Hello, everyone. Welcome My name is Fabiola Quintero Rivera. I'm an associate, full professor at the University of California, Irvine. And I am going to be moderating this session today here with my colleague, Dr. Laura lazear, who is an assistant professor of pediatrics, immunology and pathology at University Washington University School of Medicine and at San Luis. So this session is on how to turn the minority tax into minority capital and build an academic career based on the work. I would like to Thank the program Committee for choosing this proposal that Dr. Duke and I submitted to be plenary session today. I have nothing to disclose. So here is the line. I'm going to go over some basic concepts of the AI. Then I will show some data on faculty representation. Then I will briefly discuss some data that was published recently by the American Society of human genetics and as well as the ACM genomic workforce survey. I will also present some ideas from the ACM diversity breakfast. And finally, I will introduce our speaker. I would like to briefly describe diversity, inclusion and equity as these are often used interchangeably. So perhaps you found distinguishing them similarly difficult. Being able to pull these definitions apart is vital when we can hold diversity, equity, and inclusion as separate concepts and understand how they interact. We can now set clear goals and strategies around them. Diversity as is curtain nicely. Choice is being invited to the party and inclusion is being asked to dance. Inclusion involves enthusiastically welcoming the input, perspectives and involvement of every team member. Bringing your whole self to work. Being able to share your ideas, having your voice heard without includes, without inclusive inclusion, diversity efforts are practically pointless. As for equity, it is important to realize that we don't all begin on an even playing field and then work to compensate for that fact. Achieving equity in the workplace requires actively correcting for the disparity of advantages enjoyed by some and no others. Now I will present some data on faculty representation in medicine. The American Association of medical colleges, wamc, defines underrepresented in medicine as those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population. Your name or your name is status refers to persons identified as black, Hispanic, Native Hawaiian or other Pacific Islanders. American Indian or Alaskan Native. So this data from the DNC shows that in particular Hispanic, Latino and Black American Indian faculty are very underrepresented in medicine relative to their numbers in the US population. This data, also from the travel agency shows that upon entering the pipeline, nonwhites appear approximately proportional to their percentage in the general population. When you look at data from 2000 and compared to data from 1966, however, as one goes up, the ranks from instructor to assistant to associate to full professor, the representation declines. Issues, such lower retention rates, lower promotion rates and longer times to promotion are likely contributors for the gap between faculty who enters academia and those who make it into the rank to full professor. Now, if we look at more recent data, this paper from the AAMC published last April in the New England Journal of Medicine on the analysis of the US medical faculty. Diversity over 4 decades shows that from 2008 to 2020 that data has not improved. If anything has gotten worse. Percentage of your arms among clinical faculty, full professors and department chairs and medical school deans were compared with the corresponding percentage of the groups in the US Census data from 2020 10 and 2019. You are in representation worse and it became less representative across the board as compared with the US population, as shown by the increasing difference in the bars that are moving away from 0. And the distribution of Black men and women and Hispanic men and women as a percentage of total clinical faculty in panel, e full professors in panel B and department chairs in panel C is shown for each year from the period from 19 7070 through 2019. The y-axis is broken here to improve visualization of the low representation less than 5% across all the groups evaluated. As a Hispanic woman, myself and here in the pink line in the middle panel B alone with 1% of my peers who are full professors in the US. I will briefly discuss now some data released by acg as well as a CMG genomic work for surveys. So in 2018, a CMG survey shows that of the clinical geneticists M.D. licensed in the US who provide direct medical care, 8% are Hispanic, compared to 16% in the US population. 1% are of African origin, compared to 13% 13% in the US population. Highlighting the existing gap between genetics services needed and workforce capacity. And in 2023, this was the latest ethnicity report of all ACM members and these genetic counselors, and showed that two members are of American Indian origin, 20 members of African-American origin and 84 members of Hispanic or Latinx American origin, representing to 4.5% of the members, respectively. Now ASG released last November this genetics and genomics workforce survey. This was an effort in partnership with HMG and the National Society of genetic counselors, and it shows the lack of diversity in the workforce with 2% or less members of your backgrounds. This report highlights the lack of representation and how the lack of diversity impacts scientific innovation, global competitiveness, and the ability to deliver new insights into human disease and health. I would like to chair now. So an ideas from the 2019 HMG diversity breakfast in 2019. This breakfast included individuals registered for the event who were randomly seated at a small table. The feel of Medical Genetics was well represented at the table I participated in, as shown here with genetic counselor students, trainees as well as faculty. Dr. Fukuyama provided two papers to stimulate the discussion at the breakfast. Our group choose a Nature paper on scientists of the world and speak up for equality. Based on this article, we had a lively discussion and most people shared stories of how their representation and how their views growing up were impacting the way that they were seen in academia. One trainee shared one story about growing up, hearing she was different and not like other Black people. You are so articulate. You don't act African-American. She also spoke about how she felt like she has to live in two worlds. At the end of the breakfast in our table, all six-year-old geneticists, we agreed that what sometimes seems to be an innocent statement to the person expressing it to the recipient sounds like you are different. And you don't belong here. And that they at the end, we try to come out with ideas on how to move forward and agree that the best way to address this is through education and open dialogue with our peers from non underrepresented groups. And this is exactly what we are doing here today. And you can learn more as stories shared by one of your peers in this editorial, Dr. fucking sama and I put together in 2020. So now I would like to introduce our speaker, who is going to have his presentation and also that is going to be Paul in interaction as he goes through his slides. At the end, Dr. Douglas will close the session. So we are so, so, so happy, happy and glad that Dr. John Paul Sanchez accepted the invitation to be here today. He is the executive Associate Vice chancellor for the Health Science Center at the University of New Mexico school of medicine. He's also a professor with tenure and vice chair of the Dea and emergency in the emergency medicine department. And he is also the executive director of the Latino medical Students Association and the president of building the next generation of academic physicians. Dr. Sanchez has dedicated more than 25 years to DEIA related work and is nationally recognized as a pioneering faculty development. He has published over 59 peer review publications and served as the editor for a book called succeeding in academia in academic medicine a roadmap for diverse medical students and residents. He's also the co-editor of two books, health professions and academia how to begin your career and another book for Latino, Latina, Latina, x, Latina, Hispanic or of a Spanish origin identify student leaders in medicine more than 50 years of presence, activism and leadership. His publications have highlighted the voices of many groups, including women's sexual and gender minorities, underrepresented racial and ethnic minorities, especially through an intersectional lens. In this session, he will share practical tools on how to turn the minority tax into minority capital and build academic career on the work. He received his M.D. from the Albert Einstein College of Medicine and completed training in emergency medicine at the Montefiore Medical Center in New York City. He also holds a master's of Public Health from Yale School of Public Health. He was born and raised in the Bronx of Puerto Rican ancestry and identifies as they welcome Dr. Sanchez. Yes I have a big smile on my face because I was thinking what my mother would say if she saw this huge picture of me up on the stage. So it's truly an honor and a privilege to be with you all today. I want to thank, of course, Dr. Quintero Rivera, Dr. Duke lazear, also director Radford and all of the program Committee for inviting me to discuss this topic. Just as Dr. Quintero Rivera mentioned, I think it's really important for me to make some disclosures beyond my financial disclosures. As she mentioned, I did grow up in New York, specifically the Bronx. So as we talk about minority taxation and building minority capital, I just wanted to be completely transparent that my lens in approaching this work comes from my lived experiences, not only having grown up in a community that has some of the poorest congressional districts in this country, but also as an individual who identifies as a part of the racial and ethnic minorities population in the United states, as well as a member of what I would call as a group sexual and gender minoritized individuals. And most of my presentation is going to be delivered through the lens of serving as a senior leader of a Health Sciences Center at the University of New Mexico. It's truly an honor to be here on this stage delivering a plenary. But I think as many of my fellow teachers and educators, what we really enjoy is when we're up and close with our learners. And we try to make it as interactive as possible. So with that, I want to make sure that everyone understands the Slido instructions. We want to make sure that this is interactive, and we want to make sure that we have a good questions and answer session. So if you could go ahead, use the QR code or visit titosvodka.com and enter event code as listed. Give it a couple of seconds. 3 more seconds. Great so as we discuss minority tax, I also want to acknowledge for many of us who identify as a minoritized individual or stemming from minoritized communities, this is a heavy topic. This is something that we're going to be engaged in over the next hour to an hour and a half. I know that the panelists up here are always here to support you. Right and I want everyone to be mindful of the questions and the comments that they may make in terms of the Q&A. We're going to review the concepts of minority tax and minority capital. Define how to turn tax into capital, which I think we all appreciate as we approach the April 15 deadline and describe how to overcome DEI overtaxing and how to use DEI work as another metric of academic success. I think as we introduce some of these terms, it's important just to review it. So we're sort of on somewhat of the same page. We are all taxpayers, as mentioned by the approaching date that I mentioned. And just to provide a common definition, taxes are considered mandatory contributions levied on individuals or organizations for a common good for local or regional or national entity. We all benefit from paying taxes in this country, hopefully for educational access, security, other privileges. Transportation and taxes are often there to ensure that everyone has equitable access, even though we in many situations that's not the case, as many of us are faculty or senior leaders within academic health centers. We're also called to contribute an academic medicine tax. An academic medicine tax is also considered a mandatory contribution. It's on our contracts, so it's always good to see what that breaks down to. And what I mean by that is when we look at our contracts so often, give us the proportion of our FTE of clinical work or research or education, and depending on your boss, they'll say that your research service education would be the primary focus of that academic medicine tax beyond your clinical work. Often it's clear that when we're dedicating, meeting or mandatory contribution, it goes to advanced mission areas such as education, research or clinical care. And depending on your institution, die or community engagement may also be considered a fundamental mission area beyond vision right or mission, but something that carries clear, definable outcomes and metrics. That's the case at the University of New Mexico. Every faculty members annual evaluation form asks, how are you contributing to die? But that's not the case everywhere. And sometimes when we engage in DEI work, there's no place to put it on our annual faculty evaluation form, and hence it may not show up on our CV or be considered for promotion. When we think about minority tax. Similarly, some may define it as an additional mandatory contribution levied specifically on those individuals who identify as minorities, faculty, staff, and even our learners within our academic institutions. What makes it really unique and different is that it's the added burden that individuals like myself and some of you face when we're at institutions that are primarily of white identity, male, dominant, where most of the individual's background or of higher socioeconomic status. Which is the vast majority of our medical schools, whether allopathic or osteopathic across this country. And for minorities, individuals, the biggest problem is that it doesn't provide an environment where we have an equitable return on our lived experiences or what we bring as unique individuals. A couple of authors who have written prolifically on this title on this topic would reframe the definition of minority tax to be the burden of time and resources placed on minoritized persons to represent and advocate for their communities. I'm just going to highlight some clips from some of the articles that have recently emerged. One is by Dr. Sarah, who states we are armed with tools on how to deal with racist patients, mitigate aggressions, and seek out mentors who are the right fit. We are tasked with creating, promoting and leading diversity committees and recruiting efforts. While we ourselves might be drowning in the same system, we are burdened to improve. Elder and colleagues in a paper on the death tax report. There are several causative domains for deaf tax, the fight for reasonable accommodations, prejudice and discrimination, training and diversity barriers, and a lack of deaf mentorship. Such a system frequently requires deaf professionals to perform at least an extra hour of unpaid labor every week and ranging up to 10 hours in extreme situations to coordinate their accommodations. Two other examples. Dr. Rodriguez comments. Sometimes I felt like I was paying a gratuity tax gratitude tax, which kept me from seeking new positions. I had traveled so far, economically and professionally, that I was overwhelmed with gratitude. Early in my career, I lost precious time for career progress because there was no structure in place to assign value to service to your patients. And Dr. Campbell states. My first job landed me on several committees and required lots of community engagement, leaving little time for scholarship. At the time, I was unaware of the importance of scholarship and career advancement. For me, that translated to finding myself on the sofa at night and on weekends, writing and sometimes using my own resources independent of those provided by the school to advance my career. These perspectives are not unique to our faculty. In a letter to the editor of academic medicine, a group of medical students wrote in light of recent calls to action for racial equality for students of color. This task is a welcomed opportunity to inspire meaningful change and conversation to improve the lives of marginalized communities. These students increased involvement with activism may limit time for academic coursework or professional development and could directly impact resident selection or placement. I would also add to this statement that as we know, we speak to our students, our learners all the time, and sometimes we forget what we share, the struggles that we face. And we Strayer before our learners, may discourage them from following in our footsteps, especially in becoming future faculty. As someone who identifies as gay, I felt I would be remiss if I did not comment, even though there is no current article on the LGBTQ press tax. I grew up in the 80s and 90s watching grid. Gay related immune deficiency HIV/AIDS play out on TVs as the country grappled with young, primarily white men die prematurely from an unknown virus and illness. Even at that time, I was nervous and concerned that I might be then having a certain life span of maybe 20, 30 or 40 years. The imagery, although is associated with the HIV/AIDS movement that emerged through the work of ACT UP in part due to the slow response by the federal government under the leadership of President Reagan actually took, I think, 7 to eight years before the federal government devoted funding and resources to encourage prevention is titled stop killing us, silence equals death. Stop killing us. Silence equals death. I use it because although this motivated me. To become a physician to figure out how to keep people from dying. It also motivated me to become a teacher and a researcher within academia to think about the prevention. How do we heighten awareness of not only the HIV/AIDS epidemic, but how do we ensure that certain minority communities don't need to die prematurely from disease? To some, you might modify this to say, stop killing me as a minoritized faculty in academic medicine. Let's discuss what minority tax means to minorities, individuals. Listen how do we respond differently? So when we think about disparities in academic medicine and the impact of minority tax, we're just going to take a couple of minutes to talk about. What this means in terms of the diversity efforts that minoritized individuals are asked to engage in disproportionately. How minority tax plays out in terms of mentorship. How ongoing racism and ethno racism and other isms also increase the frequency and burden of minority taxation. When you suffer from minority tax, how does that worsen isolation? Clinical disparities. And in essence, promotion disparities. So when we talk about diversity efforts, disparities, you know what? This really. Is about is what minoritized individuals are called to do uniquely and differently than all faculty. Often as minoritized individuals, whether we identify as racial or ethnic minorities, individual gender or minority seem sexual or gender minority. We feel this obligation to serve our community. Above and beyond that many of our own institutions aspire to do. We're often called to sit on committees, sometimes by ourselves, to advocate and represent a group. Sometimes in doing this work, we're not valued. And in essence, we're engaged in this extra tax. It takes us away from the other scholar pursuits that we're often judged on for promotion. Mentorship when we think about the mentorship disparity, you know, we all know the value of having advisors, mentors that are congruent. I think the biggest benefit of having congruent mentors is don't have to explain what it means to be a woman or someone who is LGBT identified or someone who identifies as Hispanic or Black and why you do the work that you do. And the specific support that you might be seeking. When you're the only one in a department or at an institution. You carry a greater sense of isolation, loneliness. And sometimes when you're placed in a formal mentorship relationship with someone who doesn't understand or appreciate or value your lived experiences, that mentor might actually be a monster. Racism current events, especially through the windows of our learners and students. We know that racism is present, still exists. Plays out in our academic health centers every second and day. The current calls to eliminate affirmative action. Also places an unfair burden on those individuals that in part it was designed to protect. When you're labeled as being a benefactor of affirmative action. That's a micro-aggression. In part, it minimizes your contributions and your lived experiences. And time and time again, often racial and ethnic minorities, individuals will hear, you only got here because you are. Latino or Black or Native American. Clinical disparity. We know based on the literature that minoritized individuals in particular racial and ethnic minorities, as individuals find themselves some find themselves spending more time in clinical work than their peers. Racial and ethnic minorities. Individuals tend to spend a greater proportion of their clinical time caring for those who are poor and also caring for minoritized populations, which at times carry less reimbursement and clinical revenue. And as you dedicate and devote yourself to eliminating unique health issues and health disparities in communities that you grew up in that represent your family and your mentors, sometimes that doesn't equate to the metrics by which get promoted. And hence can contribute to promotion disparities. Isolation the feeling is not being a part of the group, not being invited to go out to golfing events or other types of activities that are being led by your chair or senior leaders within the Department. Not feeling like you fit in at times feeling invisible unless they need that one. Minoritized individuals to be on the Committee to check a box for the Office of Equal Opportunity. And you're always invited. But when you speak, does anyone really listen? So what is the outcome? Facing the burden of minority tax and some of the other components and factors that I just mentioned. What we know by research conducted by Nunez Smith and Fang is that. Individuals who identify as African-American or black, Latino or Latina. Have slower promotion rates slower and often don't get promoted at all. On average, it takes. Black and Latino and Native American faculty 5 to seven years longer to move from assistant to associate if they go up. If they're mentored to apply for the next level. And if they reach associate professor, you see the disparity once again on reaching full professor. What is the impact now? I don't know many deans of a medical school that are assistant professor. Or associate professor. Or who weren't a chair before. The data might be a little bit outdated by you at all, but this still holds true. For the most part. The vast majority of full professors, chairs of departments and deans or individuals of wide identity and male. There are more women professors and chairs and deans now, but the progress has been slow and we're nowhere near parity by gender. I'll highlight also that this includes faculty and readers of historically Black colleges and universities and the four medical schools in Puerto Rico, which primarily are made up of African-American leaders and Hispanic Latino. Now, if you remove those faculty and leaders from those two columns of African American, Black and Hispanic, can you imagine what those proportions look like? That didn't just happen. Probability is against that. Decisions are made every day to come up with these percentages. This would be unacceptable in a clinical environment. You cannot lose you cannot have high morbidity and high mortality in a unit, in an emergency room, in a clinic and still have a job. But you can have a lack of inclusion at an institution and still be touted as a great leader and then wonder why health inequities still occur in our communities. A lot of heavy material. So we're going to go into the slideshow. We're going to take about 90 seconds. Right, to stay on track. I'm going to ask you all. Everyone, please participate. It's a great time to take out your phone. My phone? So first question in this room. Who has experienced minority attacks in the past 12 months? Once again, you just type in Spider and the event code. Just give it 15 more seconds. So once again, I'll just frame this a little bit. When I think about clinical care as a physician, it's unacceptable for any patient that I see in the emergency room to have a bad outcome. I'm expected as a clinician to ensure quality care with every patient. If I was to apply that same approach around dei, it's unacceptable for any one of my learners, faculty or staff to have to deal with minority taxation or discrimination within my Health Sciences Center. As you can see here, one third of you report. Then the past 12 months, you've dealt with minority taxation and another quarter, 21. If 20% are not sure. So this is a little bit more of a complicated slide. Based on the following identifiers. Have you experienced minority taxation in the past 12 months? There's multiple options. You may have to scroll down on your screen to see all of the options as a sexual or gender minoritized individual LGBTQ. Have you experienced? I have minority taxation. Be a sexual or gender minoritized individual? I have not. As a woman, I have as a woman, I have not as a racial or ethnic minorities individual. I have as a racial or ethnic minority, as an individual, I have not. And then like many of us who hold multiple identities, if any of the above two or three you have or have not. So I think the slides aren't coming up. The way they were supposed to. If we can go back a slide. Salt Thank you. Four options in the slideshow. Sorry if you could just come up to the mic. I'm sorry. You can only see this for. I think it was mine. OK, so there's a little bit of confusion. I think that the slides that I'm seeing are not the slides that people have. I don't know if. Any of the tech individuals can just help with this, but I'll read it off of here. So the question has been changed. My apologies. So we've broken down the questions by the following require audience participation. The question that you should see is based on the following identifiers. Have you experienced minority taxation in the past 12 months as a non-sexual or gender minoritized individual? I have not as a non sexual or gender minoritized individual I have. Is that? Since OK. We're going to skip over. My apologies. This one did not work as it was meant to. We're going to jump to this question because I think you'll be just a little bit easier to navigate. In the past 12 months. What are some forms of minority taxation you have experienced? So this is going to be short answer. This is not. Multiple choice in the past 12 months. What are some forms of minority taxation you have experienced? If anyone would like to share any perspectives or thoughts on what has already been discussed in terms of the definitions, the experience of minoritized individuals. So we can maybe take a pause from Slido. If anyone would like to share, please, you can use one of the mics and please introduce yourself. Hi ooh, that's loud. My name is Noreen. I am a genetic counselor from Canada. And I was just wondering if you could maybe touch on, I guess, class in relation to race and how that plays into minority tax and working as a racially. Or someone who identifies as a racial minority. Great that's a great question. So individuals may feel taxed due to many different dimensions. We know historically that most individuals who have been able to attend medical school where individuals of higher socioeconomic status and that also translated into who makes up our faculty and our senior academic base as that when you have the majority of individuals of a certain class or socioeconomic status, they have their own lived experiences, culture, identity and practices. Someone of a different class or a different socioeconomic status on entering in to those cultures or environments may find it more difficult to navigate, socialize, be accepted, have a space where their lived experiences are valued. Now we do know that there is quite a bit of overlap between race, ethnicity and class. That's not always the case. So you really have to consider the unique experiences by every individual, some individuals of Hispanic, Black Native American identity or of higher socioeconomic status. Right or of maybe a certain class. So I think, yes, there's some overlap, but you also have to consider those factors independently, how it informed a person's lived experience and help them to succeed or thrive within any environment. Great question. Och I think we're back. All right. So I'm going to ask us, ask everyone to participate in this exercise again, because not only is this about making this session interactive, but the information that you share is going to be used by ACM, ACM to think about future steps around these topics. So we've broken down that question that had many a lot of different options into fewer options. So based on the following identifiers, have you experienced minority taxation in the past 12 months as a sexual or gender minoritized individual which would be inclusive of terms like lesbian. Gay bisexual. Transgender queer. I have B I have not C as a non sexual or gender minoritized individual for example, heterosexual. I have. I have not. Take 15 seconds. Yeah OK. Try again. Now it should be there. I can see the results here. Excuse me. I just have a sorry, a quick clarifying question. Are you asking if we've experienced the minority tax, if we identify with that group? Exactly if I'm, for example, heterosexual, have I experienced minority tax in relation to being. Yes well, Thank you. Excellent clarifier. OK so. Can the perils of using slido, right? Sometimes it doesn't go as smoothly. Switch to this one. The word cloud was really nice. I feel terrible. OK, so let's try it. I mean, we cannot display the results, but we have the results. All right. OK so just to share some of the results to minority taxation as a sexual and gender minoritized individual. It's hard to see. OK can we talk? OK does this. OK so we have some results. We're going to rest the slider. We just got a little bit more complicated, so I'm just going to advance this just in the interest of time. And just quickly, there are some resources there. If we could take a if we could go back a slide. OK so we're just going to go straight into the final question that many of you responded to in the past 12 months. What are some forms of minority taxation you have experienced? As you can see here, some of the more common ones for this general micro-aggressions, gender inequality or inequity, which is often some examples of that, is pay where we're paying based on, for example, being a woman pregnancy. Extra dye work, lack of promotion. All valid forms that are important for us to further consider and bring back to our institutions. So minority capital. So we really want to make sure that as we present and discuss minority taxation, that we also help our colleagues help ourselves and help our colleagues transform taxation to capital defined minority capital as well for owned by a minority person or even an academic organization, and contributed for the purpose of advancing the being of minoritized communities. Each of us have wealth. Minoritized individuals have wealth based on their lived experiences, competencies tied to their culture and identity, the networks that they're a part of. Sure money or other forms of assets. I always say the best part of my life was growing up in the Bronx. You don't have to explain to me health disparities. I know what health disparities are when you grow up in the Bronx and then you take the train to go to 96th Street and see how people are living on Park Avenue. You see it every day. You live it every day. The opportunity for individuals as well as institutions is to create a culture and climate. That helps minoritized individuals build minority capital and wealth. So just to review. Some promising practices that were mentioned by some of the authors that provided their perspectives earlier on. Dr. Rodriguez and Dr. Campbell, when they spoke about isolation, one way to combat isolation is really to share what your focus is and try to align that with what institutions are trying to achieve through their mission or vision. In terms of gratitude don't fall victim to staying within one community or one institution. So your personal story? I went to medical school, did residency and became a junior faculty member at Albert Einstein College of Medicine because I wanted to stay and serve my community in the Bronx. I vividly remember when my chair said all this work that you're doing around LGBT health. That's not what our department wants to be known for. Our department wants to be known for. How do you manage headaches? What's the difference between different medications and managing nausea? By that time, even as a resident, I had eight publications on LGBT health and I was giving national presentations. The bulb went off. And I said, you know what? There's Latino people everywhere in this country. I don't need to stay and only serve Latino people or gay people in the Bronx. I'll go to Newark. I became the Assistant Dean of diversity at Newark. After being an assistant professor at Albert Einstein. Mentorship sometimes we find ourselves in formalized mentorship relationships because the Department wants to roll out and say, yes, of course, my faculty, they all have mentors. Not forgetting the pitfalls of formalized mentorship and the value of natural mentorship. You want to find those individuals that nurture you, develop you, value your lived experiences, and are going to help you get better, right? So find those individuals that are congruent and like minded and as you do diversity efforts that are important to you as a minoritized individual. Always think about how this matters for your institution. Elshamy Ake GME all these accreditation bodies now require that institutions and programs address diversity, equity, inclusion. It's good. Remind your chairs and program directors how you're helping that program and department and school remain accredited. Ask them if you could even write the section. You will give them your publications and your contributions and tell them to include your name when that goes in. Williamson also talks about some strategies on how to prevent being overtaxed. How to prevent being overtaxed by the minority. Tax tax reduction. Right you can ensure that your minoritized faculty aren't placed on too many committees. You could do tax deferral. Wait until your minoritized faculty member becomes an associate professor protecting their time to complete the scholarship. So they have a steady progression on the promotion track record. Standard tax requiring that all commute departmental unit center members have to partake in DEI work. It's not only the responsibility of the Latino faculty member to talk about the unique health issues of Latino community members or to address disparities for that community. It's everyone's responsibility. Tax deduction. Figuring out how to give your members more credit. So you give them extra FTE. So at my institution I required, I shouldn't say required. I could get in trouble with that. I encouraged I encouraged all chairs to designate and assign FTE to one or two leaders to engage and support DEI work. Everyone who is responsible for my work had to have assigned FTE. Just like we do with education or research or clinical care. And then tax refund. There's always slush funds. When we need to, we find money. We can compensate and reimburse faculty when they go above and beyond. Sometimes it's called incentives, sometimes it's called bonuses. It's really about setting aside those funds to supporting those faculty and acknowledging the work and contributions that they're doing. I'm just going to go over the next couple of slides quickly because of the skydive snafu. Another framework I'd like to introduce when we talk about how to combat minority taxation and build minority. Well, for capital is this framework on determinants of health in academia. And this is a play off of pass US Surgeon General Dr. Thatcher's framework on social determinants of health and modified by Eve Higginbotham. Dr. Higginbotham at UPenn. As you see here, the same factors that influence the health of our patients and communities also affect the health of our faculty. At the center where our faculty. Their biology can be viewed or pitched as a negative. Their behaviors, the physical environment, the social environment, policies and interventions can exist to cause them to fail. Just survive. Or we can modify all these factors to ensure that they thrive and have success in academia. I would say one of the most important things is to stress value based alignment. To speak with your faculty, your minoritized faculty, staff and learners. Ask them what they want to be known for. What they want to read, how they want to advocate. Advanced excellence, whether it's in clinical education or research help them to understand how their passions and interests meet. Institutional mission. Vision, strategic planning and accreditation standards. And also always tie it to the communities that we serve around our institutions. The more that we can help our faculty understand the gap that they're feeling, the more they're going to be successful and the more our institutions will be known for driving excellence. Specifically in DEI related work. That you can do DEI across the other mission areas, right? When we think about education, we're called to design, implement and publish DEI teaching and learner assessment materials. Great journalist method portal. Clinical one example is supporting bilingual faculty. To enhance the language proficiency, to provide direct patient care in a second language, the chosen language by patients, rather than using interpreters and like Kaiser or Paso, Texas tech, giving them a bonus if they see more patients in a second language. In terms of research, including minorities, identifiers, and encouraging them to ask the questions that are specific to those other communities in terms of community engagement, are our programs affective at getting more? Racial and ethnic minoritized individuals into our graduate school programs, into our medical schools, tracking their progress, and do they go on to become our faculty? And then another example of DEI work is doing a climate survey and building an action plan around that. Some more specific examples. That in line with that framework I mentioned on social determinants of health in academia, on the individual level, right for minoritized individuals reflect and take pride in your assets. Many of the things that we were told were deficits, like speaking a second language. Or having a heavy accent. That's only in the US. You go to other countries, speaking multiple languages from a business perspective is an asset. But you have to value yourself and your lived experiences before you can ask anyone else to. Walk to the Office of Faculty Affairs. I'm amazed that we are so successful. I can ask everyone, what made you get into medical school or graduate program? Well, I went to the Office of Admissions. I knew how I needed to apply. I had to take the mcat, get a good GPA. I ask faculty, have they ever walked to the Office of faculty affairs? There was like, there's an office of Faculty Affairs with promotion guidelines. It's transparent. It's the same game. You've got to walk to the Office of Faculty Affairs and then you schedule. You take out the Dean of Faculty Affairs for coffee. And you asked them how you get promoted. And on the institutional level, institutions and leaders should offer minority minorities, faculty promotion programs. Other things to consider in terms of behavior. Commenting back on what Dr. Rodriguez shared. Critically review websites of other departments and institutions and see if they're really doing anything meaningful. Is it all fluff? Is it visionary? Or do they have real outcomes and impact in recruiting, retaining and promoting minoritized individuals historically? Minoritized individuals? Biology we can do a better job of understanding the unique health issues and health disparities of our own communities, right? So when we're put into situations, we're asked to represent Latinos or individuals of LGBT identity that we bring the research, that we develop, the competencies. And similarly, institutions can do a better job of reporting the unique issues and disparities of those communities around where their school is located at and reporting on how they are addressing those unique issues and disparities. Physical environment. Identify congruent colleagues if you're the only one. Yeah work to find that next person who's going to join you in that unit or department so you don't have to be by yourself. Work with your department or unit to implement holistic review or the talent management framework, which is a five step process to actively recruit diverse candidates, but also to track and hold yourself accountable and a department accountable for trends and success. Support heritage months and other GI related events. Invite minoritized individuals to being. Grand rounds plenary speakers. Thank you, HMG. Think about the policies and interventions and whether they're really inclusive and making a difference. And in terms of mentors and professional networks. Find spaces where you can locate congruent sponsors and mentors. National Medical Association has existed for over 100 years to support the advancement of Black African-American physicians. Attend send your faculty even if you don't identify as Black or African-American. Attend an AM to understand the unique experiences and challenges of African-American and Black faculty. Similarly, AMA, the American Medical Women's Association. Anita me, the National Hispanic Medical Association. All these associations have existed for over 100 years to create safe spaces for people to come together, sharing experiences and learn from each other. So we're going to do two quick cases. I'm not going to mess with Slido. I'm not Messing with Slido. What I am going to do is ask for two courageous volunteers to come up to the mic, read the case, and share their response. Now you know, like with all my learners, I say. You know, this is a learning experience. We're learning together if you're not sure of an answer. Teamwork would anyone like to read this case? And give their thoughts and the correct approach. Mark Williams Guissinger you are part of a faculty recruitment Committee as part of their job application package and applicant includes a Diversity Statement and mentions that she is part of the LGBTQI community and as a transgender individual, has been doing outreach in her community to LGBTQIA groups of high school students after this application package is reviewed, a senior male faculty. Gosh, that sounds like me. Inquires if the individual has had gender affirming surgery as the only are a member of the committee, your position is to a go along with and discuss the question asked by your colleague be remind them that gender status must not be discussed and the Committee should only focus on the academic qualifications of the applicant, see, say nothing and recuse the Committee meeting. Dh ask if all members of the Committee have taken the EEO D training needed to be part of the search Committee before continuing any discussion. E B and/or f. None of the above. That's an E for me. Great great. How many of you agree? Fantastic Yes. E is the appropriate and the best approach. Thank you. Excellent we're going to move on to the next part of. Well, look, Thank you for trying. Thank you. And 67% agree. 75 sorry. OK if you wouldn't mind. Or did you have a question about the prior? I'm willing to read the next case. Thank you. Nice you're a part of a faculty recruitment Committee. As part of their job application package. An applicant includes a Diversity Statement and mentions that she is part of the LGBTQI community and as a transgender individual, has been doing outreach in her community to LGBTQIA groups of high school students. After this application package is reviewed, a senior male faculty member inquires if the individual has had gender affirming surgery. How might this faculty member achieve minority capital through this experience? Great Thank you. So that was my fault. It's the same case. It was just a different question. Right but this know, this is the challenge that's brought us here. Right so we know that minority taxation is a big problem. How could we help this faculty member achieve capital off of this experience? It's pretty easy. I would ask them to talk about the experience and what parallels they see to the mission of the current institution, where they're applying for a job and how they can use these strengths and unique experiences to do community outreach. Absolutely absolutely. So I think you capture you're touching upon two ways, right? the faculty member can achieve minority capital. And then if this candidate is actually also hired, we know that they can bring specific strengths to the institution. So for the faculty member that heard this and experienced this, this may be an opportunity to speak with the leadership at the institution, talk about this experience and talk about how policies and processes need to change in the future and how they would like to serve in the capacity and chair future meetings or faculty recruitment efforts. So one is the opportunity tenecteplase themself in a new leadership role. As the chair of the search committee, they can develop, implement and evaluate new policies and procedures that support more of inclusion through holistic review. They might be trained as an OEO through OEO to serve as an equity advisor at the institution and monitor Committee. Work in this way for the individual that's being considered for the job as well. We know that they have unique skills that maybe have gone undervalued, underappreciated or don't exist in a department. Right and that might be a consideration for those people who use holistic review to modify the metric to give certain points or credits for individuals who bring this experience of working with sexual and gender minoritized populations. Great I love that you're all still participating and trying. I gave up on Scott. No, don't give up. But I appreciate you all. Has not given up. You are in it to win it. I love it. OK so. I am saying. So giving credit, right, and thinking about how you give credit. If you do charge someone to modify the policies, processes to come up with a new curricula, to put out a new training, are you protecting their time? Are you giving them 50 to do this? How is it going on? Their annual evaluation form. Making sure that when they go up for promotion. That you value this work, you convey it to the promotions Committee. Great leadership position provides job description. OK so we're going to quickly go through the second case and this is the final case. Can I have a volunteer? Someone wants to race up. Thank you. Read the second case. A Latinx junior faculty member receives an email to pose for a photograph to appear in publicity fliers for the division. They notice the only other recipients of the email were the other two members of the division that come from underrepresented communities. There is no transparency as to why they were the only ones being invited for the photo shoot or that it was not a division wide email. How do you think this faculty member might have felt? That's a question to me. Yes oh, for well, everyone. I, I think that they would feel sort of singled out or not treated with the respect that they deserve, that they were only chosen based on their demographics. Absolutely and some may frame it as tokenism. Right tokenism. Right it's like this working. I was getting nervous. I was really getting nervous. I'm happy. So tokenized. Exploited uncomfortable. Singled out. Labeled objectified. Strange, manipulated by exploited. This is your colleague. This is your friend. Some departments we often say we're all one family. Same case. Just second question. If anyone wants to give thoughts on this, how might this faculty member achieve minority capital through this experience? How might this faculty member achieve minority capital through this experience? I may have to go to Guissinger. This is good representation by Guissinger. We try the way I would think about this would be to say what? What's the purpose? Trying to understand what's going on, what message are we communicating and say, can I help you craft this message, improve this message, make this message more relevant to what it is you're trying to do? Because it seems to me that you're really not necessarily understanding how best to convey the message. Absolutely absolutely. So I think you always want to convey and spend time talking with a faculty member of the intent. Right but I think for the faculty member themselves, we know that's a common practice for institutions to showcase faculty for different reasons. But the other question is, how do you support the faculty member in being successful in that role? Right we know we all have offices of media and marketing. They can go through formalized training. They could get protected time. Not only for this one particular activity, but maybe afford them opportunities to represent the institution in multiple ways, right? Not only for media campaign, but for meetings at AMC where SMGT. Yeah I was just going to say that this is a publicity for the department, but there should also be a publicity for that individual. So expand that. Not just a photo shoot, but promote their work. Excellent so provide the training. Think about how to document this on their annual evaluation form. Think about how this will serve them in promoting. Explain to them how this helps the institution meet certain outcomes and give them credit. Has to be paid. Visibility educate proper training. So I'm going to skip over my own journey. But just quickly, some other practices, promising practices that were mentioned by individuals whose quotes I read earlier on. Dr. balsam highlights. Hey, promote and protect. When specifically in her article specifically talking about the experiences of Black women in gastroenterology, she said pay. Think about pay equity. Consider that Black females make 27% less earnings than non-Hispanic white males. Promote why is it Thank why historically and to date only 0.7% of us medical school faculty are Black women. Full professors protect. Think about concepts that we mentioned, such as Black girl magic and how these are at times considered compliments. But they're couched in race and gender based stereotypes. When thinking about the death tax, Eldora talks about facilitating language equity and communication access, implementing awareness and training of the specific experiences faced by different minoritized populations. Fostering mentorship, mentoring, mentorship comes up several times. And promoting new policies and processes and leadership positions for these individuals in particular. And I'm going to close with a quote from the medical students. Consolidate consolidate efforts between administrators, faculty and students is necessary to prevent students of color from carrying undue burden that can sometimes lead to burnout. When our medical students. Are feeling burnt out. Medicine has a real big problem. When our medical students feel burnt out, medicine as a discipline has a really big problem. In summary, minoritized individuals can combat minority taxation by reframing. And aiming for capital and wealth. Minoritized individuals have to reset. Many of our lived experiences are not deficits, but actually assets to advance clinical research, education, community engagement, excellence. But we need institutions to do a better job of supporting us. And as shared by many of the people cited in this presentation, there are emerging best practices and resources to facilitate minoritized individuals in advancing capital and wealth. With that, I want to thank everyone for their participation. We got through Slido together, but Thank you, everyone. I think we're going to we have a couple of minutes for questions and answer. OK so we have received questions through the app and we also would like to invite you to come to the microphone. So I will start with the first one. As faculty in a medical school in Iowa, I saw African-American students being continually pressured to represent in an effort to attract more diverse students. They felt obliged. I feel they were not able to just be a student, were pushed to be flag wavers. Can you speak to this phenomenon? The series. So my apologies. Yeah there was a little bit of reverberation and I couldn't. So I think this is a reality all the time. Right I think that this is a little bit of gratitude that's playing out in both ways. I think as institutions, sometimes when we give scholarships to students of color, we expect that they go above and beyond to share that they're being treated well. And black, Latino and Native American students often bear this pressure uniquely. Maybe some other students who also receive scholarships. That is an unfair, inequitable practice, right. That's a clear example of minority taxation. I think it's always important to ask learners, faculty and staff, whether they want to play this role, whether they feel comfortable playing this role, but also helping them understand how playing this role can benefit the institution, the surrounding the community. And how it will serve them in their progression. So I think the first thing is to realize that this plays out in all institutions even today. This has been going on for decades. I don't know. I welcome other people to come up to the mic and share any other perspectives. But David Miller from Boston, I don't know if I can share a perspective from my lived experience, but I would guess that your comments about people feeling burnt out in medical school might be a cumulative effect of having to sort of live up to a certain expectations for like their whole life leading up to that point or at different settings or like in high school and college also. Would that not also be the case? It could, but I think a lot of speaking for myself, I think that the lived experience lived experiences that I had growing up in the Bronx, growing up during the HIV/AIDS epidemic as an out gay person, gave me great resilience and gave me great pride. But then to walk into a medical school where, despite it being in the Bronx, Latino Health care issues weren't discussed on a day to day basis, where I was sometimes placed on these promotion campaigns without really bringing extra value, besides putting my last name or showing a picture of me because I was a scholarship recipient did take a toll of differently. It was a little bit superficial. It also didn't make me feel like we were in it together to provide better health care or better outcomes for members of the Bronx. It still seems like I was at odds. With the very institution that I thought I was going to be a part of to drive change. So I do appreciate in value the cumulative effect. But I think that the institution could have reversed that. Rather than have added an additional burden. That's my own experience. Thank you so much. So when the burden of the minority talks is to emotionally and academically burdensome. I often contemplate tax evasion, which I love this question. Is there another option? I think tax evasion is I think you have the right to say no. You owe that to yourselves to keep yourself safe. I think you do. And it feels. Really, really hard because you do end up wanting to represent your people and your community and also people, please. But I think we deserve the chance to say no, but I'll give it to you. And I think that's one of the last questions we can answer. I actually. Yeah, no, absolutely. Tax evasion sounds like tax deferral by Williamson and the article. Absolutely it's important to say no. I mean, depending on your mentor, often a mentor will say early on in your career used to say Yes to everything. That doesn't work for everyone, right? I always recommend thinking about value based alignment. Think about those opportunities that best align with your personal passions, professional interests that also help meet the institutional needs and the community that you're serving. Instead of saying no, you could say not now. You could say, wait a minute, I have a colleague who might be better suited for this position. And then sometimes if you feel comfortable or you could say, you know, no, but I think a better pound is saying not now, or let me provide two or three other recommendations. Thank you. Last question. Last question. It's a question and a comment. As a Montefiore Einstein faculty member for 35 years, I want to say congratulations. Thank you. This is the Bronx has ever been mentioned at an assembly. I will tell you that as part of a lot of my initiatives, I'm in the Department of ob-gyn and a clinical geneticist. And we have evolved over the past 20 years for sure, since you've been there. But what we haven't really been able to tackle is the fact that we, as a very diverse population, are trying to define our patients. I don't know how to put it. Our patients either identify in a certain race or ethnicity, but that may not represent their true. Race and ethnicity. Our ethnicities are very mixed and we are finding that the research is very difficult. And I don't know that that's a question we can answer. Now, it might be a question for our die committee, but I also just wanted to say Thank you. Thank you. Thank you. Thank you very much. Great OK. Thank you, everybody. This has prompted some great discussions. I just have a few thoughts to add. I have no disclosures, so some people might be asking themselves. If you don't know me, why does she care? In case you haven't noticed, I'm a Latina woman. I'm an immigrant. I'm an international medical graduate from Ecuador. And whoa. Sorry and these identities not only shape how I view the world, but most importantly, how the world views me. And as evidenced by the statistics described earlier in this session, these identities may have put me at a disadvantage in my pursuit of a successful academic career. But these identities are also the reason I'm standing here today in front of all of you and one of the biggest platforms for clinical genetics. They are the reason why I volunteered to from Dr. fujisawa to organize the diversity breakfast last year with Dr. Quintero Rivera. And the reason we proposed this session. So these identities are also the reason I've been invited to speak in engagement to joint committees, editorial boards and other wonderful opportunities. But perhaps most importantly, the question should be why should you care? Right and housing, diversity, equity and inclusion, anti-racism and accessibility is everybody's responsibility. But if you hold a position of leadership, you set the tone, you define the culture of your division, department and institution. If your thought after sessions like this is that people are shoving diversity down your throat and we should focus on the science, I'm here to tell you what others might be scared to. You might be the problem and not the solution. And I would encourage you to reassess your priorities if your identities bring you privilege. Please use that to lift others up. Educate yourselves on how you can do better and be a mentor and not a monster help people from diverse backgrounds engage in deciding how they want change to happen. We are the best resources for these discussions and build it. Build relationships and Trust and see us and hear us. If your trainees or faculty members are engaged in diversity, work, protect their time, provide financial support and recognize these efforts. Dei and the genetics workforce is essential. We should reflect the communities we serve. We should also be examples and role models for kiddos and young folk who look like us and want to become scientists and geneticists and physicians. The issue of lack of diversity is not unique to genetics, but we have a fraught history. If you have not yet, please read the entire ASG facing our history building an equitable Future Report. We all need to acknowledge this history and put in the work to move forward and enact positive change. For my fellow individuals of underrepresented backgrounds and minorities and disenfranchised groups. Seek out mentors, volunteer for committees and boards and work groups that you want to be a part of. Just because you're interested in d-I does not mean that you have to volunteer for all of the d-I related committees. You can be that diverse person in any other Committee and do the job of the work that you want to do. Do find out which opportunities. Do teach the didactic or develop part of the DEI curriculum. Sit at the table, make your voices heard, disrupt the norms. Very importantly, document all of our contributions in your CV. Build that capital and take care of yourself while you're doing that. I do want to make sure that I acknowledge my wonderful co-presenter at co-organizer Dr. Fabiola Quintero Rivera. Our speaker, Dr. John Santos. Dr. Fabiola Rivera. And I would love to Thank Dr. Fukuyama for passing the reins of the organization of the diversity breakfast that led us to be here. We'd like to Thank our mentors for lifting us up and seeing potential in us that we might have not seen in ourselves. And we also huge Thanks to the ACM program Committee for giving us this platform. We hope to see you next year. Whether it's a breakfast session or a platform session, we'll continue to dedicate ourselves to die, and so should you. Thank you very much. Thank you for being here. This concludes our session. Enjoy the rest of the meeting. Thank you.

Fabiola Quintero Rivera

University of California, Irvine

minority tax

minority capital

academic career

diversity

inclusion

equity

underrepresentation

Dr. Laura Lazear

mentorship

discrimination