What Are We Saving Our Power For?
Every social movement in American history has had young people at the front — hosed down, spit on, dogs set on them, jailed. The students who launched the Nashville sit-ins in 1960. The young people who were beaten bloody on the Edmund Pettus Bridge. The teenagers who walked into segregated lunch counters knowing exactly what was coming.There is a reason young people take those risks. In most movements, they have the least to lose. No mortgage. No children in college. No thirty-year career that can be erased with a single phone call from the right administrator. While there is no slogan or charismatic leader to define this current moment, we are living through a perpetual movement to achieve equity for Black health. And in this movement, we cannot allow Black resident physicians to be the ones on the front lines.
The Cost Is Already Enormous — And It Isn’t Equal
Simply speaking up for themselves — about a racist attending, an unfair evaluation, a hostile program environment, or even the mistreatment of a Black patient — can cost a Black resident their career, after eight years of training and a debt burden most of their peers will never carry. Median medical education debt nationally runs around $200,000. ¹ But debt is not distributed equally. AAMC data shows Black medical students graduate with the highest debt burden of any racial group — a gap researchers tie directly to the widening racial wealth gap rooted in structural racism. ² Underrepresented students’; average debt runs as much as $30,000 higher than the median, and for a substantial share, total debt — undergraduate and medical school combined — exceeds $300,000. ³
I Know What It Feels Like to Be Left Alone
I advise Black residents to find a mentor who will speak up for them — someone who will not only write letters and share wisdom, but who will put their name and their voice on the line if it comes to that. But they should not have to spend their energy trying to discern the courage of the people above them. The burden should be on us.
When a Black resident in your program is being monitored more closely than their peers, disciplined more harshly, or pushed toward dismissal on evidence that wouldn’t end a White resident’s career — and we know this is the case, because we see it — silence is a choice.
I know this because I have lived it. After ten years as a nephrology attending at San Francisco General Hospital, I tweeted about trainee bias toward women attendings of color. For two months, I was talked about behind my back. Then I was told that I was wrong, and the price for being wrong was my voice — a disclosure I would have to sign, stating I would never again say anything negative about trainees on social media. Not one of the Black or Brown people I knew in high places — deans, chiefs, full professors — said otherwise. They escalated. They avoided. They condoned.
I chose not to sign. Instead, I chose to leave and keep my voice. That was a choice available to me as a published author and accomplished researcher with double board certification. I could still go into practice as a physician. I could even found my own organization. Most resident physicians do not have that option. And if they aren’t allowed to complete residency, they can’t become an independent physician.
Escalating to protect the institution is a choice. Remaining silent is a choice. Every one of those choices has consequences for a real person whose entire future — and the health of every patient they would have gone on to truly see — is on the line.
What We Are Asking of Ourselves
We must speak up in the room where the decision is being made. We must say clearly that what we are watching is not a performance problem — it is a bias problem.
So let’s stop accepting the rhetoric that we have to be twice as good to get half as much, especially when we are the ones in positions to extend the benefit of the doubt or to hand out a warning instead of a dismissal—just like they do for theirs. Our young people should not have to be perfect to survive a system that does not require perfection of everyone.
Black Doc Village exists because the system will not fix itself. We are working on legislation, accountability frameworks, and collective strategies to change the structural conditions that produce this harm. But policy moves slowly, and residents are being dismissed right now. They are being monitored, disciplined, and quietly counseled out right now.
So use your title, and the power that comes with it. That is what it is for.
We can always get another job if need be. Our trainees cannot get their careers back if we don’t stop the system from trying to discard them.
— Dr. Vanessa Grubbs
Founder & President, Black Doc Village