Curtis Sobchak is a medical student in the Class of 2019 at the University of Toronto
It is well-known that workplaces strive for diversity and inclusion. Studies have shown that diversity improves productivity and contributes to creativity and new ideas. In medicine, this diversity is just as important. Having physicians from under-represented and marginalized communities provides unique views on what may be best for the patient. As medical schools continue to support new initiatives, such as specialized admission pathways for African American and Indigenous students, it is clear diversity is on the agenda. However, for those who are not of the majority ethnicity, diversity may not be enough. There also needs to be representation.
This idea was at the forefront of my mind during an elective rotation. After I had mentioned my interest in Indigenous health a number of times, I was asked by my attending whether I was of Indigenous background. I understood the hesitation, of course; sometimes it can make people feel uncomfortable to ask about your background or where you are from. Nonetheless, I was happy they had asked and I responded with a firm “yes.”
Their response? That “[I was their] first Indigenous trainee.” At first, I felt proud. I had worked hard to be where I was, and I was excited to be an example for an underrepresented population in medicine. However, after this encounter, I soon felt sad for those of my heritage and for the field of medicine overall. Was there really that small of a number of Indigenous trainees? And if not, why wasn’t more being done to represent ourselves?
Medicine is often described as an evidence-based community. We strive to make changes to our practice based on the data we capture. With the general consensus that increased diversity is required within our community, it would seem obvious to gather data capturing the rate of change. However, while trying to ascertain the number of individuals to whom I could directly relate to on the basis of ethnicity, I often came up empty. From an official perspective, the University of Toronto has no data I could find listing the number of Indigenous physicians, residents, or medical students. Searching for data that may be representative of the Canadian medical system was fruitless as well. The last National Physician Survey that indicated trainee ethnicity was in 2012 and listed only 3.3% of residents and 4.4% of Medical Students as North American Indigenous ethnicity. At the physician level, including those with faculty positions, the data was similarly nowhere to found. As a profession founded on data-driven evidence, we are clearly not doing enough to investigate and subsequently make changes to this issue.
As an Indigenous individual, I feel fortunate to be a medical student in a time of increased awareness of minority representation in professional fields. I recognize that as a student at the University of Toronto’s Faculty of Medicine, I am lucky to have been given the first-hand opportunity to work with other Indigenous persons in medicine—such as taking part in the University of Toronto’s mentorship program to expose members of underrepresented communities to medicine and health sciences. However, I also realize that there continues to be a large gap that we as minority ethnicities face on the professional landscape. Within my class, I can only think of four indigenous students (1.56%). This is even lower at higher levels of training, where I can only think of two Indigenous staff members: Dr. Lisa Richardson and Dr. Jason Pennington. A recent JAMA article discussing the extra workplace burdens on minority residents states that residents are asked to “perform the role of race/ethnicity ambassador at their institutions… [and are responsible for] implementing diversity curricula at their institutions. Often, they were the only individuals working on such initiatives.” When I think of the tireless work that that Drs. Richardson and Pennington do for Indigenous identity at the University of Toronto, I know very well that they face similar challenges.
Being an ally to underrepresented communities is not easy. I understand that it comes from a place of support when the medical community releases public statements calling for the increased need for inclusion in medicine. However, this is not a problem that will be fixed just by calls to action. Although many of the hospitals that I have worked at have been welcoming environments for Indigenous students, it is clear that there is a systemic-level problem in medicine regarding diversity, inclusion, and representation. Therefore, we need to do more as a whole to improve Indigenous recruitment and identity in the field of medicine. As medical schools become increasingly competitive, we need to do more to encourage underrepresented groups to enter medicine and address the barriers that may be stopping them. We also need to do more to make Indigenous physicians more visible to these populations. What really sets workplaces apart are those spaces where you can see individuals with your background and shared experiences leading the way. And, unfortunately, this is not being done.
Finally, we need to collect more data about the representation of underserved minorities in the profession. There have already been many steps taken to tackle gender and racial disparities in medicine, and these have been done through evidence-based data dissemination. But we have not seen these same steps for the Indigenous population. Therefore, this data needs to be first gathered and then analyzed to enhance recruitment, to show progress being made, and—ultimately—to invoke structural change. Without a diverse medical community, we will not be able to truly understand and advocate for our patients, especially in a country where the Indigenous population is the fastest growing population. As we continue to strive towards improved representation, it is my hope that future Indigenous students will not have to hear they are someone’s “first Indigenous trainee.”
Note: Drs. Richardson and Pennington have given their consent to be mentioned in this piece.
Daniel McKennitt MD, MPH
Thank you Mr. Curtis Sobchak for sharing this personal piece of your training experience. I will say, as an Indigenous physician, that there sounds like many improvements in recruitment and mentorship as alluded to in your post. I do also have to add to the language and terminology used. Indigenous People are not minorities. This may seem semantics but it is critical important. Indigenous Peoples have a special and unique relationship with the land, the settlers and the treaties and agreements. We must not simplify or ease administrative burden in data collection of Indigenous identity by convienent constructs. Moreover, the tremendous work on this issue by Indigenous organizations such as NAHO, the IPAC, the FNIGC amongst others including AFMC Indigenous Network. However, the key overall point is definitely critical. An often reason cited for underserving populations such as Indigenous people is the lack of available data to support program funding and services. However, as you state these are structural in nature and thus can be changed. With the continued advocacy and courage I join your call, having heard similar, to not have future students have to be ‘’someone’s ‘first’ Indigenous student”.