LETTERS TO THE EDITOR

Commenting on “URiMs and Imposter Syndrome: Symptoms of Inhospitable Work Environments”

Yulsi L. Fernandez Montero, MD, MPH | Cresandra E. Corbin, MD | Menerva Yole-Lobe, MPAS, PA-C

Fam Med. 2024;56(5):337-338.

DOI: 10.22454/FamMed.2024.131716

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To the Editor:

We commend Drs Carvajal and colleagues' work on “URiMs and Imposter Syndrome: Symptoms of Inhospitable Work Environments?” which summarizes the history of imposter syndrome (IS) and how it disproportionately affects underrepresented in medicine (URiM) versus non-URiM family medicine faculty. 1 We were captivated to learn that URiMs were not more likely to report frequent or intense IS compared to non-URiMs and that IS could instead be the mislabeling of the internalization of experienced systemic racism.

Although this is a possible explanation for obtained results, we ponder the possibility that the methodology used for participant recruitment and evaluation may be obscuring the findings. Is it possible that those who experience higher and more frequent IS will have self-excluded from the study sample due to increased work demands and less time available to complete a voluntary survey? The stress burden is also likely higher for URiM faculty. 2

Past research has shown that URiM faculty are less likely to remain in academia due to several factors, including hostile work environment, increased work, and less opportunities to be promoted. 3 Notably, their findings found that years in practice after training completion is inversely related to the frequency or intensity of IS experienced by faculty. As we aim to diversify the family medicine workforce to achieve health equity for patients, we would like to propose solutions that institutions can do to lessen IS and the minority tax 4 for their URiM faculty. We encourage changes to promotion and tenure requirements that incorporate the valuation of work that URiMs are more likely to engage in when compared to non-URiM faculty, including, but not limited to, diversity, equity, and inclusion efforts and community interventions. These proposed solutions ultimately also can increase URiM retention in academic medicine while providing non-URiM with diversity training. 3

With the recent Supreme Court of the United States (SCOTUS) decision dismantling affirmative action (AA), 5 we need to reevaluate the impact that this federal decision will have on IS, especially for URiM faculty. We face a shortage of URiM faculty in academia, a definitive crisis. 6 Without AA and other equity efforts, this crisis will likely be exacerbated, leading to further decline of URiM faculty in academic medicine. In a space where we already know there is a shortage of minority mentors, we would be remiss not to evaluate the impact of the SCOTUS action on our profession.

References

  1. Carvajal DN, Reid LD, Zambrana RE. URiMs and imposter syndrome: symptoms of inhospitable work environments? Fam Med. 2023;55(7):433-451. doi:10.22454/FamMed.2023.376821
  2. Campbell KM. The diversity efforts disparity in academic medicine. Int J Environ Res Public Health. 2021;18(9):4529. doi:10.3390/ijerph18094529
  3. Childs E, Yoloye K, Bhasin RM, Benjamin EJ, Assoumou SA. Retaining faculty from underrepresented groups in academic medicine: results from a needs assessment. South Med J. 2023;116(2):157-161. doi:10.14423/SMJ.0000000000001510
  4. Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax?. BMC Med Educ. 2015;15(6). doi:10.1186/s12909-015-0290-9
  5. Rubin R. How the SCOTUS affirmative action ruling could affect medical schools and health care. JAMA. 2023;330(6):492-494. doi:10.1001/jama.2023.13603
  6. Rodríguez JE, Campbell KM, Mouratidis RW. Where are the rest of us? Improving representation of minority faculty in academic medicine. South Med J. 2014;107(12):739-744. doi:10.14423/SMJ.0000000000000204

Lead Author

Yulsi L. Fernandez Montero, MD, MPH

Affiliations: Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

Co-Authors

Cresandra E. Corbin, MD - Capital Health Family Medicine Residency Program, Trenton, NJ

Menerva Yole-Lobe, MPAS, PA-C - Department of Family & Preventive Medicine, Division of Physician Assistant Studies, Spencer Fox Eccles School of Medicine, The University of Utah, Salt Lake City, UT

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