Abstract
The sociodemographic makeup of the professoriate in health and healthcare has been shown to have direct implications for graduation rates among minoritized populations, diversity in healthcare, the prevalence of health equity scholarship, and population health broadly. Black women academics, who navigate higher education as members of two minoritized groups, need to be intentionally recruited and retained using tailored approaches. Given the historical and ongoing dearth of Black women faculty in health and healthcare, and the mounting literature on health equity highlighting the benefits of Black women representation in healthcare, I propose an approach to the recruitment and retention of Black women using a Black feminist theory. This conceptual framework outlines barriers to recruiting and retaining Black women faculty, as well as culturally tailored and gender-specific means to mitigate them, to create a safe space for Black women scholars to seek employment and thrive once they are there.
Keywords
Introduction
Patient-provider interactions are a social-psychological determinant of health that impacts levels of empathy and connections as well as retention of patients for ongoing care. 1 Poor patient-provider interactions are a leading deterrent to care for individuals who otherwise have access to care via insurance and transportation. Patient-provider concordance is a line of research that examines the importance of shared demographics in creating strong patient-provider interactions. 2 Street et al. 3 interviewed patients, after their appointments with providers, and found that shared personal beliefs, values, and styles of communication were key indicators of positive interactions. Black women in medicine have been shown to facilitate optimal patient-provider interactions for Black women patients who, in many cases, experience medical racism, 2 and even obstetric violence, 3 from non-Black providers. Additionally, Moore 4 claimed that when Black women see Black women providers for their care that, “may allow us an opportunity to rebuild trust in the possible healthcare that can be attained.” It is difficult to match Black women patients with Black women providers due to a persistent dearth of Black women in healthcare and among health and medical faculty.
A well-established means to increasing the number of Black women in any professional space (here healthcare) is representation among educators (in health and medical programs). Black women educators often provide a sense of belonging and offer mentorship to their students that are culturally tailored and gender specific. Meaning, to increase the prevalence of Black women in healthcare, we must start by assessing and improving the prevalence of Black women faculty in health and medical programs. This assertion is supported by existing literature as scholars have pointed to racial representation among educators as a key driver of Black student success.5 –7 Yet, according to the National Center for Education Statistics, 8 only 4% of college professors are Black women. Additionally, Peter et al. 9 conducted a 12-year analysis of academic medicine and found that compared to White, Asian, and Hispanic Americans; Black Americans (1) have shown the smallest percent increase over time, (2) are the poorest represented race group among faculty, and (3) would need 1000 years to be accurately represented at the current growth rate.
Black women are an example of a group who have been historically and systemically excluded from the field of academic medicine. This happened via an initial lack of civil rights, race, and gender-specific college admissions requirements, hiring practices that centered on abstract ideas like “fit,” and the use of one-size-fits-all approaches to retention and recruitment.10,11 The lack of Black women professors in health and medicine creates both a workplace issue, whereby diversity of thought and innovations are lacking; and a health equity issue, whereby students from marginalized backgrounds lack mentorship and thus are less likely to graduate and add diversity to the field of health care. Increasing the presence of Black women in health and medical programs also has implications for culturally tailored interventions and representation in research. As an example, Frederick et al. 12 found that Black women’s involvement in sexual health research was linked to feeling safe and being interviewed by Black women scholars.
To date, there has been limited research on medical school faculty diversity that centers on Black women or considers their lived experiences. Much research on faculty diversity considers (1) underrepresented minority (URM) faculty, an umbrella term used for “Blacks or African Americans, Hispanics or Latinos, and American Indians or Alaska Natives” of all genders9,13 and/or (2) women, an umbrella term which includes all racialized groups. As members of both historically excluded groups, increasing the number Black women will take an intersectional approach that considers culturally humble and gender-specific approaches to recruitment and retention. 14 What is needed is research on recruiting and retaining Black women health and medical faculty that uses Black feminist theory to (1) contextualize the dearth of Black women in this field and (2) uncover gender-specific and culturally tailored promoters of recruitment and retention. Black feminist theory is a framework that calls for the consideration of race and gender-specific social factors that shape Black women’s lived experiences. 14 It acknowledges the social determinants of Black women’s status in society which include the legacy of slavery, Jim Crow, civil rights, women’s rights, policies, and laws in place to systematically exclude Black women from institutions like education and the paid labor market. Here I present a conceptual framework for using Black feminist approaches to engage more Black women in academic medicine. I do so by presenting institutions of higher education and future researchers with context to explain the dearth of Black women in these spaces as well as ways to use Black feminist theory to tailor recruitment and retention efforts via my proposed conceptual framework for a Black feminist approach to academic diversity.
Conceptual framework for a Black feminist approach to academic diversity
Because traditional means of recruiting and retaining faculty have been ineffective in getting Black women into academic spaces, a new conceptual framework is needed to guide future research, interventions, and practice. The creation of this conceptual framework is guided by the approach outlined by Reese. 29 To begin, concept ideation comes from diverse sources of inquiry. Here, I use the problem-solver approach starting with a social problem (the dearth of Black women medical and health professors) and using a conceptual perspective (Black feminist theory) to contextualize it. In concept building, it is important to distinguish the new concept (Black feminist recruitment and retention) from other similar concepts. 29 The current literature on diverse hiring and retention practices focuses on URM faculty and women of all races. Neither approach is intersectional in nature, considering both race and gender, and neither approach has been shown to work to mitigate barriers attributed to sex and gender as well as race and ethnicity. According to historical womanist theory, which extends Black feminism, Black women’s labor is situated and occurring in a society rife with anti-Black racism, anti-woman sexism, as well as anti-Black and anti-woman capitalism. 30 In short, Black women workers are tasked with navigating racialized patriarchy with limited resources, and this must be considered as we address the dearth of Black women in higher education. My key argument is that a conceptual model for recruitment and retention that uses a Black feminist approach (1) takes lessons from work on URM and women and (2) brings forth new concerns that are unique to Black women, to create a more impactful approach to diversifying the academy.
In the framework I have created, I start with identifying the social problem, which is health disparities faced by Black women. Next, I assert that one mechanism driving this disparity is the dearth of Black women’s health and medical faculty members. This connection comes from scholarship that shows Black women health care providers create and facilitate quality care for Black women. This means more Black women providers are needed to promote health equity. The lack of Black women in health care can be linked to the dearth of Black women professors available to mentor and graduate diverse talent. Given the racialized and gendered nature of this social problem, I call for the use of Black feminist thought to center lived experiences of Black women as we work to increase their presence in the academy.
A Black feminist analysis of this social problem and mechanism provides much-needed context and reveals a bi-directional relationship. Specifically, racialized, and gendered health disparities (a social problem) persist due to the dearth of Black women faculty and the dearth of Black women faculty (a mechanism) and as the dearth of Black women faculty persists (a social problem) so do racialized and gendered disparities. Additionally, I argue that a Black feminist approach should be used to contextualize the scarcity issue, uncover racialized, and gender-specific barriers to inclusion, and provide insights into ways to implement culturally tailored interventions and future research. The conceptual framework for using a Black feminist approach to expand the prevalence of Black women in academia is highlighted in Figure 1 below.
Conceptual framework for Black feminist approach to academic diversity.
There is clear evidence that Black women bring much to the fields of health and medicine. Black women’s experience as both racial and gender minorities equips them to address racist, sexist practices that (1) limit diversity on campus, (2) stifle scientific innovation, and (3) reproduce health disparities via colorblind, gender-neutral research as well as poor patient care. To create a more diverse workforce, we must first contextualize, and then address, barriers to the recruitment and retention of Black women scholars. In the sections below, I start with highlighting the dearth of Black women faculty via prevalence rates, continue with detailing Black feminist theory and its application in the context of recruiting and retaining Black women faculty, then I present data on race and gender-specific barriers, and close with suggestions for culturally tailored strategies universities and scholars can implement.
Dearth of Black women faculty in health and medicine
Prevalence by university designation
The dearth of Black women faculty in diverse areas of medicine is well established in the literature.15 –23 Because Black women are rarely centered in research 14 some studies examined the prevalence of women or Black faculty, but not both. Some literature was less specific and added Black faculty to a larger group of URM faculty. Mader et al. 15 studied the prevalence of URM and female faculty at Predominately White Institutions (PWIs) vs. Historically Black Colleges and Universities (HBCUs) and Puerto Rican (PR) medical school campuses. For context, there are medical schools at 4% of HBCUs, 2.66% of PR schools, and 3.66% of PWIs. 8 Findings from their study showed that women encompassed 43.5% (HBCU), 42.8% (PR), and 36.5% (PWI) of medical school faculty and had twice as many department chair positions at HBCUs and PR schools when compared to PWIs. URM faculty, separated by race, showed even larger representation differences. Black faculty made up 59.5% (HBCU), 0% (PR), and 2.6% (PWI) of medical school faculty and 73% of chair positions at HBCUs compared to <3% at PWIs and PR institutions. Latinx faculty comprised 75% of PR medical faculty and <4% at PWIs and HBCUs. Although their findings around race may not come as a surprise, their findings around gender show that female faculty of all races fare better in leadership positions at non-PWIs. This also makes institutions that are minority serving more attractive employers to Black women as the faculty is much more likely to be racially diverse. Mader et al. 15 suggest institutions looking to recruit women and URM faculty study the programs put in place at HBCUs and PR institutions as they have had much success recruiting, retaining, and promoting from these groups.
Prevalence at PWIs
Research that focused on PWIs further corroborate the fact that Black women scholars are poorly represented. For one, Asfaw et al. 16 study looked at race and gender trends among neurosurgery faculty and found that 5% of neurosurgeons are Black (all genders) and that 10% are women (all races). For two, Berry et al. 17 focused on the intersection of Black and female, by reporting on the prevalence of Black women surgery faculty. According to their report, Black women made up 123/15,671 surgery faculty, 10/3870 full professors, 11/2011 tenured professors, and 0/372 department chairs. Showing Black women are underrepresented, particularly in high-ranking positions. For three, Chaudhary et al. 18 examined the race and gender makeup of psychiatry faculty. Their findings showed that White Americans were overrepresented among tenured faculty and chairs, that there has been slow growth in the prevalence of entry-level Black faculty, and that female faculty are underrepresented on the tenure track and in academic leadership. And for four, Chiem et al. 19 pointed out that, in the field of anesthesia, women are also underrepresented in academic leadership and as scientific journal editors.
Prevalence over time
Several scholars have examined changes in the prevalence of women and URM faculty over time. Bennett and Ling 21 examined changes in the prevalence of medical school faculty from 1990 to 2020. Their findings showed that Black women faculty went from 0.96% to 2.32% of the overall faculty. When they looked at trends in particular specialties, they noted that Black faculty (of all genders) have seen the most growth in the areas of obstetrics and gynecology (from 5.76% to 8.5%), family medicine (from 3.89% to 6.22%), and the poorest representation in otolaryngology (from 0.67% to 1.96%). No area is truly representative as Black Americans make up 13.4% of the population in the United States. 20 Additionally, Kim et al. 22 analyzed the demographic makeup of otolaryngology faculty to assess rank equity by gender and race/ethnicity and to demonstrate changes over a 20-year period. Their study used the rank equity index (% at high rank/% at low rank). Intersectional analysis showed that zero Asian, Black, or Latinx women are full professors of otolaryngology and that white men are well represented at every rank. Kamran 23 analyzed data on faculty race and sex from 1977 to 2019. Their examination showed that Black women clinical faculty marginally increased from >1% to ~2% and that Black women full professors and department chairs both marginally increased from ~0% to ~1%. They argued that diversifying medicine and health education faculty is one of the most pressing social issues given the individual and societal implications of quality care. Lastly, Saboor et al. 24 outlined trends in academic pediatric faculty from 2007 to 2022. Their report showed an 11% increase in female pediatric faculty, a 20% increase in Black pediatric faculty, and that Black pediatric faculty remain underrepresented at all ranks. They argued that future research is needed that addresses barriers to diversity in pediatric faculty, and here I argue that that research needs to take a Black feminist approach. Without the use of a Black feminist approach, one could argue that the dearth of Black women in faculty positions is due to underdeveloped culture, poor socialization, or other reasons that lack a critical social analysis. Black feminism allows us to account for historic and ongoing policies and practices that create barriers to recruitment and retention for this target demographic group.
Black feminist approach
Creating a targeted approach to recruiting and retaining Black women in higher education requires consideration of their lived experiences. Existing strategies have been ineffective, as displayed in the work cited in previous sections. A more appropriate strategy is the use of a Black feminist approach. A Black feminist approach is one that uses tenets of Black feminist thought, and other Black feminist scholarship, to frame scientific inquiries and practice. It addresses Black women’s issues with consideration for social-psychological and sociocultural factors that impact them. Black feminist, Collins 14 introduced an approach to research focused on centering the lived experiences of Black women called Black feminist thought. A key assumption of Black feminist thought is that Black women have a history that is too distinct from Black men and other American women to be studied alongside them. Specifically, feminist theory missed the impact of racism on women’s experiences and critical race theory missed the impact of sexism on the experiences of racial and ethnic minorities. A Black feminist perspective, however, asserts that Black women experience the oppressive factors that impact both Black Americans and women, as well as unique factors that plague Black American women specifically. Collins 14 argued that Black women’s lower status in a white male-dominated society leaves them silenced, looked over, denied rights, and violated.
Black women’s distinct lived experience permeates every aspect of their lives including their employment in academic medicine and higher education settings. Black women have been historically used as guinea pigs for medical research,25,26 but not viewed as knowledgeable scientists and valuable academicians. This historical context is vital in this Black feminist analysis because it helps debunk the potential argument that Black women are simply unfit or underprepared for careers in academic medicine. Black women have been branded as a devalued demographic who are best suited for unethical research practices, not as brilliant scholars with meaningful worldviews and knowledge bases. This is why Black women’s presence among health and medical faculty is not only scarce but also a relatively new phenomenon. Notable Black women like Dr. Virginia M. Alexander and Dr. Sadye Beatryce Curry made medical school history by joining the faculties in women’s colleges and HBCUs, but infiltrating mixed-gender PWIs was, and continues to be, a great challenge for Black women. 27 Recently, Dr. Janice Douglas became the first Black woman to earn the rank of professor at the Case Western University Medical School in 1984 and Col. Jeannette South-Paul, MD became the first female and the first Black department chair of the University of Pittsburgh Department of Family Medicine in 2001.
Because the academy was created for and by white men, and Black women are so poorly represented, their experiences in faculty positions are often rife with stress and discrimination. Davis 28 interviewed Black women who were leaders in academia and business to understand the ways in which race and gender shaped their professional experiences. The women in her study indicated that they never felt Black or female, because they always felt both, Black and female. They noted that being Black and female meant their intelligence was questioned, they were silenced, undermined, demoted, as well as expected to fail. Moving forward, this dearth of acceptance and representation can be addressed by centering the needs of Black women in recruiting and retention efforts. This finding aligns with Collins 14 assertion in Black feminist thought that there are several domains of power in our society, one of which is structural. In the structural domain of power, white supremacy undergirds all social structures including academic, labor, and healthcare.
Another key aspect of Black feminist inquiry is to center on Black women and avoid a deficit approach to scholarship on their lives and contributions to society. 14 There are numerous benefits to increasing the prevalence of Black women scholars in health and medical programs. Black women faculty are more likely to (1) engage in disparities-related research, thus moving the nation closer to health equity, (2) provide care and interventions to poorly served populations, (3) provide empathy and model effective communication styles, (4) bring in innovative approaches to teaching and research, and (5) promote increased diversity among future hires. This is evidenced in several existing studies. For one, in their analysis of the experiences of URM faculty, Pololi et al. 31 reported that 33% of URM faculty are engaged in health disparities research compared to a smaller 17% of non-URM faculty. They also reported that URM faculty were more likely to treat poorly served patient populations. So, the impact of Black faculty on public health is multifaceted. For two, Chiem et al. 19 noted that racial diversity in healthcare can mean better care as URM providers make patients from marginalized populations feel represented. They also assert that this representation can lead to better communication and greater empathy. For three, Asfaw et al. 16 claimed that there is likely a lack of innovation and poorer quality care being provided, given the racial makeup of the field of neurosurgery compared to the racial makeup of the patients. They also added evidence that female faculty bring another benefit to academia which is continued diversity. Specifically, female presence on search committees translates to more female applicants under consideration for positions. And four, Black women may also see areas of improvement that members of majority groups are often blind to as insiders. According to Black feminism, Black women have an “outsider within” status which refers to their ability to infiltrate predominately white spaces (like the academy), but not as actors who buy into white culture. 32 Outsider within status allows Black women to critique white spaces and situates them as non-threatening people to vent to. This means they have access to more information than others and more impartiality about the daily operations of the academy. So, for example, if processes and approaches to student success need to be evaluated or reworked, Black women can be more innovative as they have no affinity toward old ways or the status quo.
There is unmistakable evidence that Black women bring much to the fields of health and medicine. Black women’s experience as both racial and gender minorities equips them to address racist, sexist practices that limit diversity on campus, stifle scientific innovation, and perpetuate health disparities via colorblind, gender-neutral research, and poor patient care. To create a more diverse workforce, we must first contextualize and then address barriers to the recruitment and retention of Black women scholars.
Uncover race and gender-specific barriers
Race and gender-specific barriers to recruiting and retaining Black women faculty must be considered and addressed to increase their prevalence in the academy. Examples of barriers include (1) instances of racism, sexism, and/or gendered racism in the workplace, (2) limited funding for disparities research, (3) pipeline programs that are not intersectional in nature, (4) poor or no mentoring around research and navigating the academy, and (5) the concept of “fit.” Konuthula et al. 33 examined anti-Black racism in medical schools in a sample of faculty that was 63% female and 56% Black. Their findings uncovered several key barriers to retention (1) a lack of representation—which meant academia was not viewed as a safe space, professors were haunted by stereotype threat, and consistently felt invisible, (2) colleges and universities make a great effort to recruit Black faculty, but make little effort to retain them, and (3) microaggressions and racism, as racial minorities who are often untenured, lower ranking professors, Black faculty reported feeling uncomfortable calling out such acts.
Racism (discrimination based on Black race), sexism (discrimination based on female sex), and gendered racism (here—discrimination based on the intersection of Black race and female sex) in the workplace create toxic environments for those who experience them. Although the academy was perceived as integrated after the civil rights movement, Black faculty continue to report experiences of racism and feelings of isolation. 34 Specific institutions have taken steps to address the racial climate among faculty, but no system-level changes have been enacted to change the culture on a macro level. A consistent problem faced by Black women scholars is workload. 34 Because they are often the only Black person—or at least the only Black female—they are tasked with the thankless jobs of mentoring most Black students and working on diversity initiatives. 33 According to Black feminist work, Black women have been viewed as “mothers” and “caregivers” to all since the inception of slavery. 35 They cared for their own children, white children, and completed all service work in the house and on the plantations. Black women continue to be seen as driven by service and mothering and according to Beauboeuf-Lafontant, they are expected to see self-care as, “trivial self-indulgence.” 36 (p. 116) This means burying them in service work and mentoring duties may be viewed as tasks that match their essential nature, rather than tasks that put them at a professional disadvantage.
Black women are also limited by research funding. The gold standard for job security in academia is research funding and work that centers on Black women has consistently been poorly funded at the national level. Furthermore, Berry et al. 17 reported that <1% of surgeons who receive NIH funding are Black women which has a direct impact on the dearth of research they engage in. Black women are also the least likely to resubmit a rejected proposal which can be directly tied to poor mentoring and feeling like an outsider in the academy.
Fit is an abstract concept used to describe whether potential faculty are right or wrong for the academy. The term “fit” can be coded for many measures of employability. Given the history of white male dominance in academia, “fit” is often a veiled reference to sociocultural aspects of white masculinity which in turn limits opportunities for those who do have access to it. In his case study of the practices and approaches of hiring committees, White-Lewis 37 reported on how the fit was used in academic hiring. He found that “fit” was conceptualized as alignment with the existing research infrastructure and teaching expertise already established in each academic unit. This shows how individuals like Black women, who likely have teaching and research agendas that center Black women, may not be deemed a good “fit.” White-Lewis also concluded that “fit” created barriers to recruiting via racial (1) aversion (use of words like “impact” and “narrow” to value race-neutral research and undervalue race-specific research), (2) neutrality (not being purposeful about having a diverse candidate pool), and convenience (claiming to target diverse hires in job listings, ignoring race during the review of applicants, then using proxies for race—like research topic and fund-ability—as reasons not to hire Black faculty).
Implement culturally tailored solutions
Centering Black women in the development of recruitment and retention efforts is a vital tenant of a Black feminist approach. According to Collins 32 research oriented to solving social problems that impact Black women requires self-valuation and self-definitions, whereby Black women can and should define who they are as well as their lived experiences. She also notes that stereotypical depictions and assumptions are controlling and problematic. 32 The idea that colorblind approaches to engaging women, or gender-neutral approaches to recruiting racial minorities will work to create a space for Black women to thrive is limiting and relies on non-inclusive efforts. Misunderstanding the interlocking nature of oppression, by addressing one form of oppression (e.g., anti-racist training or sexual harassment training) leaves Black women vulnerable to other forms of oppression. A Black feminist approach means addressing barriers using a comprehensive approach, which according to Collins, 32 benefits all, even if unintentionally. Here, a main unintended benefit of targeting Black women in recruitment and retention efforts is improved population health. The system we have in place was created with Black women on the margins, as medical guinea pigs, and has been ineffective in promoting health behaviors among Black populations. The academic system was also set up with Black women in the margins, effectively excluded from higher education and allied health programs, which means a dearth of mentors have been, and continue to be, in place to engage Black students who often have desires and plans to address health disparities upon completing their education. Kaplan et al. 38 interviewed faculty tasked with Diversity, Equity, and Inclusion (DEI) recruiting at medical schools to understand climate and change over time. The barriers to recruiting and retaining non-white non-male faculty they uncovered included: critical mass, where there was not enough URM and women to create a subculture or sense of community; programs and resources, where there were no identity-specific programs and not enough mentoring in place; and issues with senior leadership whereby the individuals with the power to create culture change had not bought into the usefulness of DEI efforts.
Using a Black feminist approach, key strategies around recruitment should include (1) intersectional pipeline programs, (2) creating financial incentives, (3) tailored support for medical and doctoral program completion, and (4) cluster hiring. Albert 39 argued that best practices in creating inclusive spaces for racially minoritized women in the academy consist of engaging young girls from high school onward, including financial incentives in the hiring process, mentoring, and prioritizing all healthcare research, not just colorblind healthcare research. Jones et al. 40 detailed how to make doctoral programs more inclusive and productive for Black women using a Black feminist approach. Their ideas around applying this approach to academic advising included (1) teaching Black women doctoral students the norms of the academy; (2) understanding that Black women value social justice, equity, community-engaged approaches, as well as qualitative research, and making training in those areas available to them; (3) helping Black women find race and gender-specific affinity groups and professional organizations; (4) having non-Black women advisors become educated on Black women’s issues and experiences; (5) acknowledging, celebrating, and integrating Black women’s ideas so they feel welcome in the academy; and (6) acting as an ally and advocating for Black women students when necessary.
According to Chiem et al. 19 the keys to recruiting diverse anesthesiologists include better diversity in pipeline programs, more inclusion in medical schools and residencies, more bias and bystander training, mentorships, networking, and sponsorship. In addition, Rodríguez et al. 41 recommended concentrated recruiting (focus on states/cities with large minority populations), pipeline programs from youth, leadership training, addressing racism and sexual harassment to promote culture change, funding more disparities research, and loan repayment programs. Pories et al. 42 adds that pipeline programs aimed at promoting inclusivity have been most successful among white women. This means tailoring for gender will not suffice, programs must be tailored with considerations for culture as well.
Each of these recommendations has implications for Black women. For one, intersectional pipeline programs that work to diversify the fields of Science, Technology, Engineering, and Mathematics (STEM) like “Black Girls Do STEM” work to create interest and overcome imposter syndrome among young Black girls via culturally tailored and gender-specific programming, which in turn works to increase the applicant pools for both medical school students and ultimately faculty. For two, more bias training will help foster a safe environment for Black women faculty as they attempt to build a career in a space they have been historically excluded from. Taking the Black feminist approach to bias training means more than anti-racism and sexual harassment training, it also means working to decrease instances of gendered racism. And for three, leadership training and disparities research funding are vital to recruitment efforts for Black women with long-term success on the radar during the hiring process. Black women are less likely to be promoted and more likely to burnout from teaching and medical rotation duties. Leadership training and mentoring can help build a cohort of highly qualified Black women leaders and funding for the research Black women are most likely to engage in and free them up from teaching and service and allow them to grow as scholars. Guevara et al. 43 examination of the impact of faculty development programs on the recruitment, retention, and promotion of URM faculty showed that program length (<5 years) and a greater number of components (mentoring, career development, social climate, pilot funding) lead to greater outcomes. Newer programs with fewer components did not have a significant impact on recruitment, retention, and promotion. This shows that recruitment and retention is a complex social problem that requires multifaceted solutions.
Once Black women have been trained and recruited efforts to retain them must be culturally tailored and gender specific as well. Key strategies around retention include (1) addressing burnout, (2) bias and bystander training, (3) mentoring, and (4) opportunities for networking and affinity groups. Albert 39 shared suggestions to improve retention among racially minoritized women, namely mentorship, allowing for academic/practitioner hybrid roles, addressing harassment/discrimination, establishing social networks, protection from over-involvement in committee work, addressing burnout, elevating financial constraints, and the concept of “fit.”
Academic burnout is a crisis faced by all academics regardless of race and gender. According to the World Health Organization 44 burnout is the result of workplace stress that is characterized as, “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.” Working as a professor, especially in medical school, can mean taking on teaching, research commitments, advising and mentoring, medical practice, and service to countless committees. For Black women, it can mean all the aforementioned sources of strain plus the added stresses of racism, sexism, and gendered racism in the workplace. 44 Black women’s experiences in academia can actually be compared to the fight or flight response whereby they either push through oppressive, stressful conditions, or leave. 45 Schools are challenged to create manageable workloads, share the burden of service work, put policies and practices in place to end discrimination and promote self-care and work-life balance. Policies and training are a vital tool for use in climate change on college campuses. Konuthula et al. 33 examined anti-Black racism in medical schools and proposed several ways to address this crisis. Examples included: comprehensive anti-racist training for all (even skits to promote role-playing and practice), making interventions mandatory such as sexual harassment and Collaborative Institutional Training Initiative (CITI Program) trainings, using outside social scientists to construct training to make sure they are tailored, address systemic issues, and utilize best practices, and structural changes like diversity in leadership, funding access, and resource distribution.
Davis 28 reminds us that institutions cannot see the recruitment of Black women as merely a means to fill a DEI quota. They must be mindful of the fact that systems were created without the inclusion of Black women, so retaining and promoting them requires shifts in the existing system. Black women interviewed by Davis indicated that mentoring and sharing lessons learned is the most vital task successful Black women can engage in to promote the success of other, upcoming Black women academics and leaders. Similarly, Black women can also work together via affinity groups and sister circles. Collins 32 outlines the need to celebrate Black women’s culture in Black feminist work. She argued that Black women must be understood in terms of values, ideologies, their agents of socialization (e.g., family, school, religious institutions, art, and music), historic time, and other interlocking identities (e.g., social class, sexuality, age, and embodiment). These can be centered in official affinity groups like, “Black Women in the Academy,” or unofficial groups like sister circles which are naturally occurring friend groups in place to support one another while navigating Black womanhood in the workplace in the United States. 46
Limitations
There are several limitations to this work that are worth noting. For one, conceptual models are not valid or reliable until there is empirical evidence to support them. 47 That means, future work using this model will aid in supporting or refuting this work. For two, concepts can be conceptualized in divergent ways by diverse scholars. 48 I argue that the recruitment and retention of Black women is best guided by a Black feminist approach, whereas others may argue for different frameworks or approaches. For three, there is often limited data that scholars can access to test conceptual models. 49 This means new projects are likely needed which could be costly for scholars and institutions. Finally, according to the literature, Black feminist approaches have been noted as being too risky to pursue. 49 Scholars and other intervention creators may find Black feminism to be intimidating due to the intersectional nature of race and gender and its focus on Black women’s marginalization in the workplace. This limitation should not be perceived as an impenetrable barrier. Black feminist research provides a guide for ways to implement Black feminist approaches to research, which are also applicable to interventions.13,50,51 Collins 14 suggests creating research teams—or intervention creators—composed of Black women who can help mitigate bias and ensure findings are interpreted with minimal stereotyping and deficit focus. Lindsay-Dennis 50 suggests using an interdisciplinary approach that allows scholars and practitioners to understand Black women’s needs wholistically, with consideration for social-psychological factors. And Frederick et al. 51 call for the use of fictive kins structures, or sisterhood, when creating research projects—or interventions for Black women. Each of these tools can be useful for scholars or institutions looking to engage in this important work.
Conclusions
The research on the state of diversity in academic medicine provides clear insights into the need for tailored recruiting and retention efforts. As a space created for and by white men, there are many practices and norms that do not work to recruit or retain diverse populations, including Black women. Here I presented a framework for the use of Black feminist theory in the recruitment and retention of Black women medical professors. First, it is vital to understand the context and prevalence to explain the dearth of Black women in academic medicine. Second, we must consider barriers to Black women’s success and create policies and interventions to address said barriers. The use of Black feminist thought offers much insight into the ways in which institutions of higher education can work to make academia a safe space for Black women, which in turn promotes retention and thriving. This also benefits society at large because a greater representation of Black women professors translates to more representation in the field of healthcare and better care for all.
This conceptual framework adds opportunities for empirical research and conceptual framework development as well. Using a Black feminist approach to future empirical research on barriers to inclusion can uncover other concerns that are unique to Black women in the academy. A Black feminist approach to policy, training, and intervention development can also ensure that Black women are centered in efforts and more effectively recruited and retained. As far as other conceptual frameworks, other intersectional identities can and should be considered as well. Here I present the case for Black feminist approaches to engage Black women in academic medicine, but there are countless other groups who are poorly represented who would benefit from targeted efforts. Black women are not the only group who should be recruited and retained with sociocultural context in mind. This discovery opens an opportunity for future research and practice strategies. If nothing else, this work shows us the weakness associated with gender-neutral URM recruitment strategies and colorblind attempts to engage all women.
