Perspective
Being “The Only”: My Experience as a Black Hematologist

The 2023 ASH Annual Meeting was a whirlwind of commemorated achievements and milestones, including the groundbreaking FDA approvals of CRISPR-Cas9 therapies for sickle cell disease and the 20th anniversary of both the Minority Recruitment Initiative (MRI) and Clinical Research Training Institute (CRTI). With this celebration comes an opportunity for reflection.

Looking back on my own journey, I was a foreign medical school graduate who matched at Mayo Clinic, where I completed my residency, a hematology/oncology fellowship, and later, an Advanced Dysproteinemia fellowship.

Throughout my categorical and advanced fellowships, I was the only Black person among approximately 30 trainees. In 2017, when I came on staff at the Mayo Clinic, I was the only Black woman in the Division of Hematology and remained so until 2022.

Being the only comes with an underlying sense of unease. Although I had beloved colleagues and wonderful allied health staff, I operated with an underpinning fear because there is insecurity in scarcity. If I succeeded, I’d be a success story. A bona fide precedent to solidify space in the room for others like me. But if I fumbled? Did that mean I’d spoiled the pass for others who might have followed?

Already bearing the weight of my worries on my shoulders, I was buckling when a colleague cemented my fears. During my first year on staff, a physician made a micro-aggressive comment, wagering whether I might be a diversity hire and insinuating that it must have been nice to have it easy.

This brief interaction haunted me over the next five years. My already impressive imposter syndrome had grown to be both oppressive and omnipresent across my professional life. Despite successful productivity with posters, oral abstracts, and manuscripts; attaining leadership roles as an associate program director for the Internal Medicine Residency; and leading the Division of Hematology as the diversity, inclusion, and equity chair, I continued to doubt my accomplishments.

It was exhausting! The stress was burdensome, coated in hyperawareness as I wondered if my peers doubted my legitimacy and success. Were my efforts enough to dispel any question of my qualification? Had I done enough to prove that I was not simply diversity, but deserving?

It was lonely and isolating, to say the least. I could not seem to find solid ground until 2018, when I volunteered to become an ASH ambassador to increase local interest in ASH MRI programs at all levels (graduate school, medical schools, etc.). This was my first opportunity to engage with ASH in an official capacity outside of membership, and it was such a fulfilling experience meeting with dedicated ASH staff and hematologists from across the nation committed to addressing disparities in hematology, sharing best practices, and improving recruitment. The following year, I was accepted to CRTI. Upon receiving coaching from members of the ASH Committee on Diversity, Equity, and Inclusion after my first unsuccessful submission, I’d been accepted for my pilot study on financial toxicities and quality of life in patients with plasma cell disorders.

I was elated by the opportunity to gain support for my projects, and to form my own niche in patient reported outcomes and financial distress. My project, which has been presented as an oral abstract at the ASH annual meeting, was eventually submitted for publication and has led to other work and successful collaborations.

The impact of CRTI on my life transcends its effects on my CV. The year-long program, which includes small-group sessions with both peers and faculty mentors, kicks off with a week in La Jolla, California, focused on training you to be successful in your project and future endeavors. The virtual and in-person meetup were pivotal in my early faculty success, and I would recommend the program to anyone interested in clinical research. It certainly helped me to combat my imposter syndrome; however, it is the community that CRTI created for me — the support and sense of belonging — that has been most significant to my career.

CRTI provided me with colleagues, friends, and mentors with whom I continue to remain in touch. It nourished my passions and put me in a position to mentor others. I am proud to say that many of my medical students, residents, and fellows have won ASH awards that have helped shape their careers.

Moreover, the network I have created during my involvement with ASH led to me accept a position on the Minority Recruitment Initiative (MRI) Programs Subcommittee, and I am now a standing member of the Committee on Diversity, Equity, and Inclusion. In these roles, I have witnessed firsthand the commitment of our Society to increasing diversity and supporting equity. The first study section of the MRI committee brought me to tears as I observed the grit of candidates taken into consideration, as well as their degree of disadvantage. The very things that had made my journey hard and limited me were recognized as perseverance. The MRI awards support a pathway to independence and success from graduate school (PhD or Medical School) all the way to the junior faculty level.

CRTI was just the beginning of my relationship with ASH. Through this organization, I have connected with Black hematologists all over the nation. Together, we have provided each other with safe spaces during challenging times, like the murder of George Floyd (which took place only 80 miles from my institution) and the pandemic, in which COVID-19 disproportionately killed minorities, magnifying historic disparities in health care.

Though there is still progress to be made, I trust that great strides are on the horizon. In this 20-year span alone, ASH has contributed $15 million to provide more than 400 awards to increase the diversity of physicians and scientists within hematology. However, ASH and the impact of the MRI supersedes the number of physicians and scientists they have recruited: They’ve aided in empowering me and others to shed the burden that comes with being the only one in the room. As I walked the halls of the San Diego Convention Center in December, it wasn’t just that I was not the only one in the room. I was no longer anchored by the fears I’d had just years before.

Importantly, hematology is not the only specialty that lacks adequate diversity: It is an issue across the board. The number of Black male physicians in practice has been stagnant over the last several years, and there has been only a miniscule increase in the percentage of Black women in the field over the last 120 years (2.7%).¹  The deficit in Black and Hispanic physicians will take 92 years to overcome even with intense improvements in recruitment efforts.²  This lack of growth is a reflection of the numerous systemically racist processes that act as barriers to success in becoming a physician or scientist in the United States.

Yet, it is programs fostered by organizations such as ASH that allow us to progress. Diversity lies not in quotas and tokenism, but rather in support systems, transparency, and community. It’s about uplifting the only voices in the room and empowering them so that there may be many.