Medical schools diversified. So where are all the diverse doctors?

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For more than two decades, medical schools have worked hard to diversify, expanding pipeline programs, scholarships, and recruitment strategies to increase representation among students from historically excluded groups. These efforts have produced measurable gains in medical school enrollment, with the proportion of Black and Latino students increasing over the past decade.

And yet, diversity in the physician workforce has remained relatively unchanged. Black and Latino physicians continue to comprise a disproportionatelysmall share of practicing physicians. 

There is a leak in the pipeline: residency.

Residency, a mandatory three- to seven-year apprenticeship, depending on specialty, is the sole gateway to board certification and independent medical practice in the United States. Failure to complete residency is not a temporary detour, but rather, a career-ending event for most people — one that is not uniformly experienced.

Unpublished 2015 data from the Accreditation Council for Graduate Medical Education showed that while only 5% of resident physicians are Black, they accounted for 20% of dismissals. Emerging national data reinforce that residency training not only shapes clinicians but also determines who is ultimately allowed to enter the physician workforce. 

Related Story: ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents

In a national study of more than 1,700 resident physicians that I led, we found that Black trainees were significantly more likely than their non-Black peers to report negative disciplinary experiences — ranging from involvement of program leaders to formal remediation. These disparities persisted even after accounting for gender, specialty type, and socioeconomic factors. At the same time, residents across minoritized groups described disciplinary processes that were often subjective, inconsistently applied, and lacking transparent criteria or due process.

A subset of residents I interviewed described being placed on remediation or probation without prior feedback, clear expectations for improvement, or a defined path back to good standing. Others described disciplinary processes that escalated quickly and unpredictably, often tied to subjective assessments of behavior rather than remediable clinical skills. In these accounts — disproportionately shared by Black residents — discipline was not experienced as part of training. It was experienced as a mechanism of exclusion. 

Residency programs are guided by a set of core competencies intended to standardize assessment across training environments. These competencies include medical knowledge, patient care, communication, and professionalism. Within this context, discipline should function as a tool for education by identifying gaps, providing structured support, and ensuring that trainees meet clearly defined competency standards. But in practice, these domains function less as standardized measures and more as flexible constructs shaped by institutional culture and individual judgment. When high-stakes decisions — such as remediation, probation, or dismissal — are tied to criteria that are not clearly defined or consistently applied, they create space for human bias.

But there is a more fundamental question that has received far less attention: Why are residency programs disciplining and dismissing trainees at all in a system explicitly funded to train them?

Related Story: Practicing medicine at a predominantly Black institution gave me the gift I didn’t realize I needed

The United States invests nearly $30 billion in public funds annually in graduate medical education, primarily via Medicare. These funds are intended to support the development of a physician workforce capable of meeting the nation’s health needs. Residents unable to complete training not only limits the return on the public investment but perpetuates the physician shortage, which is projected to reach as high as 86,000 physicians by 2036.

Yet there is no requirement that programs report completion rates, remediation patterns, or disciplinary outcomes by race or other demographic factors. Nor are there standardized expectations for due process in disciplinary systems.

At a moment when diversity, equity, and inclusion efforts are facing increasing political scrutiny, findings of racial disparities in disciplinary actions during residency training are often misinterpreted as failures of affirmative action or individual deficiency, reinforcing the belief that those who struggle in training are less qualified — even though all residents have already met rigorous and standardized criteria of having completed medical school, passed national licensing examinations, and secured positions through a highly competitive national match process. 

Rather than prompting examination of the systems in which those outcomes occur, a common counterargument is that attention to diversity risks lowering standards or excusing poor performance. But the evidence suggests the opposite problem: Standards may be applied more leniently to trainees who align with dominant group expectations, and more harshly to those who do not. A training system that produces consistent racial disparities in disciplinary outcomes must be examined and corrected, regardless of intent.

Several steps consistent with the basic principles of accountability would move the field in this direction:

First, federal agencies that fund graduate medical education should require programs to regularly report training outcomes, including who finishes, who gets disciplined, and who gets dismissed, broken down by race and other relevant characteristics. Without measurement, disparities remain invisible.

Second, accreditation bodies should establish clearer expectations for how disciplinary processes work, including documentation standards, defined criteria for escalating consequences, regular audits of disciplinary decisions to check for bias, and a meaningful appeals process.

Third, residency programs should replace vague behavioral judgments with skill-based improvement plans that give explicit criteria for success.

Finally, residents must have safe ways to raise concerns about how they’re being evaluated and disciplined, without fear of retaliation.

The physician workforce is not shaped solely by who enters medicine. It is shaped by who is allowed to finish. Unless equitable standards are created and enforced, groups historically excluded will continue to be excluded.

Vanessa Grubbs, M.D., MPH, is a board-certified nephrologist and internist; founder and president of Black Doc Village, a nonprofit organization focused on expanding the Black physician workforce; the author of two books, including “Negligent by Design: Anti-Blackness in American Medicine and How to Address It” (North Atlantic Books, 2025); and a member of STAT’s 2023 STATUS List.

From Evidence to Enforcement

The medical training pipeline isn’t broken. It’s working exactly as designed.

That is what two years of national research has forced us to conclude. Through a mixed-methods study of 1,755 resident physicians and 50 in-depth interviews, Black Doc Village examined how discipline, evaluation, and dismissal actually function inside residency training programs. What we found was not subtle, not anecdotal, and not new.

It was patterned.

Black physicians remain a small fraction of trainees, yet disproportionately experience disciplinary action and dismissal. Those differences do not reflect individual failure. They reflect something more entrenched: how standards are applied, how professionalism is defined, and who is afforded the benefit of the doubt — patterns that operate with or without conscious intent.

We completed this study in 2024. And until now, you haven’t seen it.

Not because it wasn’t ready. Not because it wasn’t rigorous. But because I made the choice that physician-scientists are trained to make: wait for peer review, wait for acceptance, wait for permission.

That was a mistake — and it wasn’t only mine to make. Academic publishing was not designed with urgency in mind. The timelines that govern how medical research reaches the public were not built to serve communities for whom delay has a body count. That is a structural problem, not just a personal one. I’m learning to navigate it differently: protecting the peer review process where it matters, without letting it hold this work hostage.

Because while we waited, nothing changed.

Residents continued to be pushed out of training programs with little transparency. Programs continued to operate with wide discretion and minimal accountability. The broader system continued to fund training programs that produce racially disparate outcomes without accountability.

Residency is not just another stage of training. It is a gatekeeper to the profession. When that gate is unevenly enforced, the consequences extend beyond individual careers — they determine who becomes a physician, who advances, and who is excluded. For too long, the solution has been to get more Black students into medical school. That work matters. But if the system continues removing people during residency, the pipeline problem was never upstream. It was always here.

Black Doc Village is no longer waiting.

This relaunch marks a shift — not in our mission, but in our strategy.

We are moving from awareness to action. From publishing to pressure. From describing the problem to forcing change. We have released a national policy brief grounded in our research. It is not a summary. It is a set of demands, rooted in the civil rights issue this is. We call for:

• Greater transparency in residency disciplinary processes

• Standardization of how performance concerns are evaluated and addressed

• Protections for residents navigating remediation, probation, and dismissal

• Accountability structures tied to federal and institutional funding

These are not requests. They are the minimum conditions for a training system that claims to value equity while producing outcomes that contradict it.

We are not a research organization that occasionally publishes. We are not a storytelling platform that documents harm and waits for someone else to act.

We are an accountability engine.

That means producing data that cannot be ignored. Translating that data into policy demands. Engaging directly with the institutions — and the federal funding structures that support them — that govern how physicians are trained and who survives that training.

It also required a personal decision. At the beginning of this year, I left my leadership role at a community health center I care deeply about. Not because that work wasn’t meaningful — it was. I left because Black Doc Village had major foundation funding and completed research that needed full-time attention to become real in the world. Leaving wasn’t a sacrifice. Rather, it was the only decision that made sense. Black Doc Village is no longer a project alongside my career. It is the work.

This is not a call for sympathy. This is not an invitation to consume stories of harm. We are not interested in trauma as proof.

We are interested in evidence. In patterns. In comparisons that reveal how the same behavior is interpreted differently depending on who you are.

If you have experienced or witnessed differences in how residents are evaluated, supported, or disciplined — differences that reveal unequal application of standards — we want to hear from you. Not just what happened. But how it happened differently.

And if you are reading this as a colleague, a leader, or someone positioned within this system: this is your opportunity to decide where you stand. The next phase of this work is not about whether disparities exist. We have answered that. It is about what happens in response.

Here is what you can do:

Subscribe. Stay informed as this work develops. Share. Put this in front of people who need to see it. Engage. Bring us into rooms where decisions are being made. Invest. This work is funded by people who understand what’s at stake.