Carl M. Truesdale, MD, a facial plastic and reconstructive surgery fellow in Beverly Hills, recently wrote about his commitment to and experience in helping to diversify medicine during his residency in Michigan Medicine’s department of otolaryngology–head and neck surgery (https://labblog.uofmhealth.org/med-u/one-doctors-journey-to-diversify-medicine). When he started his residency, he was the sole Black physician among 20 residents; when he left, five of the 23 residents in the program were Black. In this interview, Dr. Truesdale spoke on his experience and ways to build a stronger, more representative physician workforce, particularly in competitive specialties such as otolaryngology.
ENTtoday: From your experience, what do you see as the main barriers for creating more diversity among physicians in specialties such as otolaryngology?
Carl Truesdale, MD: It all begins with the pipeline [of eligible candidates]. If you think about education, minority populations [are less likely to be included in that pool of candidates] as they’re less likely to finish college, or possibly even high school. Socioeconomic factors play a role in this.
The second barrier would be in medical school itself—otolaryngology is a very competitive specialty and not all medical students are exposed to it. Right now, the U.S. population is about 13% Black, but only 7% of medical school students are Black, only 6.1% of applicants for otolaryngology are Black, and only 2% of Blacks are otolaryngology residents. The reasons for this are multifactorial, but one main reason is that if you don’t see someone that looks like you in that field, you may not want to pursue it.
ENTT: During your residency, you helped to increase diversity within your otolaryngology department. What did you do to help achieve this? Could it translate to improving diversity in other specialties?
CT: It takes a collaborative effort and people at high levels to really change the narrative. When I started in the department there were no Black residents, although historically Michigan has trained the most Black otolaryngologists out of any other residency program in the country. I knew about that history, and it’s one of the reasons why I chose to go there. I think my just being there, as a Black physician, was important for the upcoming Black applicants who could look at me and see someone who looks like them be successful. I was a mentor to people inside and outside my department, and it became a catalyst for being able to help improve diversity in several ways.
I would break it down to a pipeline effort, outreach, and creating a track record. Through a longitudinal program, I worked to increase the pipeline of Blacks in otolaryngology by talking to medical students, undergraduates, people in residency and fellowships, and even high school students. I also spoke at conferences on otolaryngology sponsored by, for example, the Black Medical Association or Latin American organization.
I also encouraged people to get involved with any kind of health disparities programing. Michigan had a rotation designed for people interested in health disparities, and it allowed residents to fulfill an elective without the financial burden of doing a month-long elective in a different city.
ENTT: From the patient perspective, do you see the benefits of having a more diverse physician workforce?
CT: I’ve had patient encounters where a white patient may say “Ah, I’m not sure about this,” when they see me as their physician. I believe the best way to change a patient’s perspective is to give patients really good care. I’ve had patients tell that they didn’t like being treated by a Black doctor, but by the end of their care they told me they were thinking differently about how they view minorities.
ENTT: What changes would you like to see in medical education and training to help create a more diverse physician workforce?
CT: The main thing is exposure. Many medical students don’t have otolaryngology as an elective, as some medical schools don’t offer it. You tend to go into specialties that you know exist. Just having more exposure would promote people going into it, especially minority students. But it is a balance. Some of the communities that actually need Black doctors need more primary care doctors for the whole health care system.