Dismantling Structural Racism in Academic Medicine: A Skeptical Optimism.

Structural racism is pervasive in U.S. society, and academic medicine is not immune to the effects of this disease. The social determinants of health have been implicated as the main drivers of health disparities and inequities in society, and racism has been well established as a social determinant of health. Research consistently highlights poor health outcomes for Black populations and other communities of color compared with White populations across a variety of conditions. Medical students, residents, and faculty of all backgrounds regularly experience the destructive effects of structural racism in medicine. Renewed attention to the problem is encouraging, but, if it is consistent with history, transient. If academic medicine can arrive at a place of discarding the shackles of biological determinism, perhaps the field can begin to take initial steps toward dismantling the structural racism that drives health inequities. To make true headway, academic medicine must be willing to make bold strategic and financial commitments to do more. This work will not be easy, and there will be great resistance to the type of change that is needed. It is time to ask whether the leaders of academic institutions have the will to act and to continue to push forward in the face of opposition. The author is skeptical-because of the scope of the work that needs to be done and because it feels as if society has been here many times before-and, yet, remains optimistic.