A Collaborative Reflection on the Model Minority Myth: Considerations for Recruiting, Retaining, and Promoting Asian Americans in Family Medicine

The experiences of Asian Americans, including health care providers, are often overlooked because Asian Americans are not considered underrepresented in medicine. ^{1, 2} In addition to not being categorized as underrepresented, Asian Americans are persistently viewed as the “model minority”: monolithically academically successful. ² The model minority has long been viewed as a positive stereotype and therefore presumed harmless. ³

In this essay, we reflect on our collective life experiences to examine how the model minority myth (MMM) has affected our lives as Asian Americans in academic medicine, and we propose that this myth must be resisted by the field of academic medicine to stop harming Asian American communities. The author team met at the University of Utah; we are all at various stages of our career, ranging from residency training, early-career faculty, to tenured professor. Five are family physicians (MDs), one a physician assistant (MPAS), and one a PhD educational researcher. Four are women and three are men. Six identify as Asian Americans. One identifies as a Puerto Rican American who has advocated for Asian Americans to be included in conversations and initiatives pertaining to diversity, equity, and inclusion (DEI). Despite our various backgrounds, we were alarmed by the increase of anti-Asian hate that accompanied COVID-19. Our shared goal of bringing attention to the discrimination that Asian Americans encounter and how that influences recruitment, retention, and promotion is what prompted this narrative. Here we discuss the history of the MMM, how it is damaging to Asian Americans and other racially minoritized communities, how it affects recruitment and promotion of Asian Americans, and what the family medicine community can do to work against the MMM.

We understand and acknowledge that we are not representative of all Asian Americans; specifically, none of us identify as Central or South Asian. However, we believe in the importance of shedding light on the experiences of an underresearched group. Our differing identities, different years of experience, different ethnic identities, and different areas of expertise are what enabled us to bring multiple perspectives to this essay. Additionally, we acknowledge that many of us embody the model minority, even as we are working to dispel it.

In reflecting on how we view ourselves as Asian Americans, we realized that we all shared this sentiment at one point. However, in time we learned that the model minority is a racial frame imposed on Asian Americans, coined by sociologist William Peterson in 1966. ⁴ Peterson stereotyped Japanese Americans as a rule-abiding and hardworking group that overcame the adversity of internment during World War II within 20 years. ⁴ Peterson’s work used the success of Japanese Americans and the term model minority for a specific purpose: to refute Black Americans’ claims of racial oppression during the Civil Rights movement. ⁴ Despite the fact that the model minority is an overgeneralization of Asian American success, it has persisted. The 1965 Immigration and Nationality Act allowed immigration of physicians from Asian countries, which contributed to the overrepresentation of Asian physicians in medicine and subsequently contributed to furthering the myth of the model minority. ⁵ Once we better understood this, we started to see the flaws of the MMM: how it downplayed the history of Asian American racism, erased the experiences of Asian American students who do not excel in school, minimized the struggles of underpresented Asian Americans in achieving academic success, and affected recruitment policies toward Asian American students/trainees and faculty.

Because so many, including Asian Americans themselves, accept the MMM as truth, ⁶ one can easily forget the explicit racism that Asians in the United States have faced. And yet, many historical examples exist, including several immigration laws that prevented Asians from entering the United States. In 1875, the Page Law ⁷ was enacted, forbidding Chinese women from immigrating. Shortly after, the Chinese Exclusion Act of 1882 barred Chinese immigrants from entering the United States. ⁷ The 1882 Act was followed by the Immigration Act of 1917, which prohibited immigrants from the “barred zone” of Asia, excluding only Japan (because immigration from Japan specifically was already prohibited) and the Philippines (a US colony). ⁸ In the mid-20th century, Japanese Americans faced forced incarceration for 3 years during World War II. ⁹ A rise in anti-Asian sentiment in the 1980s resulted in the murder of Vincent Chin. ⁹ Most recently, during COVID-19, Asian Americans experienced increased anti-Asian hate. ¹⁰

The MMM also obscures the variation in academic achievement among different Asian ethnic subgroups. ^{11, 12} In medicine specifically, Asian American students are well-represented as a whole, ⁵ but disaggregated data reveals that medical school applicants from Southeast Asian backgrounds (ie, Vietnamese, Cambodian, Hmong, Laotian) represent only 1.7% of applicants. ^{1, 13} Despite Asian Americans representing nearly one-fifth of physicians, they are lacking in the ranks of leadership, including academic medicine positions such as full professors, chairs, and deans. ^{14, 15}

Finally, resources may not be deemed necessary in serving Asian American patients (Table 1).

Just as uneven academic achievement among Asian Americans is underrecognized, so are health care disparities in the Asian American population. ^16-18 Researchers often aggregate subgroups under one racial label: “Asian.” In 2000, the US Census began separating Asians and Pacific Islanders, and in 2003 the Secretary of Human and Health Services created seven subgroups, one of which was “Other Asian.” Current research primarily focuses on the largest Asian American groups, including Chinese, Japanese, Vietnamese, Korean, Filipino, and Indian. ¹⁸ Studies examining smaller subgroups remain limited. Not recognizing such disparities, or the need to effectively communicate with Asian American patients in order to prevent disparities, is another harmful effect of the MMM. ¹⁹

Another way in which the MMM is harmful is that it juxtaposes Asian Americans against other racially minoritized communities. Asian Americans can be a model minority only because they are framed as better than Black and Brown Americans. ^{20, 21} In choosing solidarity with other communities of color, Asian Americans must denounce the privileges that come with being the model minority. ²² Although history of solidarity between Asian Americans and other racially minoritized communities exists, this history is not well-known and often left out narratives about Asian Americans. ⁹ Denouncing the MMM can promote better relationships among all racially minoritized communities.

Asian Americans exist in liminality, as racially triangulated between White and Black Americans. ²⁰ While we understand and believe in the importance of supporting underrepresented minoritized groups, not feeling caught in the middle is difficult, like we do not belong in White or Black and Brown spaces. As racially triangulated Americans, Asian Americans have dissimilar experiences to that of the racial White majority. ² Asian Americans experience racism in various environments, including professional settings. ²³ Medicine is not exempt; recent studies have documented that Asian American medical students ²⁴ and providers^{25, 26} alike felt discriminated against during COVID-19 and unsupported by colleagues. Reported cases of discrimination rose sharply in 2020, ² illuminating how Asian Americans experience racism, even in their roles as model minorities. ⁵ Another study illustrated how experiences with microaggressions and liminality are persistent issues for Asian American medical providers, not just isolated to the pandemic. ²⁷ The dangers of ignoring this sense of not belonging is that it can lead to disillusionment and feelings of invisibility. ¹ Asian Americans are an important part of the primary care and academic medicine communities, and they can play a big role in making medicine a more equitable and inclusive environment. However, this will not happen if they feel ignored. ¹

Asian Americans are not considered underrepresented in medicine because a greater proportion of Asian Americans are in medicine relative to the number of Asian Americans in the general population. ¹ In this context, the MMM is damaging because it can divert resources away from communities not deemed sufficiently minoritized. ²⁸ For instance, Southeast Asian Americans have reported experiencing “quiet neglect” as US culture highlights achievements from East Asians and erases the needs of this underrepresented subgroup. ²⁹ In turn, creating policies or practices centered around recruiting or retaining Asian American trainees and faculty may not seem necessary, which as the previous narratives illustrate, can result in feelings of exlusion within DEI committees, training programs, divisions, and departments.

Collectively, we feel strongly about resisting the MMM to change the trajectory of how Asian Americans are racialized. To us, denouncing this myth is important because of the harm it causes to the Asian American community and to other communities of color in academic medicine. Considering the interracial solidarity that occurred during the Black Lives Matter movement and the Civil Rights movement in the 1960s and ’70s where Black, Asian American, and Latinx communities came together in solidarity, we believe we can create more meaningful change in partnership with others.

We suggest several actions that can be taken to dismantle the MMM and its harmful effects, ¹ included in Table 2.

We call on our colleagues to join us. Understanding the MMM and working to resist it is a first step toward understanding the experiences of Asian Americans in academic medicine. By working together to dispel the MMM, we take a step forward in antiracism and work toward a more authentically inclusive environment that recruits, retains, and promotes our increasingly diverse community.