Primary Care Journals Address Systemic Racism in Medicine

Marcia Frellick

November 03, 2020

Editors-in-chief at 10 leading family medicine journals have banded together to address systemic racism in research, healthcare, and the medical profession.

Dr Sumi Sexton

Sumi Sexton, MD, editor-in-chief of American Family Physician (AFP), told Medscape Medical News she had been working on changes at her journal that would answer the need for action that was made clear by this summer's Black Lives Matter protests and realized the issue was much bigger than one journal. She proposed the collaboration with the other editors.

The editors wrote a joint statement explaining what they plan to do collectively. It was published online October 15 ahead of print and will be published in all 10 journals at the beginning of the year.

Following the action by family medicine editors, the American College of Physicians issued a statement expressing commitment to being an antiracist organization. It calls on all doctors to speak out against hate and discrimination and to act against institutional and systemic racism. The statement also apologizes for the organization's own past actions: "ACP acknowledges and regrets its own historical organizational injustices and inequities, and past racism, discrimination and exclusionary practices throughout its history, whether intentional or unintentional, by act or omission."

Family Medicine Journals Plan Changes

Changes will differ at each family medicine publication, according to Sexton and other interviewees. Some specific changes at AFP, for example, include creating a medical editor role dedicated to diversity, equity, and inclusion to ensure that content is not only accurate but also that more content addresses racism, Sexton said.

AFP is creating a Web page dedicated to diversity and will now capitalize the word "Black" in racial and cultural references. Recent calls for papers have included emphasis on finding authors from underrepresented groups and on mentoring new authors.

"We really need to enable our colleagues," Sexton said.

The journals are also pooling their published research on topics of racism and inclusion and have established a joint bibliography.

The steps are important, Sexton said, because reform in research will start a "cascade of action" that will result in better patient care.

"Our mission is to care for the individual as a whole person," Sexton said. "This is part of that mission."

Increasing Diversity on Editorial Boards

Family physician Kameron Leigh Matthews, MD, chief medical officer for the Veterans Health Administration in Washington, DC, praised the journals' plan.

She noted that the groups are addressing diversity on their editorial boards as well as evaluating content.

Effective change must also happen regarding the people reviewing the content, she told Medscape Medical News. "It has to be both.

Dr Kameron Matthews

"I'm very proud as a family physician that our editors came together and are giving the right response. It's not enough to say we stand against racism. They're actually offering concrete actions that they will take as editors and that will influence healthcare," she said.

Matthews pointed to an example of what can happen when the editorial process fails and racism is introduced in research.

She cited the retraction of an article in the Journal of the American Heart Association entitled, "Evolution of Race and Ethnicity Considerations for the Cardiology Workforce."

The article advocated for ending racial and ethnic preferences in undergraduate and medical school admissions.

The American Heart Associatiion (AHA) said the article concluded "incorrectly that Black and Hispanic trainees in medicine are less qualified than White and Asian trainees."

The article had "rightfully drawn criticism for its misrepresentations and conclusions," the AHA said, adding that it would launch an investigation into how the article came to be published.

Matthews says that's why it's so important that in their statement, the family medicine editors vow to address not only the content but also the editing process to avoid similar systemic lapses.

Matthews added that because the proportion of physicians from underrepresented groups is small — only 5% of physicians are Black and 6% are Hispanic ― it is vital, as recommended in the editors' statement, to mentor researchers from underrepresented groups and to reach out to students and residents to be coauthors.

"To sit back and say there's not enough to recruit from is not sufficient," Matthews said. "You need to recognize that you need to assist with expanding the pool."

She also said she would like to see the journals focus more heavily on solutions to racial disparities in healthcare, rather than on pointing them out.

Dr John Hickner

At the Journal of Family Practice (JFP), editor-in-chief John Hickner, MD, said adding diversity to the editorial board is a top priority. He also reiterated that diversity in top leadership is a concern across all the journals, inasmuch as only one of the 10 editors-in-chief is a person of color.

As an editor, he said, he will personally as well as through family medicine department chairs be seeking authors who are members of underrepresented groups and that he will be assisting those who need help.

"I'm committed to giving them special attention in the editorial process," he said.

Hickner said the 10 journals have also committed to periodically evaluating whether their approaches are making substantial changes. He said the editors have vowed to meet at least once a year to review progress "and hold each other accountable."

Statement authors, in addition to Sexton and Hickner, include these editors-in-chief: Caroline R. Richardson, MD, Annals of Family Medicine; Sarina B. Schrager, MD, FPM; Marjorie A. Bowman, MD, The Journal of the American Board of Family Medicine; Christopher P. Morley, PhD, PRiMER: Evidence Based Practice; Nicholas Pimlott, MD, PhD, Canadian Family Physician; John W. Saultz, MD, Family Medicine; and Barry D. Weiss, MD, FP Essentials.

The authors have disclosed no relevant financial relationships.

What are you seeing in your practice? Has racism been an issue in your career? Tell us about it in the comments.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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