Distance traveled: Dr. Lim’s diversity focus as AAD president still relevant today
In an interview with DermWorld Weekly, Dr. Lim shares what inspired his vision for addressing diversity as president and the strides the Academy continues to make to ensure all patients, regardless of race, ethnicity, religion, gender, or sexual orientation, have access to quality medical care.
DermWorld Weekly: For many years, Academy presidents have been tasked with identifying the needs of the membership and specialty, and dedicating their presidencies to addressing them. Why did you choose to address diversity, equity, and inclusion gaps in the specialty during your presidency?
Dr. Lim: My passion for diversity, equity, and inclusion efforts started when I came to Detroit and began to practice there in 1997. Although the city had a strong minority and Black patient population, I recognized that the understanding of diseases and the study of diseases were predominately in fair-skinned individuals. I felt an obligation to learn more and provide better care to our Black patient population. First, we established a multicultural dermatology center within the dermatology department at Henry Ford Hospital, which was the third in the entire country. In addition, we continue to lead research studies to better understand how skin diseases impact skin of color patients so that we can provide more personalized, culturally competent treatments based on their skin type.
When I became Academy president, I recognized that workforce diversity in dermatology, specifically on race, was very low. In fact, only 4-6% of dermatology residents represent underrepresented minorities (URM) backgrounds. This is alarming, especially since URM physicians are more likely to practice in underserved communities where our work is needed the most. Coming from my professional experience in Detroit, I felt very strongly that in order to improve equity in health care and increase access to care, especially in underserved areas, we needed to increase the diversity in our workforce — and that is the reason why I selected that as one of my presidential initiatives.
Prior to my presidency, the Academy was headed in the right direction to take on this issue of diversity in the specialty. The topic was addressed during an AAD Annual Meeting by Dr. Bruce Wintroub and in a JAAD article by Dr. Amit Pandya and colleagues, which focused on the call to action to increase diversity in dermatology. When I became president, I was in a better position, support wise, to bring this to the attention of everybody within dermatology.
DermWorld Weekly: Diversity can mean many different things. Tell us what it means in the context of diversifying the specialty and making a difference for underserved patient populations.
Dr. Lim: Diversity, in my mind, is a very broad term. Clearly, race and ethnic diversity is one [definition], but of course gender, age, and sexual orientation are other areas of diversity as well. To be inclusive, we have to cover all aspects. If we want to address issues effectively and get action items accomplished, we do have to have a focused approach. In addition to focusing primarily on URMs, the Academy is certainly making strides to address other areas of diversity to ensure quality medical care for all our patients regardless of race, ethnicity, religion, gender, or sexual orientation.
DermWorld Weekly: During your time as Academy president (2017 – 2018), you led the charge to shed light on racial and ethnic diversity in the specialty and worked with leadership to identify programming that would address diversity, equity, and inclusion gaps at the Academy. The Academy remains committed to these efforts and recently launched a three-year plan on Diversity, Equity, and Inclusion. While each goal in the plan is important, which goal resonates more to you and why?
Dr. Lim: The first one — promote and facilitate diversity, equity, and inclusion within the Academy, its governance structures and programs — is a very important element of the plan. The focus on “inclusion” is how we can really be effective and create a culture change. It’s more than just increasing the diversity of a group of individuals within dermatology. We also have to make sure that their [URMs] opinions count and their [URMs] opinions are valued — that’s the inclusion part. I always tell my students that 'diversity is more than just counting numbers and checking off boxes. It has to be a culture change that leads to valuing everyone’s opinion.'
The other goal in the plan that resonates with me is the one that touches on workforce pipeline efforts — increase the number of practicing dermatologists who are underrepresented minorities and provide leadership and professional development programming. This particular goal focuses on URMs. In addition to increasing diversity of the workforce, having the entire workforce embrace the culture of DEI is another important step in achieving this goal.
DermWorld Weekly: In 2017, you led the American Academy of Dermatology President's Conference on Diversity in Dermatology to discuss actions the Academy can take to increase URMs in dermatology. Participants rated the Diversity Champion Initiative, which launched during your presidency, as one of the top initiatives to bring more URMs into the field. Now in its third year, and renamed the Diversity Champion Workshop, program attendees continue to rave about how invaluable the workshop is in educating faculty on best practices to recruit and retain URM medical students seeking dermatology careers. How does this program meet your goals to get more URMs invested in the specialty?
Dr. Lim: It exceeds my goal. When we hosted the inaugural event in 2019, I remember it was myself and Dr. Amit Pandya trying to get this going. Like any first-time event, we were not quite sure how much interest we’d get; however, we were pleasantly surprised. We specifically invited residency program directors, key faculty members, and department chairs. We know that they are the decision makers of the dermatology workforce and we wanted to highlight the importance of diversity to this group.
The second time around, we hosted a virtual event to safely gather people during the pandemic. Once again, the numbers showed that this event is invaluable, with faculty from more than 100 programs represented at the event.
What makes me even more proud is the Diversity Champion Workshop, and efforts by other dermatology leaders, resulted in many dermatology departments in the country using a holistic application process, meaning that they look at more than board scores when evaluating dermatology residency applicants. Faculty who participated in the workshop are introduced to different ways to evaluate applications, taking into account what I like to call the “distanced traveled.” For example, having to work three jobs to support themselves in college, having to continue to work through medical school, or being the first-generation college and/or medical student without having much mentorship or any role models along the way. The “distanced traveled” is a huge focus at the Diversity Champion Workshop and a lot of participants see the value in using a holistic approach as a process to evaluate residency candidates in an effort to diversify the dermatology workforce.
I also want to mention that since I hosted the President's Conference on Diversity in Dermatology in 2017, many other societies have convened diversity committees to address this issue head on. These include the Association of Professors of Dermatology, the American Board of Dermatology, and several state societies.
DermWorld Weekly: Remind us about your 2018 JAAD article, “Diversity in Dermatology: Roadmap for Improvement.” It references three action items that could increase the number of practicing board-certified dermatologists who are underrepresented in medicine (UIM). Almost three years later, how is the Academy addressing those three action items in 2021 and beyond?
Dr. Lim: In that article, the first step we focus on is increasing the pipeline of students to medical school. This is the area that we have to continue to invest in. The conference proposed that the Academy support faculty members in their efforts to identify and engage students who are interested in STEM and medical careers long before they get to college and/or medical school. This effort exposes inner-city middle and high school students to dermatologists who look like them and have the same lived experiences as them. It’s powerful.
The second step addressed in the article is this notion of increasing the number of dermatology residents by considering a holistic application review process. As I mentioned earlier, a lot of faculty and department chairs have taken on this approach specifically because we know URM medical students in general don’t score as high on the standardized exams due to other life factors. The resulting change will take a few years to analyze, of course.
The third element is mentorship. The Academy continues to invest in its Mentorship Program designed for URM medical students seeking guidance from a seasoned dermatologist in the field.
DermWorld Weekly: As a specialty, why is it important to be intentional about addressing inequities in and barriers to care that impact underserved communities the most?
Dr. Lim: We need to be intentional in order to achieve a desired result. I want to emphasize here that when we are talking about diversity of workforce, we're not only talking about URM physicians. Diversity of the workforce encompasses all physicians and health care providers who value culturally competent ways to effectively take care of URM patients and underserved patient populations. There have been quite a number of studies that show that minority patients are more satisfied during race concordant visits. But going a step further, even in a race discordant visit, minority patients still found the experience satisfactory as long as the physician was perceived by the patient to be well educated on skin of color issues.
Without a doubt, cultural competency is an element of the specialty we need to focus on to improve health care inequities. The Academy is doing a very active and excellent job on that by investing in resources to develop programs such as the Skin of Color curriculum and module on AAD.org and a photo bank to demonstrate how diseases manifest differently on skin of color patients. These initiatives will increase the education in recognizing the unique aspect of skin of color in dermatology not just for residents, but for any Academy member who wants to be more inclusive in practice.
