Sawbones: A Marital Tour of Misguided Medicine - Systemic Racism in Medical Honors

Episode Date: June 26, 2020

AOA is a medical honors society that's supposed to separate top-tier medical students from the rest of the pack. It helps determine which doctors get the top jobs in the most competitive fields. The problem? There's implicit racism in the way it chooses members, and fixing it may be a massive challenge.Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. Hello everybody and welcome to Sawbones, a metal tour of Miss Guy, the medicine I'm for the mouth. Hello, everybody and welcome to Saw Bones, a mayoral tour of Miss Guy,

the medicine, I'm your co-host Justin McElroy. And I'm Sydney McElroy. Sid, a few weeks back, in light of the recent protests and upheaval, we talked a little bit about racism in medicine, sort of from a patient perspective. And this week, we're going to kind of look at it from the other way. If I understand correctly, in sort of how we select and honor doctors and how those doctors advance in the system,

is that fair? This is a very personal one for me. I think that part of the work that myself and other white people need to be doing right now is, of course, as we've already said, educating ourselves and acting in ways that are not just not racist, but anti-racist. And we're all trying to do that and do better and challenge our own implicit biases. And part of that is realizing that maybe your in systems, almost certainly your in systems, if you're a white person, that continue to like privilege white people over everybody else. And perhaps you have been party to that and not realized it. And we got an email like privileged white people over everybody else.

And perhaps you have been party to that and not realized it. And we got an email from a listener, thank you, Charlotte, for calling it to my attention. And good luck in medical school. And it, or actually you're probably done now, either way. Good luck or congratulations. But she called my attention an organization called AOA,

or Alpha Omega Alpha. You hadn't heard of it before. No, I am in it. Oh no! So Alpha Omega Alpha or AOA, which also I should clarify, if you start looking into this, AOA is also the abbreviation for the American osteopathic association, which are osteopathic physicians, DOs, which is totally separate from what we're talking about.

That has nothing to do with this. And the- Does one make that clear? And the OA is a sci-fi Netflix series that your parents keep telling us we should watch but have not yet. I just can't keep our terms. I don't want people to start looking into like criticizing the AOA in terms of like all osteopathic physicians.

No, this has nothing to do with that. Well, I don't want people to think. This is the same abbreviation, totally different words. I don't want people to think we're criticizing the AOA. It may be super racist. I don't know. I don't know anything about it. I don't know anything about it.

It's on Netflix though. But I do know about AOA, Alpha Omega Alpha, the medical honor society because I was inducted into it when I was a third year medical student, fourth year medical student, fourth year. Anyway, and I also served as counselor for our chapter for a brief period of time. Did you do this episode just so you could brag a little bit?

No, I mean, as you'll see, I don't, I'm not proud of, I, let me say this, when I received, school to be inducted into AOA, and the motto of AOA is worthy to serve the suffering. And when that was said at my induction ceremony, I felt that very deeply. And so I think that this for me, it was really important to talk about this and to challenge this because while this was something very meaningful to me to see that there are problems with it and things that need to be changed and challenged, it was important work for me to do.

And I think everybody else in AOA would want to do the same thing and the national office would want to do the same thing, to do that hard work, to dig into it and see if we can't do better. We could do better. We have to do better. Anyway, I think that this is a good example of how white supremacy can get ingrained into these systems without anybody intentionally. And with, and with, as we're, I'm going to go through the history of it, with people

actively like saying the opposite, you know, actively stating that diversity is one of our goals, but still, you know, perpetuating white privilege. So let's get into what AOA is. Okay. Alpha omega alpha. Yes. There it like I said, it's incredibly prestigious. They'll there are elections to induct new members. Our chapter held them twice a year. I think you can do it once a year either way.

Many medical schools have chapters. There are 132 total in the US, Puerto Rico, and Lebanon, and you can be inducted as a student, but you also we also have inductions for residents and fellows and attending physicians as well. People have already done what they're training, so but the the real the real thrust of this is for students. That's where it really matters. And I know this might sound strange because you're probably familiar with like the honor society in high school, right?

There was something called the honor society. And then in college, I know we had... I heard of it. I guess I heard of it. Heard about it. So there's the National honor society, which... I heard of. Well, I was in, so I...

You were in, so you kind of got a more of a familiar... There are. To give you a rose, is that the national honor society? They give you a rose to let you know that you're in. Did they? I don't know. Maybe making that up. As I said, didn't make it to that specific event.

I think handles were part of it. Okay. You're making this sound wild now. You are freaking me out. If you want to get into wild, I was in the chemistry fraternity. Next. And that was a wild induction. You know that I want to hear all about that.

I don't want to get a few drinks into you first, so I can get the real darts. In college, I think there are a variety of honor societies as well. Like Omacron Delta Kappa was what one I was in there. Go there it is. But what about the key club? What are they up to get in there? What are they? I was in the key club.

What is that? A club. Those are those are community service organizations though. Those that's slightly different, but it's all tied together. I was not I have nothing to do with skull and bones. I don't different. But it's all tied together. I have nothing to do with skull and bones. I don't know anything about it. That is what you would say. But what I would say differentiates AOA a little bit from these other organizations is that while those things look good, I'm not saying they don't, you know, if that's on your high school, if when you're applying to

colleges, if you can say you're in the National Honor Society, of course, that's, that's great. Better than not. That's good. For the same. Um, but when it comes to AOA, it can be very meaningful for a physician. Uh, when you, um, apply to residency programs, being able to say that you are in AOA can really help your chances of getting into competitive specialties and certain schools within that specialty. It's a big deal.

This is not me bragging. I'm saying this to emphasize why if there is a racial disparity in it, it's a big problem. And just to make it relatable to the listener, this, if I'm understanding correctly, so we can walk it back from like, what does this mean for me and for the world at large? What we're talking about is who, what your doctor looks like,

or what your, what doctor ends up in front of you, especially in some of these very competitive specialties, is tied to whether or not they are in AOA. And I'll get into some more of that data towards that. I want to establish the chain though. Like that's the chain, right? So far, the person that you are seeing as your doctor who gets to be in the very prestigious specialty or get the more competitive gigs or whatever is tied to whether or not they're

in AOA. Yes. I'm not saying that is the only thing like... Sure, right. But I mean, it definitely helps in a big way. Yeah. ...and I have some data on that when we get to the end. There's research to back that statement. But let me get into the history, because it's a show about history.

So let's talk about the history of the AOA. Why do we have a medical honor society? Because in some ways, shouldn't all doctors be worthy to serve the suffering? You would think, yes. Yes. I mean, hopefully. But there's Dr. Oz. So I don't know. Certainly we not all of us aren't, but we should be ideally. I didn't mean to side swipe draws. No, you did. It's fine. It's fine. Okay. AOA dates back to 1902. And if you listen to this show a lot, you may know that 1902 in medical history in the US is a wild time. Yes. Yes. Technology was advancing very quickly. And we were starting

to understand things like hygiene and the germ theory of disease and all these different ideas, but not very well. They weren't broadly accepted. We knew, and 1902, we knew just enough to be dangerous. We did. If you've ever watched the show, the Nick, you get a good idea of kind of what we were doing. This wasn't the heroic era of medicine. This was just past that. And I think that that's important, too, because in the heroic era of medicine, it was like,

do anything it takes to keep someone alive, no matter how wild or off the wall, it might seem, do anything it takes to keep someone alive no matter how wild or off the wall it might seem, just do it. And so, you know, bleeding and mercury and all kinds of wild things were done. What the response to that, which we see at this part of medical history, is this rise of other types of medicine that maybe aren't quite as deadly for the patient. So in this point in history, you have like homeopathy is on the rise. The clectic medical colleges are on the rise. This like, well, look, if you go to a doctor, you may be more likely to be killed by the

doctor than the disease. So don't go to traditional doctors, come see these other people who are doing this other kind of medicine where we don't really have any evidence for it, but at least we're not going to bleed you to death. So it was a really tumultuous time in medicine and medical schools themselves were not very well regimented in terms of what their curriculum was, who was teaching you, it varied wildly. And add to that, the qualifications to get into medical school varied. So there were maybe three that required

some college education before you went to medical school, but there were many that were fine with like elementary education. Wow. Thanks. Yeah, so the idea of what a doctor was was still pretty nebulous. And medical students had a certain reputation at this point in medical history. Because doctors were already regarded with suspicion, right?

Because there was this idea like, we don't know if you wanna help us and we kinda feel like we're being experimented on and you do these things that are painful or dangerous. So we're not sure we trust you. You can imagine that the people who are in training to do that were regarded with even more suspicions. Like, so you don't even know the stuff yet. You're even more dangerous.

And they were also seen as like reckless and messy, kind of inappropriate. I believe the word that I saw was borish was used the block in the car. We don't keep that all in the air. I don't know how to wrap it. Enough. They just weren't seen as like,

your parents would not be thrilled if you brought home a medical student as your date. Because they're wild. Yes. Doctors in regard to suspicion, medical students aren't like, medical schools are all over the place. Medicine is, you know, it's this whole, it's a wild world. And basically, there were a group of medical students

who said, we don't like this. We don't like this reputation. We don't like that. We're not always relying on science. We don't like that, you know. People don't invite us to really fancy parties, because they're afraid we'll, like, put a cake on our head and get just wild like the Marx brothers.

We don't want people to, we don't want people to continue to view the medical profession this way. We could do better. And so this group of six medical students met on August 25th of 1902 at the College of Physicians and Surgeons in Chicago and in like the bacteriology lab that got together and they said, we want to create a society of doctors that will be, we will promise to be of good moral character to honestly try

to do the best for our patients and to base our decisions on science, on academic rigor, we will be the best of the best, basically, and we are going to create this. And this way you will know if your doctor is in this organization, you can trust them. Yes, this is like a, like the Nintendo seal of quality. Exactly, I guess. Trust me.

Probably. It is exactly like it. It's perfect. Perfect. You know what I mean? So they had their first meeting in October of that same year. They had 21 students. And it really caught on.

That's what I kind of say is wild to be like, we're going to create this super secret cool stamp of approval. And the first people are in it is just like us. And some other people we know are all very chill and cool so we're fine. Well, that's, I mean, if you think about it, if you want to start talking about how systems are bad from the bottom up.

Yes, exactly. These were probably six friends, right? I mean, or at least six acquaintances, and everybody who joined these original six probably felt that they were of good moral character. Yes. And social standing. And honestly, wanted to do the best for their patients. I mean, I'm sure they felt they did. But they started this society, and many other schools followed suit very quickly within the next few years, you would see other medical schools starting their own chapters of AOA and even like very prestigious schools like Harvard and Johns Hopkins within the next few years would start their own chapters. So, it really caught on very quickly and that exclusivity of it was a big part of the

allure, right? Like, first of all, in the beginning, you could only be considered even have a chapter if you were like what they would consider a legitimate medical school. Like, okay, Harvard, you'll pass. Right. But, uh, but Uncle Justin's school for discount medical learning, you are on the wait list. Well, and this specifically would exclude places, like the eclectic medical colleges that were popping up and things like that. Right.

So aimed at like some good stuff, which is like we don't want to include schools that aren't teaching science-based medicine, but bad stuff because you don't look like us and we don't think much of you so you can't have a chapter. Right. So initially, they were only at the best medical schools, and the way that they would choose members, so they had to come up with a way to choose members. So if you were ranked in the highest tier of your class,

now it's the top 25%. I don't know what it was. I think it was something similar at the time, like the top core tile of your class. Then your name was on a list for consideration. This has changed over time, but in the beginning, what they would do then is take this top 25% of the medical school class, send that list of names around to all the faculty members of AOA.

Because the faculty members didn't have a vote for all they had was a vote against. So they had like veto power. So basically they would send this list around to all the faculty and the faculty would weed out anybody who they knew wasn't, I don't know, was about boy play about their own rules. Exactly. They would rule out all the Gregory houses. And then they would send what once they had the list, you know, if it was paired down, they would send it to all the student members and the student members would

get to vote on who to choose. And the reason that they let the student members actually do the voting and, you know, whittle it down to the ones who were selected, or because there was a belief that the students would know better if there was dishonesty or poor character among their fellow students. And that stuff didn't rise up to the, well, it's kind of like, it's also like pure accountability, right? It's like, yeah, at least in concept, the idea that like, you know, your teachers may not find out, but the students talk and they know everything and they'll weed out the bad eggs. Which again, like, I think it's important to look at that and see where sometimes you

are doing things without the intention of discrimination, but it is. I would, having been in medical school, the students do, no. You do know when you're a student, what's going on with other students a little better than once I was a resident and now being a faculty member, I'm sure I don't know everything that's going on. I don't know all those things that the students know about each other. So like, I can see where that idea came up. But what this also does is start to exclude people you just don't know as well. Right. That you just didn't hang with. Yeah.

You know, but I. They might be maybe kind of kept to themselves or didn't, you know, warners close friends. And is that intention baked in? Do you want to keep it exclusive to just your friends? Or is it just an accident? Does it really matter if it's perpetuated either way? That's how it starts, that's how it continues. The society did expand to include women in 1906, so pretty soon. And they made a statement early on in AOA. There is a statement that they do not discriminate

against anybody for entry, for any reason. So they claimed diversity pretty early, whatever your race, whatever your gender, you are welcome in this society, as long as you are academically founded, basically a high performing student who has good moral character, that you are welcome in AOA.

They claim that from the beginning. Now whether that's the reality, we're going to talk about, but before we do that, let's go to the billing department. Let's go. The medicines, the medicines that ask you let my God before the mouth. So it seems like the wheels are about to come off a little bit.

Before I bring you up to date with AOA and why we're doing an episode about it, what has shifted, I think it's important to talk briefly about the Flexner report in 1910. So when AOA started, there were very clearly segregated medical schools. There were white schools and there were black schools. And there were not nearly enough, well, first of all, of course, there shouldn't have been segregated schools, but if we are also trying to create black physicians,

there weren't enough schools to do so to begin with. Now, the Flexner report was the result of, and I think we may have mentioned this briefly on the show before, Abraham Flexner. So it's familiar here, yeah. Spent two years funded by the Carnegie Institute, traveling the US and Canada, basically evaluating all the medical schools.

Because of all this stuff we talked about, how medical schools were all kind of doing their own thing, and being a doctor who came from one medical school in this part of the country did not necessarily mean the same thing as being a doctor, you know what I mean? So they're trying to create a little bit of homogeneity and counter at least standard baseline.

I would say homogeneia is a very apt word in this particular context. So, Flexner went around and he came out with the Flexner report, which was like a book. I mean, it's a giant report in which he kind of lays out his prescription, so to speak, for streamlining medical education and fixing all the problems

and making everybody, all the schools do the same thing. As part of that, he wanted to, one, he felt like there were too many medical schools. So we thought we needed to close schools in general. We don't need this many medical students, we don't need these many schools, we need to close some schools. And two, if we're going to close schools, I want to close the schools that are the furthest from meeting the standards I feel like schools need to meet. Now as a result of this, he closed all but two black medical schools.

So already you're seeing a problem. Why did he have the ability to close medical schools? Okay, well, no, I should clarify it. He did not, he recommended based on his recommendations all but to black medical schools are close. Thank you for clarifying that. Yeah, he would not have had the authority, but his recommendations were taken quite seriously.

They're the echoes of the Flexner Report are today in today's medical education. I mean, this was a big deal. In the history of medical education, this Flexner report is defining. So anyway, he, so because of this, all but two black medical schools were closed. He also, in the report, there is an insinuation that perhaps black doctors are best left to only serving black patients and That they might have sort of a lesser role in the medical hierarchy

As I think you believe I believe we call them sanitarians Insinuating that a black physician. He doesn't say this explicitly But it you definitely get a feel that a black physician could never be equal to a white physician. So they have a place, but it is not at the same place that he would rank a white physician. And again, this is not explicit in the report, but that is certainly the feel that people got. And it also kind of solidified the picture, not just of a perfect medical school, but of a perfect doctor. The idea of what a physician should be and look like was a very white male, New England refined

probably from a better family, probably a little more affluent, you know, conservative austere kind of figure. Which is wild because if you think back and you think it like, especially, I mean, this is, this is probably better in recent years, obviously. But if you think back to like, shows you watch when you're a kid or whatever, anytime a doctor is represented, like you have just described described is the same stock dude. Yes. Every single time somebody goes to the doctor.

And this flex and report really. Dr. Hibberd from The Simpsons is the only count example from my childhood that easily springs to mind. I'm really happy that our kids have Doc McStuff and his mom. Yeah, absolutely. Yeah. But I, I, Although it must be extremely hard uh... doc mixed up and small yeah absolutely uh... but i uh... i

although it's must be extremely hard for her to get taken seriously uh... besides her race definitely just the name mixed up and must be extremely challenging to be taken seriously as a professional in this world uh... have you watched the show yeah what what what are you talking about? Yeah, what?

She runs that place. I bet she has no problem being taken seriously. Make stuff and so are otherwise. Anyway, my point is it really gave America its idea of what a doctor was. And what a medical school should shape doctors into. It obviously created way fewer pathways for black students to become doctors for black people to become physicians in this country. It also limited pathways for women as well, although he did not explicitly say that the way he did against black physicians. But as a result of this, it wouldn't

be until the 50s that medical schools were integrated. And at that point, I mean, like the integration is so essential, not only because it's the right thing to do, obviously, but because there were so few black medical schools. So you have segregation, then you have no schools for anybody to attend. So of course, we have this huge disparity in the percentage of the American population, as we've talked about, that is black and the percentage of physicians that are black.

There's a huge difference there, and this is the root of that. This is part of the root of that. Obviously there are many, but this is a big chunk of it. So I think it's important to remember that that culture of medical schools, of medical training, of medicine in general, goes beyond AOA. It is ingrained in the way we teach students. It has been part of the roots of medical schools for a long time. Now, all of this, when it comes to AOA

to get to zoom back into Alpha Omega Alpha specifically, all of this was called into question in 2017. There was a study that came out, and I say that it has probably been called into question many times on individual levels, but it was published in the and JAMA internal medicine, the Journal of American Medical Association internal medicine journal. Good. You guys are great. We're great at naming things. The in 2017 that looked at the racial breakdown of AOA members and

Basically what this study said was let's let's Look at it was Dr. boatwright was the lead author. Let's look at AOA honor societies and Say let's control for the things that should be the same right? Let's let's remove From there step one scores. That's your first board examination that you take. So that's a big giant test that we have to take. Let's take out of it research,

how much research they're doing. Let's take out of it community service. Let's take out of it leadership activity. Let's take out of it membership in the Gold Humanism Honor Society, which is another honor sign. Let's take all that out of it, cause control for all that and then see.

And what would that leave? Well, then we're just race. Like, if you remove all that, what accounts for the difference? Like what percent of students are white or black or Hispanic or Asian and what they found is that even controlling for all that, if two students have the exact same board scores, research experience, leadership, all that stuff, you are still more likely to be in AOA if you're white than if you're black. They found that both black students and Asian students were less likely than their white counterparts to be members of AOA, and that this could reflect a bias, and this could impact these students, these physicians for the rest of their career.

So a lot of medical schools started to re-examine the whole thing, because this is, again, this is one of those things that we probably should have not, we should have not, not probably, we should have seen, but we didn't see. And so then it was called everybody's attention. And if you look at the selection process the way it is now, this can help understand. And it's important to know too, every chapter can do the selection process their own way. There's some general rules laid out by the National Office, but like how you apply those rules are really specific to each chapter.

The general idea is that the top quarter of the class is still eligible. So basically if you're in the top 25% of your class, you get sent an application. You get an email. You're eligible for AOA, fill out this application. So you fill out your applications, and the students will have to report things like grades, scores, research, leadership,

community service, awards they may have received, that kind of stuff. Then the society meets and looks at all this. So you have a meeting and they sit down with all your packets of all your stuff, and then they vote. And now what you do in the middle there is up to interpretation. Do you want to use some kind of scoring system to like rank each student based on what they've turned in? Do you want to do whatever it does? American Gladiator style physical combat with like nerf weapons, stuff like that. They encourage you to come up with objective ways to evaluate all this criteria and then at the end.

One could say this. Well, then they're gonna have to go to the agar crag because that radical rock is objective. It's just about can you get to the top? Do do do do you have it? Good. 16% of the class can be inducted. So a different number of students depending on the size

of the school. And then of course, like I said, there are also residents and fellows in attendings. But the students are the important thing because when I applied to residency programs, and I was filling out my, because you fill out a general application that you send to all the different residency, so you may like to attend. You may be interested in attending. to attend. You may be interested in attending. When I did that, there is a box that you can check for AOA membership. It is its whole own box. There are places where you can list awards and leadership and organizations and positions. But there is- Save the kid from a brain building.

You can list that on your application. There are places for you to write that stuff down, but AOA is its own distinct box. I say that to outline what a big deal it is. As once you can check that box, there are a lot more opportunities open to you. The ability to get into the very competitive specialties. And even, we've actually, there have been studies done that show people who are in AOA have a higher likelihood of going into the better lifestyle specialties. They have a subset of medical specialties that are considered the most conducive to like, you know, you get to have a balanced lifestyle. You can see your family, you can go on trips, you can do hobbies and stuff and do medicine. Those are the more lifestyle

specialties. You're more likely to get into a lifestyle specialty if you're in AOA than not. So these are, this has been proven. It also outside of like the very specific, they're gonna look at your application and you know, if it's a really competitive specialty and you have each spot you have 20 applicants for and 19 of them are in AOA and one isn't, well, that's a really easy.

Yeah. That's a really easy choice. I'm not saying, I'm not, and I'm not saying this is the only thing the people look at, but like it's there. It's up there. It's up there. It is looked at. Um, it also feels like an exclusive club. I say this based on my own experience when I was interviewing in four residency programs,

uh, one of, when I sat down for an interviewer, with an interviewer, one program, the first thing that she said to me, the very first thing was, I'm so happy to finally see a fellow AOA member. It's so refreshing. Because I am not in a specialty that is considered competitive, you know. We need more family doctors. So you don't necessarily, there are certainly a lot of us out here who are in AOA in family medicine, but you don't necessarily see as many.

A lot of those AOA people going through the big bucks and other specialties. Well, you can. You are eligible to make a lot more money in those other specialties than I am in mind. Yeah, I don't think people, I don't think lay people, especially appreciate how like, I think it's assumed that like doctors make a lot of money period into sentence. And I think

compared to the median doctors make overall, if you have a trim out more, but I think that you people would be shocked to know the kind of disparity that there is just in, like just between doctors. Like, even, I mean, which kind of, which I bring up to mainly the highlight part of this, you know, part of this issue, the way it's all tied together. Yes, there are definitely, as a family medicine doctor, I can tell you, there are physicians in our community

and other specialties who make multiples, right? Multiple of my salary, many multiples of my salary. What are, what are, like, what are a few that are just like the known as being some of the radiology, radiology is one. Radiology is one. Radiology is one. Radiology is one. Radiology is one.

Radiology is one. Radiology is one. Radiology is one. Radiology is one. Radiology is one. Radiology is one. Radiology is one. you can make a lot of money in those specialties. Which is. That's when like they, you don't just like, radiologists is gonna look at the pictures and interpret, you know, studies, imaging studies. And interventional radiologists does the procedures that you do while using radiology. Which is X-rays, right?

Yeah, I mean, well, radiology is X-rays, cat scans, MRIs, call sounds. I mean, like there's tons, all imaging. Okay. A radiologist reads all the imaging, but a radiologist is mainly going to be sitting in a room reading images and giving reports, and making, and making bank.

And an interventional radiologist is going to be actually seeing the patient and doing a procedure on them while using radiology to visualize what they're doing. Does that make sense? Yeah. Anyway, I've distracted over there. The procedure-based specialties typically make more money, like orthopedic surgery, because the way that the American medical system works is you're reimbursed a lot more for a procedure than you are for sitting and talking with somebody and prescribing a medication or something. I mentioned this is not a detour. When we're talking about systemic racism and really trying to

like root it out and the ties to income inequality, like this is part of what we talk about, right? You get the chain that I was trying to describe. Like you get the AOA check, then you can make a lot more money. You know, you have the opportunity to make a lot more money. And it's for sure. All, you know, all tied together. Yeah, because they're, they're again, anecdotally, I know I have heard there are some specialties that, I mean, they look for that box. That box is a must. And I do not think that is universal to every program, but I know specific programs where that is a must, to get into their competitive specialty. So what goes wrong with the process,

like we talked about, it's different for each chapter. So it's hard for me to say what's going wrong all over the place because everybody could be applying these rules a little differently. And that's probably part of the problem, right? Yeah. Because each school can kind of do their own thing. Right.

And everybody always thinks that's a good thing in this country, but that rarely works the way we want it to. So it could just be subjective. Like you see the voting part, and it's really easy to see where friends like, oh, I know that person. And it's not intense. It's never, I'm not going to say it's never, but so often it's not overt. It's not saying, well, I'm going to choose that student because he's white.

It's not like that. It's, I know that guy because we hang out together. And so I'm going to choose him. And I'm white. And so also he happens to be white. And so I'm going to choose him. That's how these things happen. Because I hung out with white people

when I was a kid, because that was what I was most comfortable with and so on and so on and so on and so on. And so like, and it's really important to recognize that because people get so defensive and wanna say like, but I'm not racist, I would never, I would never. No, it's not, you're not saying it out loud, you're not trying to do it.

It's just the way our society has formed and it's why we have to break it all down. And it's why we talk about things in terms of like systemic racism because you have to understand that like the system that you're part of is racist. And even if you are not, if you have a hundred people who are non-racists in a systemically racist program, it still racists. Right.

It still is. And I think this is evidence by the fact that there was one school that tried to fix this. The icon school of medicine at Mount Sinai dug deep into this to try to fix this system, to try to see like, is it just that simple? Is it just that when we vote, we're tending to vote for people we know better and they happen to look like us? And so that's the problem.

So they looked at their chapter, realized that it had a racial problem, that white students were way more represented than everybody else. So they came up with a new system. They blinded all their members to who would be like in a study when you, you know, blind to study to who would be, um, to what the candidates look like, and they anonymized them. So they took all the steps necessary,

you would think, to eliminate race as a factor. They just showed them all of the, the good stuff, right? Here's all the good stuff the students did pick them It's still didn't work. Why not? Okay, so just like we've been talking about The problem that exists within an AOA has been I will say as a member of AOA I am happy that they are at least they're talking about it their because this, this study out of Mount Sinai came out last month. They just put this out that they are going to suspend their AOA chapter because it cannot be done fairly.

So, and this just came out and AOA addressed it and of course they're not thrilled about it, but at the same time they see the problems. They are recognizing they're these problems. The system of medical school creates all of these inequalities in what you can achieve that it looks like it's always going to look like a white student might be more qualified than a black student or not always, but it is often going to look that way. Let's think about how grades are assigned. And your third and fourth year of medical school, a lot of your grades are subjective.

How well did the student do on the rotation? How good is their bedside manner? How well did they connect with patients? How organized were their presentations? How professional did they act? These are, yes, you can see how many places... Yeah, you don't have to peel up too many layers of the onion to see the...

And again, I am not saying people are intentionally grading based on race, that's the thing with implicit bias. You don't see it, it's just in you, and you don't know it's there until you challenge yourself to change it. So grades are part of it. When it comes to research, research. So it's big in medical school to like partner with

and attend and do some research, get your name on a paper. That looks really great, especially if you want to go into something like orthopedics. It looks really research, get your name on a paper. That looks really great, especially if you want to go into something like orthopedics. It looks really great if your name's on a paper. Who gets to work with the attendings and who do the attendings like, no, and offer like, hey, I'm gonna write up this patient you wanna work? You wanna work on the case with me?

Again, we're getting into like, who do I feel comfortable with, who looks like me? Who has the time when we're talking about things like community service and things like that, I didn't work in medical school. I spent all my time devoted to medical school. I didn't have to work. It was just me and you and you worked. And so I didn't have, I didn't have any family to support. I didn't have any bills to pay. I mean, we had bills, but you pay them. That's privilege. All that privilege gave me more time to do another research project, to do another community service project,

to do all that stuff. That's all privilege that allows you to participate in that. And then we turn around and reward your privilege with the privilege of being in AOA, which is rewarded with the privilege of a competitive medical specialty, which is rewarded with the privilege of a competitive medical specialty, which is rewarded with the privilege of a great lifestyle and a big paycheck.

Which is rewarded the privilege of choosing the med students that will work with the on-research projects. And so on. And who do you give awards to? Who do you make the leader? Who gets voted to be president of different clubs? I mean, all this stuff is tangled up with discrimination and implicit bias.

And so when you start looking at other criteria, it's all a problem who gets to be in AOA. It all starts to fall apart. So of course, if the system is inherently racist, of course, the honor society is going to become racist too. It's just an extension of that system. So some schools don't have them. There are handful schools out not many, but there are like seven or eight, I think this might make eight that don't have chapters. Some in part, because of the racial issue, some just because it creates this really unhealthy,

competitive atmosphere within the students where you're not really focusing on being the best doctor, you can be as much as beating all the other students, which is a culture in medical school that we don't need. And there are lots of things in place to try to eradicate that. That's already a known problem. But what needs to be addressed is so much deeper than that. And they've talked about it, that Mount Sinai study talked about it. And AOA has kind of mentioned it. But I think what we all need to address in medical education, and I say this as a faculty member, maybe the whole way we grade and evaluate medical students, maybe it all needs to be reexamined.

I mean, why do you need an A or a B or a C or a D for a medical student? Why aren't they all pass fail? I mean, either you can be a doctor or you can't be a doctor. It's a joke that doctors and their families tell a lot is what do you call a doctor who made all sees in med school a doctor? Yes. I mean, and I say this, by the way, like as a student who went into medical school,

and I truly believe in my heart of hearts that I did want to help people, and that I went into medical school for what I think are the right reasons. I truly believe that. But that being said, I did want to be the best based on their criteria. I fell into that trap very quickly.

I made straight A's. I had very high board scores. I had that AO trap very quickly. I made straight A's. I had very high board scores. I had that AOA box checked. I wanted all that, all those honors and accolades. I was part of that very negative, unhelpful and discriminatory piece of med school. I fell right into that because when you are the kind of person who is used to, and I think medicine

attracts this high performing people, you know, who want to be the best, and who like, when people tell them they're good, who like praise, you, that this feeds into that very easily. And I think that until we do away with that, I mean, and that's not the whole problem, obviously there are many problems, you know, that we've got to with that, I mean, and that's not the whole problem. Obviously, there are many problems. We've got to get into who gets into medical school as well, and that's a whole other issue. But in medical school, it shouldn't really matter what your grades are, your scores are,

as long as you know enough, and you care about people, and you are capable of doing the job. Why does the rest matter? And I think like if we started looking at maybe your ability to overcome barriers to get into medical school and become a physician, maybe that's more valuable than a really high board score. I would argue that it is, maybe your capacity

for compassionate communication is more important than your GPA. I think that a past fail system would be a really easy way to start with these things. Because I can teach, as a medical educator, I will tell you, I can teach students and residents, I can teach them anatomy, I can teach them bacteriology, I can teach them biochemistry. Well, I don't want to teach biochemistry, but you get the idea.

I can teach that stuff, but I can't teach you how to be worthy to serve the suffering. That is a whole other thing. And the idea that in AOA, where that is our model, which I took very seriously, and I think should be taken very seriously. To be worthy to serve the suffering, we need a different culture. And if we change that culture, that is one piece of diversifying who is a doctor, who gets to be in whatever special do they want to be.

And how do we change the American medical system so that it reflects the population of our country better. Well here's hoping it's at least the wreck I mean this is relatively new like you said at least they're recognizing it. I mean I don't know if it affects but I have hopes for AOA in that I as a member I know personally and like I said a former counselor I know personally a lot of the members, I feel like there will be a drive to do better. I hope they're well. I hope they're well. Because until we can

make it better, I don't think it should be considered in residency interviews, you know, until it's more fair. And I'm, and also why am I excluded as long as we're talking about it? Well, honey, you're not, you're not a doctor. Didn't seem fair. Or a medical student. It just doesn't seem fair. Thank you so much for listening to our program. We hope you've enjoyed yourself.

We are part of the Maximum Fund Network. If you want to listen to more great podcasts, head on over to MaximumFun.org and check them totally out. If you want some solbona's merchandise, you can go to mackelroymerch.com and you will see a bevy of beautiful items, just waiting to be bought up by you, our beloved listeners. I'm sorry, I made you seem like a sheephole that I was hurting into our merchandising wagon. Can I say one thing, the student, Jizelle Lynch, who was quoted in all the articles about

Mount Sinai and who helped with this study that just came out last month? Really, I think it's really impressive how a medical student took it upon themselves to see this problem and speak out about it and take on a system that, I mean, is so entrenched and I imagine got a lot of pushback about, a lot of people were probably angry. I just think, I really admire that. I wish I had had more of that stuff in me when I was younger.

I'm glad I have a little bit of it now, but I just wanted to congratulate her on doing what she did. Thank you so much for listening to our program and be sure to join us again next week for solvones. Until then, my name is Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Music Alright!

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