More than ever, diversity matters in dermatology

As a profession, I think it’s fair to say that dermatology has done a good job welcoming women and including them into this field of medicine. But how many of your physician colleagues are African Americans? How many are Latinos or Latinas?

Does the diversity of your clinician colleagues reflect our patient population? The 2013 census shows that 13.2% of Americans are African American and 17.1% are Latino. Because these populations are not represented in medicine at anything like these percentages, African American and Latino physicians are referred to as underrepresented in medicine (UIM).

A brochure for an upcoming medical conference states that by 2050, “half of the U.S. population will have skin of color.” This may well become a fact. But I argue that a professional workforce that is as diverse as the population we care for is a much better workforce.

I serve as the interim dean of the University of California, San Francisco (UCSF) School of Medicine, which is one of the great medical schools in the United States. The school has 632 students – 26% from underrepresented minorities, and 56% women – the most diverse student group in California and perhaps the United States. There are 2,180 full-time faculty members but less than 2% are underrepresented in medicine. The annual operating budget is more than $2 billion and the school is No. 1 in National Institutes of Health funding. But there are some important shortcomings.

Three things happened after I took the job as interim dean last year. First, the accrediting body of medical schools, the Liaison Committee on Medical Education, served us with a citation for our hiring practices and the lack of diversity among our faculty.

Second, I ran into something called the “climate survey.” We have all heard about climate change, but have you heard of a “climate survey”? No, it’s not an opportunity to complain about too much snow in Boston and too little water in San Francisco. People on every University of California campus were asked if they felt included in the organization that they worked in. Did they feel comfortable? Did they feel part of the club?

The UC survey found that at UCSF and its sister institutions, people from groups underrepresented in medicine – mainly Hispanics and African Americans, whether they were faculty, staff, or students – felt less comfortable than did their white counterparts. They did not feel our climate was inclusive. That’s not the same as being specifically excluded. It’s about not being included.

Third, there were the racially charged events in Ferguson, Missouri, and in Staten Island, New York, and the way our students responded to them. On December 9, 2014, our students organized a “die-in” protest to demonstrate their concern about racism in health care in our country. They called it WhiteCoats4BlackLives. So here I was, the dean of a medical school, and I find all of our students lying down in the street on campus in a very peaceful but profoundly moving demonstration to protest racism. Not only did our students protest at UCSF, they instigated the same WhiteCoats4BlackLives protest simultaneously at 83 medical schools across the country.

I recalled my own student days when we protested public events, and university administrators responded. But this time, as dean of medicine, I was the administrator. It gave me pause to think: What did those three pieces of evidence tell me? They made it clear that race matters. Once that realization finally became clear to me, the question was, what do we do? We were a few weeks away from our annual leadership retreat. The topic was going to be “strategic partnerships.” I sat down with the vice deans and said: Let’s talk about race instead.

And we did, and it turned into an amazing discussion. Just one example: Before the retreat, all of us took the Implicit Associations Test for race. This is a test designed to detect unconscious bias, the kind of bias we are not even aware of. Like me, many of us who considered ourselves fair and unbiased were shocked at the results. We were unconsciously biased for white people and against people of color.

Nicholas Kristof talked about this in the Feb. 21, 2015, edition of The New York Times, in a piece called “Straight Talk for White Men.” It’s worth reading the whole piece, but a study he cited especially struck me. Two scholars sent out fictitious résumés in response to help-wanted ads. Each résumé was given a name that sounded stereotypically black or white. The résumés were otherwise the same.

A résumé with a name like Emily or Greg received 50% more callbacks than the same résumé with a name like Lakisha or Jamal. Having a white-sounding name was more beneficial than 8 years’ work experience.

We heard stories from our students and faculty of color. I will highlight two. A medical student of color was called to the ED and was stopped by a nurse who thought he was a custodian. A senior faculty member was returning to his alma mater medical school in North Carolina as a visiting professor and was traveling from the airport to the medical school in a rental car. He was stopped and detained because he was black. His hosts came to his rescue and were required to prove that he was indeed visiting at their invitation. Needless to say these and other stories were startling in 2015. America is not post racial.

As a result of the retreat, we are now finishing a plan to make UCSF an inclusive institution for all who work here. The plan includes both short- and long-term elements, and an investment of at least $10 million to recruit and develop faculty from populations that are underrepresented in medicine.

Today’s doctor-patient relationship has become more and more collaborative. Patients actively look for doctors whom they feel they can talk to, who will understand their special concerns, their background, and their culture. There is neuroscience behind this. Research by Mahzarin Banaji, the coauthor of “Blind Spot,” found that we are in fact wired to react more positively to someone who looks like us.

All of us probably understand why a woman might want to choose a female gynecologist. Why a Chinese family will prefer a doctor who speaks their language. Our patients, too, are looking for physicians, for dermatologists, whose skin reflects theirs. They feel better if their doctor looks more like them.

The website Blackdermatologists.org is meant to help patients find exactly that. Guess how many black dermatologists are listed there in the whole State of California. Three. None of them are in San Francisco. None of them are across the bay in Oakland, a city with a large African American population. I did some research via other websites and found one African American dermatologist in the East Bay.

It’s one thing to be underrepresented in medicine, it’s another thing to be unrepresented. The lack of access to a physician who looks like our patients, whose background and experience might reflect theirs, is crucial. But what about the lack of research focused on African Americans, Latinos, and other underrepresented populations by people who understand the culture from the inside and what questions to ask?

I came across such an example in JAMA Dermatology, in an study titled, “Hair Care Practices as a Barrier to Physical Activity in African American Women” (JAMA Dermatol. 2013;149:310-4). My first reaction to this article was “what?” But that’s my unconscious bias talking. In fact, this study points to something significant. We know regular exercise is important for health. Research shows that African American women are the least likely to meet recommended levels of physical activity. Therefore, we want to be aware of any barriers to exercise for that population. But who would have imagined that one of the barriers to exercise for black women was hair care? This never would have occurred to me.

The people who did think to investigate this were in a team led by and including African American women dermatologists and researchers. So now that this is a known barrier, it can be addressed with patients. This is just one example of the type of knowledge we gain if we have a more diverse group of physicians and clinical researchers.

We know we don’t have enough practicing physicians of color in medicine in general, and in dermatology in particular. We easily fall back to the pipeline as the excuse for the situation. So, let’s look at the pipeline. Unfortunately, the current numbers are not encouraging. According to data from the Association of American Medical Colleges, from 1980 to 2013 the number of applicants to U.S. medical schools rose by 4,296. In 1980, 2,507 applicants were African American/black (7.1%), but by 2013 that number only rose to 3,490 (8.8%). During that same time period the number of Hispanic/Latino applicants rose from 5% to 10%.

How many of the applicants entered medical school? From 1980 to 2013 the number of African American/black students rose by 235: from 999 to 1,234, or 6.5% to 7%. At the same time, Hispanic/Latino students rose from 5.2% to 10.6% of entering students.

How many of the applicants matriculated? In 1980, 39.4% of African American/black applicants matriculated, but in 2013 the rate fell to 35%. What explains the data? Lack of role models? Lack of qualifications? Unconscious bias? An exclusive climate? Continued racism in our country? I don’t pretend to know the answer, but we always fall back on the pipeline as the excuse for the situation. So, what are we going to do about the pipeline?

Given the current state of the pipeline, the question may not be “what is the ideal” but “what is an achievable goal for dermatology?” In 2014, 47 of 731 applicants to dermatology programs were African American and another 47 were Latino. I don’t know how many of these finally matched, but only 6.4% of the applicants were either African American or Latino. This is well below their representation in the population at large.

There may be many reasons why physicians of color are not choosing dermatology as a specialty. Not surprisingly, many of them go into primary care. There is nothing wrong with that. You could argue that having African American and Latino doctors in primary care is where they are most needed, where personal relationships are most crucial. But that should not be an argument against trying to improve the general pipeline and diversify our own specialty pipeline. One goal could be to double the annual number of UIM applicants. I think this is achievable and would have an impact.

Here’s how we might get there. For those of us who are involved in the training of new dermatologists, we have to “lean forward.” Instead of receiving those who choose to come to us, we have to reach out to them. We have to engage, mentor, and ask questions. Find out about hidden bias, your own and others. Understand how your organization or institution can be enriched by having a more diverse pool of learners and leaders.

For those of you who are in practice, there is something you can do as well: You can plant a seed. You all see young people with skin problems. Many of them are and will be from underrepresented populations. Some of them may strike you as particularly bright and lively. So when you have the opportunity to talk to such a bright young woman or young man, ask, “Have you ever thought about becoming a doctor?” And if that strikes a spark, ask, “Have you thought about becoming a dermatologist?” Do this twice a day, 10 times a week, and 500 times each year.

If you do only that, whenever you have an opportunity, you may just plant a few seeds that will make a difference down the line. You will never know the outcome, but it’s worth doing. There’s no downside.

For those of you who are involved in organizations such as the American Academy of Dermatology or the Dermatology Foundation, what can the leadership in our field do? Think about mentorship, role models, scholarships, outreach, and pipeline programs. Think about recruiting colleagues who are UIMs into leadership positions. Let’s be the most inclusive specialty in medicine.

Ultimately, our goal is to have a workforce that mirrors our population. I know this is not achievable in the short term. It will take decades. But this will never occur if we don’t take the first step. To ensure the future of dermatology, let’s all lean forward and embrace this task. Diversity matters in medicine.

A board-certified dermatologist, Dr. Bruce U. Wintroub is interim dean of the University of California, San Francisco School of Medicine. He has been professor and chair of the department of dermatology at UCSF since 1985. This text was extracted from a plenary presentation he delivered at the 2015 annual meeting of the American Academy of Dermatology meeting in San Francisco.

As a profession, I think it’s fair to say that dermatology has done a good job welcoming women and including them into this field of medicine. But how many of your physician colleagues are African Americans? How many are Latinos or Latinas?

Does the diversity of your clinician colleagues reflect our patient population? The 2013 census shows that 13.2% of Americans are African American and 17.1% are Latino. Because these populations are not represented in medicine at anything like these percentages, African American and Latino physicians are referred to as underrepresented in medicine (UIM).

A brochure for an upcoming medical conference states that by 2050, “half of the U.S. population will have skin of color.” This may well become a fact. But I argue that a professional workforce that is as diverse as the population we care for is a much better workforce.

I serve as the interim dean of the University of California, San Francisco (UCSF) School of Medicine, which is one of the great medical schools in the United States. The school has 632 students – 26% from underrepresented minorities, and 56% women – the most diverse student group in California and perhaps the United States. There are 2,180 full-time faculty members but less than 2% are underrepresented in medicine. The annual operating budget is more than $2 billion and the school is No. 1 in National Institutes of Health funding. But there are some important shortcomings.

Three things happened after I took the job as interim dean last year. First, the accrediting body of medical schools, the Liaison Committee on Medical Education, served us with a citation for our hiring practices and the lack of diversity among our faculty.

Second, I ran into something called the “climate survey.” We have all heard about climate change, but have you heard of a “climate survey”? No, it’s not an opportunity to complain about too much snow in Boston and too little water in San Francisco. People on every University of California campus were asked if they felt included in the organization that they worked in. Did they feel comfortable? Did they feel part of the club?

The UC survey found that at UCSF and its sister institutions, people from groups underrepresented in medicine – mainly Hispanics and African Americans, whether they were faculty, staff, or students – felt less comfortable than did their white counterparts. They did not feel our climate was inclusive. That’s not the same as being specifically excluded. It’s about not being included.

Third, there were the racially charged events in Ferguson, Missouri, and in Staten Island, New York, and the way our students responded to them. On December 9, 2014, our students organized a “die-in” protest to demonstrate their concern about racism in health care in our country. They called it WhiteCoats4BlackLives. So here I was, the dean of a medical school, and I find all of our students lying down in the street on campus in a very peaceful but profoundly moving demonstration to protest racism. Not only did our students protest at UCSF, they instigated the same WhiteCoats4BlackLives protest simultaneously at 83 medical schools across the country.

I recalled my own student days when we protested public events, and university administrators responded. But this time, as dean of medicine, I was the administrator. It gave me pause to think: What did those three pieces of evidence tell me? They made it clear that race matters. Once that realization finally became clear to me, the question was, what do we do? We were a few weeks away from our annual leadership retreat. The topic was going to be “strategic partnerships.” I sat down with the vice deans and said: Let’s talk about race instead.

And we did, and it turned into an amazing discussion. Just one example: Before the retreat, all of us took the Implicit Associations Test for race. This is a test designed to detect unconscious bias, the kind of bias we are not even aware of. Like me, many of us who considered ourselves fair and unbiased were shocked at the results. We were unconsciously biased for white people and against people of color.

Nicholas Kristof talked about this in the Feb. 21, 2015, edition of The New York Times, in a piece called “Straight Talk for White Men.” It’s worth reading the whole piece, but a study he cited especially struck me. Two scholars sent out fictitious résumés in response to help-wanted ads. Each résumé was given a name that sounded stereotypically black or white. The résumés were otherwise the same.

A résumé with a name like Emily or Greg received 50% more callbacks than the same résumé with a name like Lakisha or Jamal. Having a white-sounding name was more beneficial than 8 years’ work experience.

We heard stories from our students and faculty of color. I will highlight two. A medical student of color was called to the ED and was stopped by a nurse who thought he was a custodian. A senior faculty member was returning to his alma mater medical school in North Carolina as a visiting professor and was traveling from the airport to the medical school in a rental car. He was stopped and detained because he was black. His hosts came to his rescue and were required to prove that he was indeed visiting at their invitation. Needless to say these and other stories were startling in 2015. America is not post racial.

As a result of the retreat, we are now finishing a plan to make UCSF an inclusive institution for all who work here. The plan includes both short- and long-term elements, and an investment of at least $10 million to recruit and develop faculty from populations that are underrepresented in medicine.

Today’s doctor-patient relationship has become more and more collaborative. Patients actively look for doctors whom they feel they can talk to, who will understand their special concerns, their background, and their culture. There is neuroscience behind this. Research by Mahzarin Banaji, the coauthor of “Blind Spot,” found that we are in fact wired to react more positively to someone who looks like us.

All of us probably understand why a woman might want to choose a female gynecologist. Why a Chinese family will prefer a doctor who speaks their language. Our patients, too, are looking for physicians, for dermatologists, whose skin reflects theirs. They feel better if their doctor looks more like them.

The website Blackdermatologists.org is meant to help patients find exactly that. Guess how many black dermatologists are listed there in the whole State of California. Three. None of them are in San Francisco. None of them are across the bay in Oakland, a city with a large African American population. I did some research via other websites and found one African American dermatologist in the East Bay.

It’s one thing to be underrepresented in medicine, it’s another thing to be unrepresented. The lack of access to a physician who looks like our patients, whose background and experience might reflect theirs, is crucial. But what about the lack of research focused on African Americans, Latinos, and other underrepresented populations by people who understand the culture from the inside and what questions to ask?

I came across such an example in JAMA Dermatology, in an study titled, “Hair Care Practices as a Barrier to Physical Activity in African American Women” (JAMA Dermatol. 2013;149:310-4). My first reaction to this article was “what?” But that’s my unconscious bias talking. In fact, this study points to something significant. We know regular exercise is important for health. Research shows that African American women are the least likely to meet recommended levels of physical activity. Therefore, we want to be aware of any barriers to exercise for that population. But who would have imagined that one of the barriers to exercise for black women was hair care? This never would have occurred to me.

The people who did think to investigate this were in a team led by and including African American women dermatologists and researchers. So now that this is a known barrier, it can be addressed with patients. This is just one example of the type of knowledge we gain if we have a more diverse group of physicians and clinical researchers.

We know we don’t have enough practicing physicians of color in medicine in general, and in dermatology in particular. We easily fall back to the pipeline as the excuse for the situation. So, let’s look at the pipeline. Unfortunately, the current numbers are not encouraging. According to data from the Association of American Medical Colleges, from 1980 to 2013 the number of applicants to U.S. medical schools rose by 4,296. In 1980, 2,507 applicants were African American/black (7.1%), but by 2013 that number only rose to 3,490 (8.8%). During that same time period the number of Hispanic/Latino applicants rose from 5% to 10%.

How many of the applicants entered medical school? From 1980 to 2013 the number of African American/black students rose by 235: from 999 to 1,234, or 6.5% to 7%. At the same time, Hispanic/Latino students rose from 5.2% to 10.6% of entering students.

How many of the applicants matriculated? In 1980, 39.4% of African American/black applicants matriculated, but in 2013 the rate fell to 35%. What explains the data? Lack of role models? Lack of qualifications? Unconscious bias? An exclusive climate? Continued racism in our country? I don’t pretend to know the answer, but we always fall back on the pipeline as the excuse for the situation. So, what are we going to do about the pipeline?

Given the current state of the pipeline, the question may not be “what is the ideal” but “what is an achievable goal for dermatology?” In 2014, 47 of 731 applicants to dermatology programs were African American and another 47 were Latino. I don’t know how many of these finally matched, but only 6.4% of the applicants were either African American or Latino. This is well below their representation in the population at large.

There may be many reasons why physicians of color are not choosing dermatology as a specialty. Not surprisingly, many of them go into primary care. There is nothing wrong with that. You could argue that having African American and Latino doctors in primary care is where they are most needed, where personal relationships are most crucial. But that should not be an argument against trying to improve the general pipeline and diversify our own specialty pipeline. One goal could be to double the annual number of UIM applicants. I think this is achievable and would have an impact.

Here’s how we might get there. For those of us who are involved in the training of new dermatologists, we have to “lean forward.” Instead of receiving those who choose to come to us, we have to reach out to them. We have to engage, mentor, and ask questions. Find out about hidden bias, your own and others. Understand how your organization or institution can be enriched by having a more diverse pool of learners and leaders.

For those of you who are in practice, there is something you can do as well: You can plant a seed. You all see young people with skin problems. Many of them are and will be from underrepresented populations. Some of them may strike you as particularly bright and lively. So when you have the opportunity to talk to such a bright young woman or young man, ask, “Have you ever thought about becoming a doctor?” And if that strikes a spark, ask, “Have you thought about becoming a dermatologist?” Do this twice a day, 10 times a week, and 500 times each year.

If you do only that, whenever you have an opportunity, you may just plant a few seeds that will make a difference down the line. You will never know the outcome, but it’s worth doing. There’s no downside.

For those of you who are involved in organizations such as the American Academy of Dermatology or the Dermatology Foundation, what can the leadership in our field do? Think about mentorship, role models, scholarships, outreach, and pipeline programs. Think about recruiting colleagues who are UIMs into leadership positions. Let’s be the most inclusive specialty in medicine.

Ultimately, our goal is to have a workforce that mirrors our population. I know this is not achievable in the short term. It will take decades. But this will never occur if we don’t take the first step. To ensure the future of dermatology, let’s all lean forward and embrace this task. Diversity matters in medicine.

A board-certified dermatologist, Dr. Bruce U. Wintroub is interim dean of the University of California, San Francisco School of Medicine. He has been professor and chair of the department of dermatology at UCSF since 1985. This text was extracted from a plenary presentation he delivered at the 2015 annual meeting of the American Academy of Dermatology meeting in San Francisco.

As a profession, I think it’s fair to say that dermatology has done a good job welcoming women and including them into this field of medicine. But how many of your physician colleagues are African Americans? How many are Latinos or Latinas?

Does the diversity of your clinician colleagues reflect our patient population? The 2013 census shows that 13.2% of Americans are African American and 17.1% are Latino. Because these populations are not represented in medicine at anything like these percentages, African American and Latino physicians are referred to as underrepresented in medicine (UIM).

A brochure for an upcoming medical conference states that by 2050, “half of the U.S. population will have skin of color.” This may well become a fact. But I argue that a professional workforce that is as diverse as the population we care for is a much better workforce.

I serve as the interim dean of the University of California, San Francisco (UCSF) School of Medicine, which is one of the great medical schools in the United States. The school has 632 students – 26% from underrepresented minorities, and 56% women – the most diverse student group in California and perhaps the United States. There are 2,180 full-time faculty members but less than 2% are underrepresented in medicine. The annual operating budget is more than $2 billion and the school is No. 1 in National Institutes of Health funding. But there are some important shortcomings.

Three things happened after I took the job as interim dean last year. First, the accrediting body of medical schools, the Liaison Committee on Medical Education, served us with a citation for our hiring practices and the lack of diversity among our faculty.

Second, I ran into something called the “climate survey.” We have all heard about climate change, but have you heard of a “climate survey”? No, it’s not an opportunity to complain about too much snow in Boston and too little water in San Francisco. People on every University of California campus were asked if they felt included in the organization that they worked in. Did they feel comfortable? Did they feel part of the club?

The UC survey found that at UCSF and its sister institutions, people from groups underrepresented in medicine – mainly Hispanics and African Americans, whether they were faculty, staff, or students – felt less comfortable than did their white counterparts. They did not feel our climate was inclusive. That’s not the same as being specifically excluded. It’s about not being included.

Third, there were the racially charged events in Ferguson, Missouri, and in Staten Island, New York, and the way our students responded to them. On December 9, 2014, our students organized a “die-in” protest to demonstrate their concern about racism in health care in our country. They called it WhiteCoats4BlackLives. So here I was, the dean of a medical school, and I find all of our students lying down in the street on campus in a very peaceful but profoundly moving demonstration to protest racism. Not only did our students protest at UCSF, they instigated the same WhiteCoats4BlackLives protest simultaneously at 83 medical schools across the country.

I recalled my own student days when we protested public events, and university administrators responded. But this time, as dean of medicine, I was the administrator. It gave me pause to think: What did those three pieces of evidence tell me? They made it clear that race matters. Once that realization finally became clear to me, the question was, what do we do? We were a few weeks away from our annual leadership retreat. The topic was going to be “strategic partnerships.” I sat down with the vice deans and said: Let’s talk about race instead.

And we did, and it turned into an amazing discussion. Just one example: Before the retreat, all of us took the Implicit Associations Test for race. This is a test designed to detect unconscious bias, the kind of bias we are not even aware of. Like me, many of us who considered ourselves fair and unbiased were shocked at the results. We were unconsciously biased for white people and against people of color.

Nicholas Kristof talked about this in the Feb. 21, 2015, edition of The New York Times, in a piece called “Straight Talk for White Men.” It’s worth reading the whole piece, but a study he cited especially struck me. Two scholars sent out fictitious résumés in response to help-wanted ads. Each résumé was given a name that sounded stereotypically black or white. The résumés were otherwise the same.

A résumé with a name like Emily or Greg received 50% more callbacks than the same résumé with a name like Lakisha or Jamal. Having a white-sounding name was more beneficial than 8 years’ work experience.

We heard stories from our students and faculty of color. I will highlight two. A medical student of color was called to the ED and was stopped by a nurse who thought he was a custodian. A senior faculty member was returning to his alma mater medical school in North Carolina as a visiting professor and was traveling from the airport to the medical school in a rental car. He was stopped and detained because he was black. His hosts came to his rescue and were required to prove that he was indeed visiting at their invitation. Needless to say these and other stories were startling in 2015. America is not post racial.

As a result of the retreat, we are now finishing a plan to make UCSF an inclusive institution for all who work here. The plan includes both short- and long-term elements, and an investment of at least $10 million to recruit and develop faculty from populations that are underrepresented in medicine.

Today’s doctor-patient relationship has become more and more collaborative. Patients actively look for doctors whom they feel they can talk to, who will understand their special concerns, their background, and their culture. There is neuroscience behind this. Research by Mahzarin Banaji, the coauthor of “Blind Spot,” found that we are in fact wired to react more positively to someone who looks like us.

All of us probably understand why a woman might want to choose a female gynecologist. Why a Chinese family will prefer a doctor who speaks their language. Our patients, too, are looking for physicians, for dermatologists, whose skin reflects theirs. They feel better if their doctor looks more like them.

The website Blackdermatologists.org is meant to help patients find exactly that. Guess how many black dermatologists are listed there in the whole State of California. Three. None of them are in San Francisco. None of them are across the bay in Oakland, a city with a large African American population. I did some research via other websites and found one African American dermatologist in the East Bay.

It’s one thing to be underrepresented in medicine, it’s another thing to be unrepresented. The lack of access to a physician who looks like our patients, whose background and experience might reflect theirs, is crucial. But what about the lack of research focused on African Americans, Latinos, and other underrepresented populations by people who understand the culture from the inside and what questions to ask?

I came across such an example in JAMA Dermatology, in an study titled, “Hair Care Practices as a Barrier to Physical Activity in African American Women” (JAMA Dermatol. 2013;149:310-4). My first reaction to this article was “what?” But that’s my unconscious bias talking. In fact, this study points to something significant. We know regular exercise is important for health. Research shows that African American women are the least likely to meet recommended levels of physical activity. Therefore, we want to be aware of any barriers to exercise for that population. But who would have imagined that one of the barriers to exercise for black women was hair care? This never would have occurred to me.

The people who did think to investigate this were in a team led by and including African American women dermatologists and researchers. So now that this is a known barrier, it can be addressed with patients. This is just one example of the type of knowledge we gain if we have a more diverse group of physicians and clinical researchers.

We know we don’t have enough practicing physicians of color in medicine in general, and in dermatology in particular. We easily fall back to the pipeline as the excuse for the situation. So, let’s look at the pipeline. Unfortunately, the current numbers are not encouraging. According to data from the Association of American Medical Colleges, from 1980 to 2013 the number of applicants to U.S. medical schools rose by 4,296. In 1980, 2,507 applicants were African American/black (7.1%), but by 2013 that number only rose to 3,490 (8.8%). During that same time period the number of Hispanic/Latino applicants rose from 5% to 10%.

How many of the applicants entered medical school? From 1980 to 2013 the number of African American/black students rose by 235: from 999 to 1,234, or 6.5% to 7%. At the same time, Hispanic/Latino students rose from 5.2% to 10.6% of entering students.

How many of the applicants matriculated? In 1980, 39.4% of African American/black applicants matriculated, but in 2013 the rate fell to 35%. What explains the data? Lack of role models? Lack of qualifications? Unconscious bias? An exclusive climate? Continued racism in our country? I don’t pretend to know the answer, but we always fall back on the pipeline as the excuse for the situation. So, what are we going to do about the pipeline?

Given the current state of the pipeline, the question may not be “what is the ideal” but “what is an achievable goal for dermatology?” In 2014, 47 of 731 applicants to dermatology programs were African American and another 47 were Latino. I don’t know how many of these finally matched, but only 6.4% of the applicants were either African American or Latino. This is well below their representation in the population at large.

There may be many reasons why physicians of color are not choosing dermatology as a specialty. Not surprisingly, many of them go into primary care. There is nothing wrong with that. You could argue that having African American and Latino doctors in primary care is where they are most needed, where personal relationships are most crucial. But that should not be an argument against trying to improve the general pipeline and diversify our own specialty pipeline. One goal could be to double the annual number of UIM applicants. I think this is achievable and would have an impact.

Here’s how we might get there. For those of us who are involved in the training of new dermatologists, we have to “lean forward.” Instead of receiving those who choose to come to us, we have to reach out to them. We have to engage, mentor, and ask questions. Find out about hidden bias, your own and others. Understand how your organization or institution can be enriched by having a more diverse pool of learners and leaders.

For those of you who are in practice, there is something you can do as well: You can plant a seed. You all see young people with skin problems. Many of them are and will be from underrepresented populations. Some of them may strike you as particularly bright and lively. So when you have the opportunity to talk to such a bright young woman or young man, ask, “Have you ever thought about becoming a doctor?” And if that strikes a spark, ask, “Have you thought about becoming a dermatologist?” Do this twice a day, 10 times a week, and 500 times each year.

If you do only that, whenever you have an opportunity, you may just plant a few seeds that will make a difference down the line. You will never know the outcome, but it’s worth doing. There’s no downside.

For those of you who are involved in organizations such as the American Academy of Dermatology or the Dermatology Foundation, what can the leadership in our field do? Think about mentorship, role models, scholarships, outreach, and pipeline programs. Think about recruiting colleagues who are UIMs into leadership positions. Let’s be the most inclusive specialty in medicine.

Ultimately, our goal is to have a workforce that mirrors our population. I know this is not achievable in the short term. It will take decades. But this will never occur if we don’t take the first step. To ensure the future of dermatology, let’s all lean forward and embrace this task. Diversity matters in medicine.

A board-certified dermatologist, Dr. Bruce U. Wintroub is interim dean of the University of California, San Francisco School of Medicine. He has been professor and chair of the department of dermatology at UCSF since 1985. This text was extracted from a plenary presentation he delivered at the 2015 annual meeting of the American Academy of Dermatology meeting in San Francisco.