said, “Oh go to room such and such, the sheets need to
be changed.” …making the assumption that if I am
African-American, I’m here to clean the beds. (URM
female, left academic medicine)
A pervasive example of stereotyping was that colleagues and
supervisors often had low or mediocre expectations of what
URM faculty (or students) could accomplish.
I have heard it from African-American students that
were very interested in science, and they had teachers
that said, “I don’t think you really can get a PhD.” (URM
Individually, URM faculty consistently believed that they
had to perform at a higher level than others in similar
situations to be perceived as accomplished.
I think you always feel like you’re expected to do a
mediocre job. Always. And so, you strive to be super
woman. To combat the expectation that you’re only
going to be mediocre. (URM female, plateaued)
Others recounted instances of racism.
I sent my resume for something and when I showed up
someone said tome, “Yourresumedidn’t look black.”Can
you imagine someone saying that? (URM female, senior)
There was a night shift that I worked, the resident came
down and asked me if we could hold a patient in the
emergency department because it had been a busy
night for the resident, and he didn’t want to admit the
patient. And I said “No,” because the patient was an
older woman on a stretcher down here in the ED, I
Pololi et al.: Minority Faculty Disadvantage
wanted her to go upstairs. He walked away and
mumbled, “You black bitch.” My boss happened to
come down first thing in the morning, and I recounted
the episode to him, and told him I was so angry I could
have punched this guy and he says to me, “Well, you
know,wedon’tliveinthe jungle.” Thatwashis response. I
will never forget that. (URM female, plateaued)
Discrimination in recruitment emerged as a sub-theme. One
respondent recounted her experience of discrimination by
other faculty members. She pointed out the burden of dealing
with discrimination for many years.
So he asked the chair to bring me on as a faculty
member. And one faculty went to the Dean, and said:
“Let’s not bring her on. Let’s wait ‘till next year because
we want (name), because we believe that a white,
Jewish male will fit the environment better.” So,
sometimes you look back and wonder why you stayed.
(URM female, leader)
Another Caucasian faculty explained discrimination on the
basis of class. He believed that prejudice exists against non-
white speech patterns.
I think that even though people may not be prejudiced
against skin color, they may be prejudiced against—
and I know I'm prejudiced—language patterns. It's the
way I'm prejudiced against people who put their Rs in
the wrong place. It's a sign of class. (Non-minority male,
Devaluing of Professional Interests
In the departments where there was focus on research on
underserved populations or community-based health care,
URM faculty perceived a more favorable microenvironment
for themselves. Such departments were better able to recruit
URM faculty. Conversely, respondents commented on how
research in communities and giving back to their communities,
as well as research on minority health disparities (MHD) was less
rewarded, and perceived as less weighty.
I think from all the other departments’ perspective
they'd say, “What's going on with them? They're doing
soft research out in the community and they're not real
scientists.” (URM male, left academic medicine)
Minority faculty felt a sense of responsibility to their
communities that often conflicted with the demands of an
It’s important that we’re out in the community actually
caring for patients, giving back to our community. I
know that my closest colleagues who are African-
American definitely feel that way. They felt that they
couldn’t do that within the confines of academic
medicine. (Non-minority male, left academic medicine)
Additionally, issues of tokenism and “window dressing” were
voiced. Some faculty suggested that URM faculty are “just a
pawn to be used by the institution” to show that the institution
is attending toURM recruitment ordoingsomething about MHD.
the representative in that it shows that the institution is
doing something about health disparities and they get
used,andthey alsodon’twind upinthedecision-making
circles. (Non-minority male, plateaued)
Burden of Affirmative Action Programs
and Representing One’s Own Race
Compounding tokenism, faculty spoke of the stigmata of
having participated in affirmative action programs or programs
specifically targeting MHD, thus being simultaneously benefited
and disadvantaged. URM perceived that others thought they had
“got there because they were Black.”
You almost feel that you have to do better than anybody
else to prove that you are where you are because you
deserve it. I was very lucky and I got my R01 very
quickly and I got a very, very good score. I was really
proud of that. I worked very hard on that grant. And a
colleague of mine, he looked at me and said, “I’m
convinced that these things are decided based on
ethnicity.” (URM female, leader)
Often URM faculty were asked to provide service and
committee work to promote diversity. They felt conflicted in
the realization that this service on behalf of URM detracted
from personal scholarship and an individual need to advance
in the system.
They told me the only reason I got the job was because I
was Black. And when I came into the Dean’s office,
there was talk of: “We don’t have an Office of Minority
Affairs (OMA) here.” Every time they start talking about
an OMA they start looking at me. And I said, “If I’m good
enough to be the Dean of Minority Students, I’m good
enough to be the Dean of all the students.” (URM
A dilemma for many faculty was how to manage concurrent
efforts to take care of other people of color, as well as to
advance professionally to be accomplished role models.
Responsibilities of Leadership
Many faculty commented on the pivotal role of leaders with
respect to diversity and the scarcity of people of color in
leadership roles in medical schools. Leaders were perceived as
not valuing diversity and needing to make a firm commitment to
diversity goals if to acheive real change. Leaders tolerated
unacceptable behavior or even racism (e.g., see Racism section).
Interviewees believed that leaders rarely selected people of color
for leadership positions as doing so would detract from their
sense of comfort interacting with people like themselves.
It has to be something that leaders prioritize. When
everything else is equal, you have to step up to the plate
Pololi et al.: Minority Faculty Disadvantage
and choose the person who does bring diversity. So you
need leaders who are willing to stand for it. (URM male,
Some commented that having more URM faculty in posi-
tions of leadership would dispel stereotypic myths and create
greater exposure to minority excellence on an individual basis.
An intern on my teaching service said to me “I really
enjoyed working with you. I truly respect the way that
you take care of patients and I want to try to mimic the
way I take care of patients after you.” He was a non-
minority young man and I thought that was incredibly
important for me to be in a position to have somebody
like him say that. But you have to have the commitment
from schools, from hospitals, from administrators to
find the people to be in those [leadership] positions and
I think it has a huge calming effect on society in general.
(URM male, early career)
URM faculty reported that they usually have to be the one to
notice and comment on inequity and that this responsibility is
not assumed by majority leaders. Some commented that when
URM faculty assume administrative leadership, it’s at the
expense of advancing their own scholarship. On the other
hand, having an URM in a leadership role gives the clear
message about commitment to achieving diversity.
Some drew a contrast between African-American, and Asian
or Middle Eastern faculty. perceiving that the latter groups
often came from educated and privileged families who were
more familiar with academic pursuits and hierarchies:
I think Asian and Middle Eastern men have been
accepted much more than African-American men, and
that reflects who’s going to medical school. Second and
third generation people from Pakistani, Indian and
Iranian families. They're well trained and they’re very
hard workers, and excellent clinicians and teachers—so
no issues there. But I think that gives the institution
the feeling that they’re ethnically diverse, but with all due
respect,theseare “WASPs” withbrownskin.They’re more
similar in their behavior to the white Anglo-Saxon
Protestant model than a Brooklyn Jew, for instance,
who’s noisy and loud. (Non-minority female, leader)
This white woman shows a nascent understanding of a
certain way one has to act in order to be accepted, i.e.,
similarly to a white male. Asian and Middle-Eastern faculty
with more privileged backgrounds may more easily adapt to
expected behavior patterns and consequently advance more
frequently than URM faculty.
A persistent interview theme was the financial sacrifice
perceived by choosing a career in academic medicine.
So they are seen as not just the breadwinners for their
household, but for the greater family at large. There’s a
sense of responsibility not only to give back to the
community, but also to earn a higher wage to help out
the extended family. (Non-minority male, left academic
Slowness of Change
The history of segregation and slavery in the US is still a part of
many people’s consciousness. Several faculty highlighted the
slowness of realizing the full positive outcomes of legislation
resulting from the civil rights movement. “I’m just disappointed
with the progress of our country.”
I mean it’s your normal change process, establishing
the value of the differing person or persons and
eventually change occurs. It’s the same process that
we went through with integration. That wasn’t over-
night either. And we’re still struggling with it in
academic medicine. (Non-minority male, senior)
URM faculty bring knowledge and experience of different
backgrounds and world views to medical schools. Our findings
suggest that these valuable attributes and abilities, instead of
being perceived and received as beneficial, are often responded
to as untoward contributions and become barriers to accep-
tance in the systems of academic medicine.
Isolation and feeling like an outsider resulted from a
combination of barriers to communication and relationship
formation with majority faculty; scarcity of faculty of color; and
lack of role models. Lack of family instrumental support and
social capital combined with education-related debt added to
the burden of trying to advance professionally. Faculty expe-
rienced disrespect, discrimination, racism and a devaluing of
their professional interests in community service and MHD.
Women faculty commented on the double disadvantage of
gender and minority status.
URM faculty experience social as well as professional
discrimination and may feel justifiably angry. The “tokenism”
and “window dressing” they describe pertains to at least three
concepts: a lack of authenticity among institutional leaders in
efforts to include minorities; the burden of having to represent
one’s entire race; and being on the receiving end of special
programs and assumptions that the achievements of people of
color are due to special favors rather than merit. Faculty
ascribe a pivotal role to leadership in combating discrimination
and achieving diverse faculties. Many leaders lack the experi-
ence of having different types of people in leadership roles, and
it may seem risky to put power in the hands of less experienced
people. Most URM faculty come from non-affluent families (in
contrast to many white majority students) and incur substan-
tial debt during training. URM physicians supported their
households and often their extended families. The combination
of this and dedication to their communities contributed to
URM leaving academic medicine.
While published research on diversity in medical school
faculty report on a single school,18on URM physicians in
practice15and some national recommendations,27this paper’s
contribution is in-depth data on the experience of URM
medical faculty from diverse subspecialties, collected from five
disparate schools in different US regions. While we have
Pololi et al.: Minority Faculty Disadvantage
focused on URM faculty, other faculty of color may contend
with many of the same disadvantages. The findings on
relational barriers align with our study results in non-minority
faculty.28Limitations of the study are those inherent in
qualitative studies with relatively small numbers of partici-
pants: selection or sampling bias, potential for response bias
and the subjective nature of analytic strategy. Even so,
qualitative studies singularly allow voicing of perceptions of
individuals who voluntarily share such information. We found
the themes to be consistent and highly congruent for faculty of
varying rank, discipline and sex across the five schools.
McIntosh observed that people who benefit most (in the
short term) from privilege systems are mostly unaware of and
blind to the existence of privilege systems. This preserves the
myths of moral and managerial meritocracy.29This likely
occurs because the exposure of bias is often painful and
disturbing, particularly among individuals who explicitly hold
egalitarian and humanitarian views. Having inherited uncon-
scious biasesthatare manifestedunintentionally in interperson-
al interactions, these individuals may feel guilty about their own
advantage (acquired typically without effort or consent on their
part) and its role in keeping others disadvantaged. Through
elucidation of URM faculty experiences, we hope to raise
awareness among health professionals, educators, administra-
tors and policy-makers of obstacles to achieving the goal of
having URM faculty as leaders in academic medicine.
Medical schools and their policies need to reward service
and research on community-based health care and MHD,
similarly to other accomplishments and research if this work is
to be shouldered by a broader set of faculty. Health disparities
in the US are among the highest in the developed world, and
reducing them is a major health priority.30–32Successful
strategies to reduce disparities must address the physician
workforce.27,33We propose that having more URM faculty in
senior and leadership roles in medical schools will support
training a more diverse physician population and increase the
cultural awareness and skills of all physicians-in-training and
biomedical scientists. These factors will contribute to a greater
capacity to care for underserved groups and to better elucidate
the causes of and solutions to health disparities. Failure to
fully engage the skills and insights of URM faculty means that
we don’t have the best science and the best medical care that we
could have. We agree that medical schools and their leadership
should be evaluated on the extent to which their graduates meet
the health needs of the nation.33–35Achieving a diverse medical
school faculty would help meet the institutional mission of
academic medicine to train a physician and research workforce
that meets the needs of our multicultural society.
ACKNOWLEDGMENTS: The authors gratefully acknowledge the
critical funding support of the Josiah Macy, Jr., Foundation and the
supplemental funds to support data analysis provided by the US
Office of Public Health and Science, Office on Women’s Health and
Office on Minority Health; the National Institutes of Health, Office of
Research on Women’s Health; the Agency for Healthcare Research
and Quality; the Centers of Disease Control and Prevention, and the
Health Resources and Services Administration (contract:
HHSP233200700556P). The authors thank Peter Conrad and
Sharon Knight, who participated in data collection and data coding,
and Kerri O’Connor for manuscript preparation. The authors are
indebted to the medical faculty who generously shared their
experiences in the interviews.
Contributors: Specific Contributions From Each Author
Pololi: conception, design, data collection, analysis and interpre-
tation, drafting the article, final approval.
Cooper: analysis and interpretation, drafting the article, final
Carr: data collection and coding, manuscript review, final
Funders: United States Office of Public Health and Science, Office
on Women’s Health, Contract: HHSP233200700556P
Josiah Macy, Jr. Foundation
Prior Presentations: Society of General Internal Medicine, 33rd
Annual Meeting, 2010. Research plenary presentation.
Conflict of Interest: None disclosed.
Ethical Approval: Brandeis University Institutional Review Board
for the protection of human subjects approved the study.
Corresponding Author: Linda Pololi, MBBS, MRCP; Women’s
Studies Research Center, National Initiative on Gender, Culture
and Leadership in Medicine: C - Change( Brandeis University,
Mailstop 088, Waltham, MA 02454-9110, USA (e-mail: lpololi@
brandeis.edu; URL: http://cchange.brandeis.edu).
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Pololi et al.: Minority Faculty Disadvantage