The nation's physicians and medical students continue to acknowledge the realities of structural racism in medicine by adding to policy that informs the American Medical Association's ambitious work to dismantle racist policies and practices across all of health care.
Members of the AMA's House of Delegates representing their peers from all corners of medicine voted to adopt guidelines addressing systemic racism in medicine, including discrimination, bias and abuse, including expressions of prejudice known as microaggressions. The AMA will recommend that health care organizations and systems use the new guidelines to establish institutional policies that promote positive cultural change and ensure a safe, discrimination-free work environment.
"Systemic racism in medicine is the most serious barrier to the advancement of health equity and appropriate medical care," said AMA Board Member Willarda V. Edwards, M.D., M.B.A. "Today's actions by the House of Delegates will inform the AMA's active work to proactively identify, prevent, and eliminate racism and will help the AMA guide health care organizations in efforts to adopt workplace policies that promote positive cultural transformation and address the root cause of racial health inequities."
According to the newly adopted guidelines, an effective workplace policy to address systemic racism in a health care setting should:
- Clearly define discrimination, systemic racism, explicit and implicit bias and microaggressions in the healthcare setting.
- Ensure the policy is prominently displayed and easily accessible.
- Describe the management's commitment to providing a safe and healthy environment that actively seeks to prevent and address systemic racism, explicit and implicit bias and microaggressions.
- Establish training requirements for systemic racism, explicit and implicit bias, and microaggressions for all members of the healthcare system.
- Prioritize safety in both reporting and corrective actions related to discrimination, systemic racism, explicit and implicit bias and microaggressions.
- Create anti-discrimination policies that:
- Specify to whom the policy applies (i.e., medical staff, students, trainees, administration, patients, employees, contractors, vendors, etc.).
- Define expected and prohibited behavior.
- Outline steps for individuals to take when they feel they have experienced discrimination, including racism, explicit and implicit bias and microaggressions.
- Ensure privacy and confidentiality to the reporter.
- Provide a confidential method for documenting and reporting incidents.
- Outline policies and procedures for investigating and addressing complaints and determining necessary interventions or action.
- These policies should include:
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- Taking every complaint seriously.
- Acting upon every complaint immediately.
- Developing appropriate resources to resolve complaints.
- Creating a procedure to ensure a healthy work environment is maintained for complainants and prohibit and penalize retaliation for reporting.
- Communicating decisions and actions taken by the organization following a complaint to all affected parties.
- Document training requirements to all the members of the healthcare system and establish clear expectations about the training objectives.
The guidelines also suggest tactics that can help medical staff leaders establish work environments within their institutions that are safe and discrimination-free.
In the past year, the House of Delegates has adopted several policies that explicitly acknowledge racism's role in perpetuating health inequities and inciting harm against historically marginalized communities. These AMA policies include acknowledging racism as a public health threat, removing race as a proxy for biology and eliminating racial essentialism in medicine.
Through research, collaborations, advocacy, and leadership, the AMA believes in supporting system-level solutions and identifying and addressing root causes of health inequities while elevating their importance to patients, communities, and stakeholders.