Women’s Dermatologic Society (WDS)

As previously mentioned, this two-part series was inspired by a virtual panel discussion on Diversity in Recruitment in the Dermatology Workforce hosted by The WDS Diversity, Equity, and inclusion Committee of The Women’s Dermatologic Society: Physician | Leaders | Mentors. In part 1, I focused on recruitment efforts to increase diversity in dermatology and strategies to help aspiring nurse practitioners gain early exposure to dermatology. In part 2, I want to follow-up on a point brought up during the panel discussion on the assumption that minority dermatology providers have to specialize in skin of color.

 Assumptions Lead to Stifled Success

Prior to this discussion, I hadn’t given much thought on whether it’s assumed people of color (POC) are expected to dedicate their clinical practice to issues related to race and ethnicity. Having given it some thought prior to writing this post, I think it’s too much pressure and it creates a population with limited thinking. If someone of color wants to be an exceptional Mohs surgeon, they are going to have to dedicate all their clinical training to developing those skillsets. They may go on to save the lives of thousands of people of all hues. Will we see them as any less successful because they didn’t solely treat people of color? I think not.

While the Black or Brown dermatology provider may not be able to dedicate their clinical time specifically to skin of color dermatological issues, it doesn’t mean they can’t be committed to advocacy outside their niche and outside of the clinical setting. People are multi-dimensional. We can do more than one thing and be great at as many or as few interests as we desire. It is my aim that this article helps to free anyone who may think their success has to be tied to their racial and ethnic identity. Your race and ethnicity are social constructs, and yet badges of honor. You determine what you do with it.

Assumptions Can Cause Limited Thinking

Dr. J. Thomas Smith, author, speaker, and attorney wrote about nine types of limited thinking including the all or nothing way of thinking which is polarizing and prevents us from seeing someone’s full value. Then there is the fixed mindset which is believing that all people of color must be dedicated to the same thing because that’s the way it’s always been. Indeed, we would have never made the progress of the last 59 years had we not broken free from a fixed mindset. Since the Civil Rights Act of 1964, things have changed and there are now a multitude of angles from which we can identify problems and positions in which we can take to address them. This is what makes us a strong people. This is where our greatest progress has occurred. Lastly, the most important type of limited thinking may be overgeneralization. Overgeneralization is using isolated events (good or bad) to draw conclusions about the future. Young clinicians are often advised by seasoned professionals with great intentions. However, our advice is based on the world we grew up in, not the future they need to prepare for. Therefore, we must be mindful not to steer clinicians into a corner of racialized career choices as a result of limited thinking.    

Mahogany Dermatology

I chose the name Mahogany Dermatology to make it easier for people who look like me to find me. There is a dearth of evidence that supports the fact that people have better health outcomes when their healthcare providers look like them. I wanted to make the search a little bit easier as I’ve struggled to identify providers who look like me. Over they ears the search as improved with the increased number of providers on social media and healthcare sites that post the picture of the providers. Still, a significant amount of time is spent visiting websites that meet all the criteria only to find out there are no providers who look like me. There are websites like the National Black Nurse Practitioner Association, BlackDoctor.org, and Find a Black Doctor that have built a directory of Black providers. While publicly available, a large percentage of people still don’t know these directories exist or understand why they need to. Please share these websites and continue to the discussion with me and your colleagues. All of them.

We Need All Dermatology Providers to be Committed to Skin of Color

According to the 2021 Physician Workforce Data report, there were 940,254 active physicians and 328,239,523 people in the United States. This means, there were only 286 physicians for every 100,000 persons. When we look at the table, we see physicians of color barely comprise 30% of the physician supply. When you look at individual races/ethnicities there is even less representation compared to the general physician supply. In the table below, I’ve broken down the number of physicians according to each community of color.

Dr. Loretta Ford is credited for collaborating with pediatrician Dr. Hendry K. Silver to develop the first (pediatric) nurse practitioner program in 1965 to address the primary care physician shortage. The overall physician shortage persists in America. However, there is no shortage of White physicians and there are too few physicians of color. The numbers show there aren’t enough providers of color to meet the needs of communities of color. We need everyone to be committed to skin of color dermatologic concerns to improve health inequities, to deliver culturally competent care, and increase patient satisfaction.

It’s never been satisfactory to pressure person of color to represent an entire race, nor is it acceptable for others to ignore their responsibility to be well informed of American history and the systemic impact of racism. All healthcare providers have a moral obligation to understand the barriers and facilitators to delivering care and patients receiving it. Additionally, we must all understand how the social determinants of health (SDOH) and the political determinants of health (PDOH) influence accessibility to the care we provide. This cannot happen when people are expected and only allowed to care about the community/communities to which they belong.

In short, the primary goals are:

- To ensure people of color have equal and fair access to safe, timely, effective, efficient and affordable healthcare services

- To promote and support efforts to increasing diversity in dermatology so that the American population is represented in academia, the clinical setting, research, policy, and entrepreneurship (including funding and investment opportunities).

Kimberly Madison, DNP, AGPCNP-BC

Kimberly Madison is a new dermatology nurse practitioner with a passion for writing, entrepreneurship, financial literacy, and mentorship. I created this blog to share my journey as I become a dermatology nurse practitioner and entrepreneur. Most importantly, I’m looking forward to helping nurse practitioners and aspiring students to better understand the business of dermatology and their role to improving access to care, providing culturally competent care, and advancing education.

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