When I began medical school in the summer of 2000, I was sure I wanted to be a surgeon. I was coming off a two-year stint as the captain of the Rutgers women’s fencing team. I was a four-time varsity letter winner in the sport. My path was already very unusual for a black woman, but I was proud of what I had accomplished. My background and interest in sports led me to what I thought was a very natural interest in orthopedic surgery.
I went through my coursework and did well, despite losing my mother to metastatic colon cancer in the early part of my second year. By the autumn of 2003, I had done a research elective and three acting internships in orthopedic surgery. When I submitted my application to 89 residency programs, I felt pretty confident about my chances. While I waited, though, something interesting happened. In January of 2004, I did a student elective in forensic pathology. I was amazed at how those physicians put all the pieces together to figure out exactly how a patient died. This experience was not my first clinical interaction with pathologists; in my first acting internship, I would often accompany the orthopedic oncologists to anatomic pathology to read the frozen section slides with the pathologist. It was positively exhilarating to watch her render diagnoses. But seeing as I was going to be a surgeon, none of this mattered – right?
Wrong. In March of 2004, on a crisp Monday afternoon, I – like residency hopefuls all over the country – hurried to the nearest computer to check my email. I saw the message from the National Residency Match Program, a program we in the United States lovingly refer to as “The Match.” I got as far as, “We regret to inform you…” and that was all I needed to read. I spent much of the following hour crying on the shoulder of my favorite emergency physician. Over the following 24 hours, I re-evaluated what I was going to do with my life. I knew I had enjoyed my brief interactions with pathologists, and I was fascinated by – and completely in awe of – what they were able to do for their patients. I wondered if my awe and fascination was enough for me to make a career out of it. After much consideration, I decided to give pathology a chance. The next day, I sent my application to pathology programs all over the country. I received several offers, but chose to begin my training at Albany Medical Center.
I went to New Jersey Medical School in Newark, New Jersey, a very diverse medical school; I was used to seeing faces that looked like mine. But when I began my residency in pathology, there were almost no black faces – something I hadn’t even considered. One of my co-residents was a black woman, but there were no black faculty (or, indeed, any other black people) in the department. After my first year, I returned to my medical school to complete my residency. While I was a student, there was one black faculty member, a woman, in the department – but by the time I returned, she had retired; two black women were co-residents, but no black faculty. When I became a fellow at a very large academic center in a major city, I was the only black fellow. Two black women were residents – but, yet again, zero black faculty.
It is appropriate at this juncture to note that I’ve said nothing about black male pathologists in my training. I spent time with three during my forensic pathology rotation. I have not had the honor or pleasure of training (or training with) a black male pathologist, although I have mentored one black male student who went on to train in pathology. I know others exist – I am friends with several – but in academia, we just don’t see them as often as other groups – including black women.
After completing my training, I returned once again to my medical school alma mater, this time as a member of the faculty. Nearly a decade later, I am still the only black woman on the faculty. That has not gone unnoticed by applicants to our residency training program. Several years ago, I was interviewing an applicant – a black woman – who was incredible. Indeed, she was far and away the best applicant we had seen during the cycle, and I would have loved to have her join our program. She asked if it was okay to ask me a question. Of course it was, because we love it when applicants ask questions! And then this brilliant young woman leaned in and asked me, “What is it like to be the only one? You’re the first black attending I’ve met on the interview trail.” My answer then remains my answer now: it is hard. Allow me to give you some examples of how hard it can be.
Once, I was having a seemingly lighthearted conversation with two other people. The conversation was centered on the exclusivity of a group within a particular organization – one with which we were all familiar. One participant mentioned that no one gets into the inner circle with the exception of a select few. That same participant then looked at me and said, “They don’t have any black people, though, and everyone loves you. You can be their token.” The third participant, who had said almost nothing up to this point, looked at the first speaker in complete disbelief. I felt the blood rush into my face with anger as I excused myself and left the room. What is “tokenism?” Tokenism is the practice of making a shallow attempt at appeasing a group by including a person of that group (often an underrepresented minority) into a select circle. The colleague clearly either did not understand or did not care that it is offensive to imply that I would be allowed into the inner circle simply to stand there, smile, and be black. Worse, what was implied – though not stated – is that my skin color was the only thing worth recognizing.
My existence is that of a double minority: a black woman. Because of this, I have encountered people who question whether or not I deserve to be in the spaces I work in. I’ve been asked pointedly if I was an affirmative action hire. I can imagine how an insensitive person with no home training would ask such a question. After all, as I stated earlier, I continue to be the only black faculty member in my department. Clearly, that must be because they need a black person – and, by hiring a woman they can fill two quotas at once. Believe it or not, I was hired based on my ability and commitment to patient care!
It’s also hard to hire that which does not exist in large numbers. Black people are one of the least represented ethnic groups in pathology in the United States; only indigenous Americans have less representation. In the 2017 and 2018 Medscape Pathology Compensation Reports (1,2), there were so few black respondents that our salary data could not even be published. How can we expect departments to hire more black pathologists when we’re not entering the specialty in the first place?
Imagine an existence where you have to work two or three times harder than your peers to prove to others that you are just as good as they are. Imagine experiences where your efforts to explain that you’ve been mistreated by someone because of the color of your skin are dismissed as being merely your perception, rather than reality. Microaggressions and gaslighting are easier to face when you’re not facing them alone – and, in my professional world, I often face them alone. I was discussing this piece with a friend and colleague as I was writing it and she said something profound: “I have no idea what your world is like. This piece you’re writing is important. Because, as close to you as I am, I still don’t know.” I hear what she is saying. As a woman who has been asked to discard garbage while wearing scrubs in the hospital (and, by the way, our cleaning staff doesn’t wear scrubs), I am grateful for the opportunity to share my experiences. I am certain I have colleagues of color who have been through worse professionally than I have. I also recognize the opportunity I have been given with this piece. Although there are people who condemn my blackness, there are many more allies who seek knowledge so that they can learn and understand. It is impossible to know what it is like to be black unless you actually are black, but I appreciate those who seek to better understand what our lives are like.
There is good news, though; I have had some truly amazing experiences. I have had the opportunity to mentor some wonderful students. I have presented in many places in the world. I’m a member of a couple of editorial boards. I’m working on my first book. I run and teach in a course at my medical school involving the musculoskeletal and integumentary systems. I have the honor and pleasure to teach in many other courses at all levels of the medical school curriculum. I’ve chaired the medical school’s curriculum committee over the last several years. I’ve accomplished all this despite the challenges I have faced as a black woman in pathology, not because of them.
And stories like mine aren’t limited to pathology; on Twitter, we use a hashtag, #BlackWomenInMedicine, to celebrate our triumphs and successes. We use it to call attention to ourselves and to remind others that we do exist – that we’re not unicorns. Social media is not always kind either (I have been racially trolled), but we are able to use it to come together in a common space and show the world that we are an important piece of the medical landscape. Diversity and inclusion are of the utmost importance in medicine. Although pathology desperately needs more diversity, it will not exist until we improve recruitment. I’m committed to improving recruitment of underrepresented minorities in pathology by starting to attract them as early as possible. Perhaps I can inspire women and men (and girls and boys) who look like me to consider pathology as a career.
Hearing the difficulties I’ve faced, you may be tempted to ask if I would choose pathology again. My answer is a resounding yes. I have been incredibly fortunate in my career. I have the awesome responsibility of helping people every single day, even if most of those people don’t know I exist (which is okay). I’m not looking for immediate gratification; my gratification lies in arriving at the correct diagnosis for my patients so that they can get the treatment they need. My subspecialty has allowed me to travel the world. I get to teach and mentor amazing medical students. I have an amazing network, much of which I have gained through my interactions on social media, as well as through publishing and speaking. It may not always be easy to be “the only one,” but I would not change any of the experiences I have had – and I invite others to join me on this amazing journey.
- Medscape, “Medscape Pathologist Compensation Report 2017” (2017). Available at: wb.md/2CyNiDv. Accessed October 22, 2018.
- Medscape, “Medscape Pathologist Compensation Report 2018” (2018). Available at: wb.md/2EDmpAH. Accessed October 22, 2018.
Valerie A. Fitzhugh is Associate Professor and Interim Chair in the Department of Pathology, Immunology, and Laboratory Medicine at Rutgers New Jersey Medical School, Newark, New Jersey, USA and the Department of Pathology and Laboratory Medicine at Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
