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Nerys Benfield, M.D., addresses those assembled on the lawn during Einstein’s moment of solidarity, held June 5 in the wake of the killing of George Floyd. At right, Irene Blanco, M.D., holds a sign. (Photo by Lori Adams)

Examining Racism and Social Justice

Q&A With Drs. Nerys Benfield and Irene Blanco

By Sue Byrne

In the wake of nationwide protests against police violence and systemic racism, we reached out to two Einstein leaders to get their take on these major events. Here, Nerys Benfield, M.D., M.P.H., senior associate dean for diversity and inclusion, and Irene Blanco, M.D. ’04, M.S., associate dean for diversity enhancement, share their thoughts on how we at Einstein and Montefiore can help stop institutional racism.

Dr. Nerys Benfield, left, and Dr. Irene Blanco

How do you feel about the events surrounding George Floyd’s death and the resulting social-justice movement?

Dr. Benfield: My overriding feeling is of being energized. It feels like there finally is momentum on many levels. The work within one institution is valuable, but structural racism needs a breadth of effort to make real change. I’m also incredibly saddened that it took something this dramatic to push the conversation back into the national space. We were here in 2014 with Michael Brown. And we were here with Rodney King [1991] and with Amadou Diallo [1999]. But I’m optimistic that there is real momentum for change. And hopefully we can sustain this.

Dr. Blanco: I agree that it is incredibly energizing to see all these millions of people who have taken to the streets, amplifying these voices and bringing light to police brutality and systemic racism. But at the same time, it is frustrating because we’ve been talking about this for a very long time—and in my own career for decades. Do we really have to watch someone’s televised murder to galvanize people around this issue? But I am heartened by the discussions we are having on campus. I just hope we can keep moving forward and use this energy to effect positive change.

Public opinion has shifted in a very short time: Most Americans now believe that systemic racism is a real problem in this country and needs to be addressed. Have you seen a corresponding change at Einstein?

Dr. Benfield: I think what has changed is the sense of urgency. Einstein developed a diversity and inclusion strategic plan years ago. It was understood as important and valuable to the Einstein community. But this has ramped up the sense of urgency dramatically. That’s the momentum I want to capture and maintain. There have been some incredible voices within academic medicine who have been at the forefront advocating for change for a while, saying “Let’s shift things up. Let’s create a new admissions process. Let’s create a new kind of network to draw people in. Let’s focus on pipeline. Let’s make some direct funding options.” But now a large group is finally saying “Oh, right, it is a structural issue.” But we’re still on the upslope of the curve.

Dr. Blanco: Especially when we’re talking about an incredibly difficult subject fraught with so much emotion. Making changes is not simply like introducing a new test for hepatitis B. You run the test, you do the numbers, it looks like a great test, you capture more patients, you implement it. This is not that. We are talking about changing things that are ingrained and structural and touch every aspect of the institution. It’s naïve to think there will be quick solutions.

These efforts [to address racism] have to be systematic and widespread. And one more thing I’ll add to that—a lot of the conversation has focused on undergraduate medical education or graduate medical education faculty, but we haven’t talked enough about the pipeline—through medical school, into residency, into faculty, into leadership. People talk about the faculty as if admission to medical school is sufficient, right? No—that is step one. You can increase the number of underrepresented medical students, but they are not going to be faculty members until about 10 years down the road. We need immediate as well as long-term solutions. We can spend millions and millions of dollars on a molecule that may or may not become a drug. But if your patients don’t have access to it, what’s the point? People are actively dying today because of the social determinants of health.

We have to make sure our candidates understand that diversity and inclusion are central values for us.

— Dr. Nerys Benfield

You are both successful practicing physicians. Why did you choose to pursue leadership positions in the area of diversity and inclusion as part of your career?

Dr. Benfield: I felt it was important for me to give back. I have benefited from mentors, pipelines, and scholarships. These are the things that it took to get me to where I am. So it’s almost an obligation that I have to help others succeed. Also, I picked obstetrics and gynecology because I wanted to have an impact on women’s health. I specialize in family planning because it’s something that is really a global, universal, inexpensive, high-impact area of work and investigation. We want better health for our patients in our communities. We want our communities to be more successful and more empowered, and that aligns a lot with my personal mission.

Dr. Blanco: We are often the only ones in certain spaces, and voices don’t get amplified unless there’s a critical mass to amplify them. And so you need to start adding to the number of people in the room who are talking about these issues and these subjects. Unless you get the right people in the right room who bring in a different perspective—that people need to shake things up—it’s never going to happen.

While Einstein’s faculty is more diverse than that of many institutions, can more be done to improve diversity in hiring and promotion?

Dr. Benfield: If we think about the hiring process, we should think about each step and how we can intervene. How can we ensure that our network is broad and focused on diverse candidates? Whether we are working with a search firm or doing it ourselves, we need to use an expanded network list. We also have to make sure our candidates understand that diversity and inclusion are central values for us. And we need to support junior investigators of color once they arrive, whether it be through funding, mentorships, or opportunities for program participation. And how can we hold leaders accountable for the diversity that they foster—or don’t—in real ways within their departments?

What are some things Einstein is doing to change how faculty members are recruited and retained? Are there any success stories to share?

Dr. Blanco: The creation of Nerys [Benfield]’s position was an enormous success story. She has accomplished quite a bit since she started in the fall of 2019. I have the long-term perspective of having seen diversity and inclusion efforts at Einstein since I was a medical student 20 years ago. Things picked up speed when students were reacting to national events like Eric Garner’s death [2014]. We had multiple town hall meetings between the administration and students, who wanted to escalate our response. How were we going to address these things in our curricula? How were we training students who work with marginalized populations to be understanding of the needs of these communities? Students today have absolutely no qualms about putting the spotlight on what needs to change, while we were so scared—were we going to lose our scholarships? Were we going to get kicked out of school? Our students today are saying “Enough is enough.” Seeing how much the students have accomplished now is mind-boggling, but their job is to be trained and then potentially leave Einstein. The onus is on us to stay and take up the flag. I hope we can move a little faster now, because there’s a lot of continued, persistent work that needs to be done. This is not a sprint—it’s a marathon.

How does our curriculum address social justice, which Einstein views as one of its core missions?

Dr. Blanco: How do we take things that are part of the elective curriculum and make them compulsory? All medical students must take at least an introduction to implicit-bias mitigation training during orientation. How do we make this more continuous? We do discuss the social determinants of health as they affect populations with certain diseases, but how do we think about and discuss that more broadly? And not only the medical school curriculum—how do we teach our M.D./Ph.D. and Ph.D. students to think about these issues in the context of their research? We are very much a translational school in terms of our research, right? So we need to start thinking about how our research affects the community and how we teach our future scientists to advocate for those communities.

We need to start thinking about how our research affects the community and how we teach our future scientists to advocate for those communities.

— Dr. Irene Blanco

During one of the Einstein town hall meetings on racism and antiracist action held in June, we heard medical students talk about how they’ve overheard patients being referred to as “Bronx specials.” How can we address this? 

Dr. Benfield: I think what it points to is that antibias education is not needed just for the students. It’s needed for the faculty. It’s needed for our administrative staff. It’s really needed for everybody, because we all form the culture. And students are at the bottom of that hierarchy, so they are the least able to really effect change across the institution. And that is something that we are working on. We are putting together a faculty development series and a “train the trainers” program to expand that expertise within our institution. We need to make sure that everyone is on the same page with respect to our patient population.

What else have you heard at the town hall meetings that you hadn’t heard about before or thought was worth addressing?

Dr. Benfield: I had more awareness of student and faculty issues, but I had much less awareness of the challenges that the staff are confronting and the infrastructure that is not as supportive as it should be. So that was something that I learned and I’m working to address.

Can you explain the difference between diversity and inclusion, and why both are important?

Dr. Benfield: If you have a diverse group, but no one feels that they can speak, no one feels that their voice is respected, and no one feels that they’re going to be appreciated, then you’re not actually going to be able to get the maximum benefits from that diversity. So you need to have an inclusive culture to make sure that diverse people help you get to the excellence that you want, and also feel supported and have trust in the institution. So you need to have both to get to the end goal. And that is better clinical care and better science.

A recent Yale study published in JAMA Internal Medicine reported that multiracial medical students report higher rates of mistreatment compared with white medical students. Is that also true at Einstein? If so, how has Einstein addressed this sort of discrimination? 

Dr. Blanco: If we look at our diversity engagement and climate survey, we know that certain populations definitely do not feel included, particularly our Black associates and students, as well as our LGBTQ associates and students. And it’s a work in progress. We need to address everything that these students are facing. Let’s say that we made the most-inclusive environment in terms of the faculty and all the administrators. If students go out to an affiliate hospital and they are faced with microaggressions, that’s not an inclusive environment. When you see people addressing patients in disparaging ways and you’re from that community, you take it to heart, right? That faculty member is actually talking about you. That resident is talking about you. Our climate survey shows that we need to do more and we need to do better, because there are still a lot of areas where we have to make everyone feel included. If you ask our students what their opinion is about this, they’re going to give it to you. They are not going to hold back. A lot of them have done community-organizing and social-activism work. They are adults and they have lived life and they have perspective. When they see something that is not true to their values that they know we can do better, they’re going to tell us.

Do you think Einstein students are more outspoken today than in the past?

Dr. Benfield: There are different approaches that people have taken. My mom could tell you about getting arrested at protests in the 1960s, for example. But it has always been young people who see the problems most clearly. They have been the most shocked when they hit the doors of the system and think, “What the heck is happening here? This is not the way I learned about things. I was told to share and we’re all equal.” So this is not a new paradigm. I do think that our students are more informed, and because they have better access to education, they have larger opportunities for communication and organization. And that’s why they can be more effective as advocates.

Dr. Blanco: When I was a medical student we had email, and we had Google, but there was no social media. There were maybe 10 to 15 underrepresented minority students in a class of 180 medical students. And you really didn’t know any other medical students anywhere else. You didn’t have examples of what was happening at other institutions. Now the students are finding each other. There are so many forums, there are so many networks that they can link into, and it helps to drive the movement forward. So it becomes “Look what they’re doing at this school,” and then they take it back to their institution and ask “Why can’t we do this?” It just galvanizes the movement.

You are both relatively new to your positions. How do you plan to measure improvement or success in your role?

Dr. Blanco: I’m actually entering my sixth year—time flies! To measure success, you need to create concrete metrics: the number of underrepresented students admitted, how they go through the school, and are they accomplishing what they need to accomplish? I’m also thinking about how we get them prepared in terms of residency. Another measure of success is bringing other identity groups into the fold and interacting with the graduate school, which is a brand-new sort of role.

While there is no “silver bullet,” if you could pick one change you could make at Einstein, what would it be?

Dr. Benfield: Your priority changes based on what’s going on in the institution at that moment. My number one priority might be admissions because we’re coming up on that, or faculty hires because that has been on pause for a while because of COVID-19. Because of the depth of bias that exists across the entire system, whether it’s racism or sexism or homophobia, you have to have a multifactorial approach. You cannot say “This is the one thing that will solve everything,” because it won’t.

Einstein students hold posters during the moment of solidarity assembly in June.

Students Seek Immediate Steps Against Systemic Racism

Prompted by national events over the past several months, Einstein’s chapter of White Coats for Black Lives, in conjunction with the Student Collective for Action on Diversity, sent a letter in July to Einstein’s leaders indicating their concerns about systemic racism, which they stressed require meaningful and immediate action.

“In order to put an end to the cyclic violence against Black Americans, we must now act to fundamentally transform the ways our society and institutions function,” their letter stated. The two student groups listed specific areas for action; the letter was signed by more than 200 medical and graduate students, faculty, staff, residents, and alumni. It addressed 12 major categories for change, from antiracist training to increasing recruitment and retention of underrepresented groups among the students and faculty.

Faculty, Staff, and Alumni Issue a Call to Action

In support of the Black community at Einstein and Montefiore, a letter signed by more than 300 faculty, staff, alumni, and students was sent to leaders at the two institutions in August, asking for an investment of resources to “uproot the weeds of white supremacy from medicine.”

The letter further stated: “The communities that we jointly serve and the communities that many of us belong to are being hit hard by two crises—COVID-19 and police violence—with the common roots of structural racism and systemic inequality.”

The letter outlined a series of steps to take “in order to create truly benevolent institutions in which all students and residents can learn and thrive.”

Added one anonymous signer: “Real investment in an antiracist healthcare system is long overdue and necessary.”

READ MORE
Find the letters and the administration’s response:
magazine.einstein.yu.edu/letters20

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