What is the impact of shaving waivers on promotions for Black/African American U.S. airmen?

By Kathryn Schwarzenberger, MD, FAAD, October 1, 2022

In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Lt. Col. Simon Ritchie, MD, FAAD, about his Military Medicine paper, ‘Shaving Waivers in the United States Air Force and their impact on promotions of Black/African-American Members.’

DermWorld: First, can you explain to our readers, who may not know, what is a shaving waiver?

DermWorld: Dermatologists are aware of discriminatory practices resulting from natural or ethnic hair practices, some of which led to the recent passage in the House of the CROWN Act. I suspect that most of us have focused on scalp hair and not thought about facial hair as a possible source of discrimination. One of our colleagues, however, recently came across your articles in Military Medicine in which you identified a potential detrimental impact of facial hair on promotion in the Air Force. Tell us about this issue.

Dr. Ritchie: For a long time now there has been an unspoken acknowledgement that men in the U.S. military who are not able to maintain a clean shave are seen as different, and possibly treated differently. This notion predates my service and is even reflected in the literature going back to the 1960s. Furthermore, we all knew that if those who cannot shave are actually treated differently that it would really affect our Black/African American airmen as those are the patients we see most often for shaving problems like PFB.

DermWorld: Why did you look at this topic?

Dr. Ritchie: In 2019, I was the dermatologist at an Air Force base just outside Washington, D.C., and had a stellar staff sergeant working for me. He was a Black male who suffered from PFB when he shaved, so he had been on a shaving waiver for most of his career. He really was a great airman; he was a consummate professional, a leader, and dedicated to ensuring our patients had the best experience possible in our clinic. As I got to know him better, and as we treated more and more patients for shaving issues, I began to understand the problems that his shaving waiver had caused him. He told me stories I couldn't believe, like how he wasn’t allowed to become a recruiter because his beard was “unprofessional” and that in his previous clinic he was told to leave the clinic when a general officer was meeting the staff (which is a big deal for a young, enlisted member). He felt like he was on the outside looking in and ultimately decided that he needed to leave the Air Force and find somewhere he fit in better. This was devastating to watch happen; a smart, talented, experienced, non-commissioned officer run out of the Air Force due to a policy that doesn’t seem to add a lot of value. It was then that I decided we needed to look into this more and figure out if this policy is hurting our people, why we have it, and what changes we could consider.

DermWorld: Can you tell us about your studies? What did you find?

Dr. Ritchie: To do that we needed to understand the impact that shaving waivers really have on someone’s career, so I wrote a protocol that a small group of us used to conduct a study of over 10,000 airmen. The result was pretty clear: Shaving waivers are associated with delays in promotions (p=0.0003). We controlled for every covariate we could think of that could correlate with promotion rate, including race. Interestingly we found that the effect of a shaving waiver was not dependent on race (i.e., a white, Black, Asian, and Hispanic airman). Having a shaving waiver will have a similar delay in all their promotion rates. Although Black/African American airmen are only about 15% of the total Air Force, they hold 66% of all the shaving waivers. Therefore, any negative impact from shaving waivers will disproportionately negatively affect them. So, the take-away from the study was that the male grooming standards of the U.S. Air Force led to an unintentional racially discriminatory effect against our Black/African American airmen.

DermWorld: Were you surprised by any of these results?

Dr. Ritchie: Sort of. Again, I think we all knew that airmen on shaving waivers were seen as different, and probably treated differently, but I was surprised that we were able to prove it (at least to the extent that a survey tool can do so). This had never been studied before and I assumed the effect would be so small that I think I just assumed we wouldn’t be able to tease it out. However, the effect is actually pretty large so it wasn’t hard to find it.

DermWorld: Can you explain to those not in the military why the Air Force prohibits facial hair? Are there any accepted indications for having facial hair?

Dr. Ritchie: That’s a great question, and I don’t have what I would consider a satisfactory answer to it. Going back in history, it’s clear that the U.S. military allowed beards at one time. Around the post-World War I era is when shaving requirements started, likely in response to the introduction of chemical warfare and the resulting need for protective masks. To this day, the need for chemical gas mask seal is the most common reason I hear for not allowing facial hair. However, this argument does not hold up well to even mild scrutiny. Right now, there are maybe a handful of U.S. Air Force personnel in the entire world who have a functional (non-training) gas mask on their person, and maybe even none. I was previously stationed in South Korea where we maintained the highest defense against chemical attack of any base in the world, and even there we didn’t have immediate access to our chemical gear. If an attack were to occur, we would have sufficient notice to get to our gear and even shave if that’s what’s necessary to achieve a proper seal. In addition, our special operators commonly maintain facial hair in combat environments, so it’s hard to believe that there is a legitimate risk to the mission. Lastly, we don’t even know the actual impact of facial hair on the seal of the military’s gas mask (the M-50). There are no published studies on the topic, which is a major blind spot when we’re trying to make an important decision like this.

DermWorld: While I suspect no racial discrimination was intended, your study does show that Black/African American military members are disproportionately affected by such regulations. Are there any other hair or skin conditions you have encountered that might potentially impact a service member’s success in the military which would warrant study?

Dr. Ritchie: There are still some barriers to service that are related to hair and skin conditions, but we have made some progress. About a year ago, a group that included several Air Force dermatologists led an effort to change the women’s hair standards to allow longer and looser hair styles as opposed to the tight bun that most women were required to maintain. The latter hair style led to serious issues like frontal alopecia and migraines. We have also loosened the restriction around accepting people into the Air Force who had a history of atopic dermatitis. The concern for a long time was that these members would be at risk for a reaction to the smallpox vaccine, but in reality, this risk appears to be quite low especially when we are talking about a remote history of the disease.

DermWorld: Do you have any advice for nonmilitary dermatologists who might be providing care to active-duty service members regarding this or other dermatologic issues?

Dr. Ritchie: I think there’s a lot we can offer to these patients whether you are a military or civilian dermatologist. First is to understand that these patients often suffer for years before seeking help because many of them know a waiver will hurt their career. Second is to explain their options. Upon your recommendation, a military provider can place them on a shaving waiver, they can try treatments for the condition, or they can seek laser hair removal. The latter obviously has issues (discomfort, inability to grow a full beard in the future, treatment course interrupted by moves or deployments) but is covered by TriCare. If they are suffering from shaving irritation and not true PFB, then I try educating them and using a light topical corticosteroid as needed in order to keep them shaving. I’m still unsure if discussing the study I conducted is a good idea or not; on one hand I want them to have all the data to make a decision, but on the other I don’t want to put up another barrier to their service or even facilitate their exit from the Air Force. My team and I are hopeful that we can continue this discussion with senior Air Force leadership to come to a solution that values our people and ensures mission readiness.

Lt. Col. Simon Ritchie, MD, FAAD, is a U.S. Air Force dermatologist and serves as assistant professor of Dermatology at Uniformed Services University of the Health Sciences. His paper appeared in Military Medicine.

Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.

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