Background

Equity and diversity in medicine are the subject of an important, ongoing discussion for medical professionals and patients. Greater equity and diversity in the medical workforce will improve system adaptation and patient care, but many barriers need to be addressed for the profession to move forward.

To better understand and address these barriers, the CMA launched a conversation with CMA members and stakeholders on equity and diversity in medicine in January 2019.

Members and stakeholders were encouraged to ponder questions such as:

  • In your opinion, what are the most prominent issues or challenges related to equity and diversity facing the medical profession?
  • What actions or solutions, big or small, might lead us toward a more equitable and diverse future for the medical profession?
  • How can an increasingly diverse profession positively affect patients?
  • What role should the CMA play in improving equity and diversity to support you as a member?

Since receiving and reviewing feedback, the CMA has developed a draft policy on equity and diversity in medicine to promote increased equity and diversity in medicine and to foster a more collaborative and respectful professional culture. By developing this policy, the CMA aims to identify a set of guiding principles and commitments to achieve these goals. It provides support for the view that improving circumstances and opportunities for physicians and learners is essential in creating a more equitable and sustainable culture and practice of medicine.

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Defining equity and diversity

Equity refers to the treatment of people that recognizes and accommodates their differences. Equity relates to the opportunities of any given person, with their own identity, culture and characteristics, to create and sustain a career or to receive medical care without discrimination, harassment or cultural- or characteristic-related negative bias.

Diversity includes those (observable and non-observable) characteristics that are constructed — and sometimes chosen — by individuals, groups and societies to identify themselves (e.g., age, culture, language, gender, sexuality, health, cognitive abilities, socioeconomic status) in different contexts and that may describe them in relation to others in those contexts. It describes them in relation to other people (e.g., age, socioeconomic status, geographic location, health).

Feedback options

The consultation period for reviewing the draft policy closed on Nov. 18, 2019. Thank you to all stakeholders who shared their thoughts. 

Parents
  • “Individual protection from bias and discrimination is a fundamental right of all Canadians.” I wholeheartedly agree with this statement which is at odds with the substance of this policy. The policy document presents hypotheses as statements of fact without supportive data. This policy is partisan and will dissuade many Canadians with mainstream political beliefs from pursuing careers as physicians.

    Giving preference to one individual over another based on sex or ethnicity is unethical, yet this policy advocates such practices. If we wish to overcome racism and sexism we should treat people based on their individual merit not by group identity. How can we claim to seek to treat all individuals fairly if we judge different individuals by different standards based on their race or sex? If we wish to ensure people are protected from bias and discrimination we should give greater weight to objective measures of assessment such as standardized tests.  The document proposes “Considering subscribing to a holistic process of defining pools for medical training interviews” This kind of process which at Harvard means that for a given SAT score an applicant would have a 25% chance of admission if they belong to one minority but 95% if they belong to another. 

    Bigotry is directed at individuals based on group identity, but is not necessarily a uniform process. Some members of an identity group may experience bigotry, but others may not. If bigotry prevents an individual from achieving their potential, setting a lower bar for another individual who shares group identity but who has not been victimized does not bring justice to the victim. In order to lower the bar for one, the bar must be raised for another, another who must be discriminated against based on group identity. Where is the individual protection from discrimination? This policy espouses regressive concepts of group merit and guilt. To borrow from Bari Weiss; in practice, intersectionality does not dismantle the caste system but functions to replace it with a new one. This does not advance the cause of justice.

    If Applicant A belongs to a group that is overrepresented in the medical community but is otherwise in the 85th percentile of all applicants, should she be passed over for Applicant B who is in the 10th percentile but from an underrepresented group? Who will define what group identities merit consideration and what weight will be given to each intersectional factor? The potential for bias and abuse in such a system should preclude giving it any further consideration. It will likely lead to the same outcomes seen at Harvard.

    Will Applicant B serve patients better than Applicant A? If patients become aware that standards are lowered based on group identify what unintended consequences might arise? Would parents consider a physician’s skin colour or other group identity when choosing who they entrust with the care of their children?

    The central tenet of social justice is implicit in this policy. I’ve recently seen it  expressed as follows on social media:

    Coleman Hughes refers to this as the disparity fallacy.”The disparity fallacy holds that unequal outcomes between two groups must be caused primarily by discrimination, whether overt or systemic.” 

    Clearly beliefs, culture, and biology impact outcomes. Patients who refuse blood transfusions will be less likely to survive a severe GI bleed. If a woman can’t become pregnant, she will not suffer an ectopic pregnancy. A culture which supports physical activity will likely see lower rates of obesity than one which does not. Clearly discrimination plays a role in outcome differences, but we cannot assume that outcome differences are solely the result of discrimination.

    While one of the aims of this policy is to foster a culture of diversity, it will likely only foster the skin deep forms of diversity and deter many people with mainstream political beliefs. How will this “create, foster, and retain a community of physicians and learners that reflects the diversity of the communities they serve?“ 

Comment
  • “Individual protection from bias and discrimination is a fundamental right of all Canadians.” I wholeheartedly agree with this statement which is at odds with the substance of this policy. The policy document presents hypotheses as statements of fact without supportive data. This policy is partisan and will dissuade many Canadians with mainstream political beliefs from pursuing careers as physicians.

    Giving preference to one individual over another based on sex or ethnicity is unethical, yet this policy advocates such practices. If we wish to overcome racism and sexism we should treat people based on their individual merit not by group identity. How can we claim to seek to treat all individuals fairly if we judge different individuals by different standards based on their race or sex? If we wish to ensure people are protected from bias and discrimination we should give greater weight to objective measures of assessment such as standardized tests.  The document proposes “Considering subscribing to a holistic process of defining pools for medical training interviews” This kind of process which at Harvard means that for a given SAT score an applicant would have a 25% chance of admission if they belong to one minority but 95% if they belong to another. 

    Bigotry is directed at individuals based on group identity, but is not necessarily a uniform process. Some members of an identity group may experience bigotry, but others may not. If bigotry prevents an individual from achieving their potential, setting a lower bar for another individual who shares group identity but who has not been victimized does not bring justice to the victim. In order to lower the bar for one, the bar must be raised for another, another who must be discriminated against based on group identity. Where is the individual protection from discrimination? This policy espouses regressive concepts of group merit and guilt. To borrow from Bari Weiss; in practice, intersectionality does not dismantle the caste system but functions to replace it with a new one. This does not advance the cause of justice.

    If Applicant A belongs to a group that is overrepresented in the medical community but is otherwise in the 85th percentile of all applicants, should she be passed over for Applicant B who is in the 10th percentile but from an underrepresented group? Who will define what group identities merit consideration and what weight will be given to each intersectional factor? The potential for bias and abuse in such a system should preclude giving it any further consideration. It will likely lead to the same outcomes seen at Harvard.

    Will Applicant B serve patients better than Applicant A? If patients become aware that standards are lowered based on group identify what unintended consequences might arise? Would parents consider a physician’s skin colour or other group identity when choosing who they entrust with the care of their children?

    The central tenet of social justice is implicit in this policy. I’ve recently seen it  expressed as follows on social media:

    Coleman Hughes refers to this as the disparity fallacy.”The disparity fallacy holds that unequal outcomes between two groups must be caused primarily by discrimination, whether overt or systemic.” 

    Clearly beliefs, culture, and biology impact outcomes. Patients who refuse blood transfusions will be less likely to survive a severe GI bleed. If a woman can’t become pregnant, she will not suffer an ectopic pregnancy. A culture which supports physical activity will likely see lower rates of obesity than one which does not. Clearly discrimination plays a role in outcome differences, but we cannot assume that outcome differences are solely the result of discrimination.

    While one of the aims of this policy is to foster a culture of diversity, it will likely only foster the skin deep forms of diversity and deter many people with mainstream political beliefs. How will this “create, foster, and retain a community of physicians and learners that reflects the diversity of the communities they serve?“ 

Children
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