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Stories of overworked and burned-out, frontline healthcare workers have been in the news since early in the pandemic. Job vacancies in healthcare and social assistance are at a record high, according to published in March 2021.
At the same time, COVID-19 has highlighted the between white and Black, Indigenous, and people of color (BIPOC) communities in Canada and the U.S. BIPOC healthcare providers play a unique role in closing this gap, but we are not immune to the effects of racism and colonialism. BIPOC physicians and nurses report experiencing , and it is contributing to burnout.
It is well-known that improves cultural safety and subsequent outcomes and that BIPOC remain underrepresented in healthcare professions. Part of the approach to improving health outcomes of BIPOC has been to increase the numbers of BIPOC in healthcare. For example, the (call to action #23) calls for an increase in the number of Indigenous professionals in healthcare, and retention of Indigenous providers in Indigenous communities.
Medical and nursing schools have made efforts to increase the numbers of BIPOC students, and many universities have BIPOC-specific supports in place. But retaining these highly skilled professionals in the workforce hasn't received as much attention.
As a white-passing mixed Indigenous physician, I acknowledge the privilege I carry both at work and outside of work. For many , particularly Black physicians, the experience of racism is amplified. I've frequently witnessed the mistreatment of other Indigenous people by other healthcare providers and dealt with inappropriate comments made by co-workers and patients who lack basic knowledge of the lived experience of Indigenous people. It's exhausting and demoralizing.
It started early in my medical education and continues still. In my first week of medical school, when we were instructed to introduce ourselves and include "something we don't know about you," I included my Indigenous background. A fellow student asked me if that's how I got into medical school -- implying that I must have received special treatment.
During most of medical school, isolated from family and usual supports due to the time demands, the only people I saw from my background were patients. I couldn't wait to get out working in Indigenous communities. After 4 years of medical school and 2 years of residency, I did.
As I progressed in my career, much of my work was in Indigenous communities, both rural and urban. It was hard work, but fulfilling and often fun. As I gained more experience, I started being asked to be involved in various committees and take on leadership roles in Indigenous health.
At first, I was thrilled -- here was my chance to make a difference! But more often than not there were no resources available to implement changes, and higher-ups seemed more interested in the appearance of Indigenous involvement rather than the reality of it. I started to resent being the only Indigenous person in the room and being called on frequently to answer questions that a Google search could've answered.
During this time, my clinical practice remained busy. I took more time than some physicians on hospital rounds because I wanted to make my Indigenous patients feel safe. In clinic, I saw the persistent effects of colonization on my patients, daily: depression and suicidal thoughts, substance use disorders, child apprehension, infectious disease, diabetes -- and it took time and emotional energy to address their concerns and advocate for additional services.
When I started to experience symptoms of burnout, I made changes to my practice to try to salvage my mental health and maintain the quality of my work. I left hospital practice. I gradually extricated myself from various leadership and advocacy roles and settled into working "only" part-time in an office-based practice.
Then COVID hit. Locally, the First Nation council and health directors were leaders in developing a community response plan. They endeavored to protect their community by implementing a stay-at-home order and publishing community COVID-19 infection rates well before non-Indigenous health leaders introduced these measures.
This was met with hateful racism by some members of the larger community, who fell back on the old racist stereotype of the "dirty Indian" spreading disease. More recently, I had to gently correct a colleague who called me an "Indian giver" when I borrowed a piece of medical equipment.
Each little event is manageable on its own, but they pile up. I'm tired. My patients are wonderful, and they deserve an attentive physician, not an exhausted one.
The recently shed light on Indigenous-specific racism in healthcare in British Columbia, including the effect on Indigenous healthcare workers. According to this report, 92% of Indigenous healthcare worker respondents reported that their mental health was significantly affected by experiencing and/or witnessing racism or racial prejudice. Almost all (95%) reported that their emotional health was affected. Most also reported their self-esteem (81%), spiritual health (80%), and job satisfaction (80%) were impacted by experiencing and/or witnessing racism or racial prejudice.
In addition, data from the Statistics Canada Research Data Centre (RDC) at McMaster University suggest that while there are no differences in hours worked, the . Similar are seen in the U.S.
So how do we keep these skilled professionals, who are more likely to work in underserved communities and who contribute greatly to patient care, in the workforce?
- First, we listen. We create safe spaces to talk about racism, and we believe BIPOC people when they talk about their experiences. We create policies that support people to bring their concerns forward without fear of job loss or intimidation. We hold everyone accountable for their words and actions
- Second, we support mentorship programs that connect BIPOC healthcare workers with colleagues from their communities. This includes supporting time away from work duties and financial compensation for mentors. Organizations such as the and are already working to strengthen mentorship programs. Meanwhile, we continue to increase the numbers of BIPOC healthcare providers to better reflect the population our health system serves
- Third, we must recognize that it is not enough to just be "not racist." We must require all healthcare staff to have basic cultural safety and anti-racism education so that BIPOC patients and staff do not have to deal with micro- and macroaggressions daily. We must employ BIPOC-led educational and EDI (equity, diversity, and inclusion) organizations to educate our staff rather than relying on BIPOC colleagues to provide this education and unpaid emotional labor
As workforce shortages worsen, it becomes even more important to retain highly skilled BIPOC healthcare providers to improve health outcomes for BIPOC patients and the health of all patients and the system itself.
Morgan Lindsay, MD, is a family physician.
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