Eyeworld

22 | EYEWORLD | SEPTEMBER 2020 N EWS Contact Laroche: dlarochemd@aol.com Nivet: Marc.Nivet@UTSouthwestern.edu Wilson: president@wayne.edu Xierali: Imam.Xierali@ UTSouthwestern.edu is typically very high," Dr. Wilson said. "A more holistic review of candidates would be preferable. Plans are underway for the USMLE to become pass/fail, and I think this will offer greater opportunities for deserving minorities to be considered." The focus on standardized testing, Dr. Laroche thinks, starts in middle schools, with some middle schools around the country feeding into more specialized high schools that are designed to prepare students to become doctors, lawyers, and businesspeople. "Some states have moved to a more holistic approach where they take the top students from each neighborhood community," he said. "Those magnet schools become representative overnight, and students can receive the educa- tion, guidance, and preparation to be part of the pipeline to be future physicians, lawyers, and business owners." There are initiatives to increase diversity in ophthalmology, such as the Dr. David Kearney McDonogh Scholarship in Ophthalmology/ ENT, named after the first African Ameri- can ophthalmologist/ENT, and the Minority Ophthalmology Mentoring program organized by the American Academy of Ophthalmology and the Association of University Professors of Ophthalmology. Dr. Laroche said these are ex- cellent efforts, but he thinks there is still a heavy reliance on board and test scores. "There is no correlation with board scores and how good of an eye surgeon one is," he said. He thinks if a student does have a deficit, they should be given a year to put in extra time to overcome it to allow them the opportunity to come into the profession. "[We have to] create opportunities to ex- pose the profession of ophthalmology, mentor- ships, scholarships, and research opportunities, and acknowledge that we have a desperate need for this. We have to create scholarships at the high school level and college level and demand that our educational system creates students who are ready to be our new doctors. … We have to fund those opportunities and further open the doors of ophthalmology." According to the U.S. Office of Minority Health, there are 41.4 million Black/African Americans in the U.S. The data pulled from the American Medical Association masterfile by Xierali et al.'s study found 2.5% of ophthalmol- ogists (out of 17,904) in 2015 were Black. "Those are the numbers, and that's not OK, but no one is talking about it," said Daniel Laroche, MD. "This shortage of Black ophthalmologists translates to lack of access to eyecare in Black communities across the country and higher rates of blindness from cataracts, glaucoma, and diabetic retinopathy. You're not going to be able to offer premium healthcare to the population because people often identify and trust people from their culture and community," Dr. Laro- che said. "Also, when you live in such a diverse country, when you have diversity in leadership, you make better decisions, you make better conclusions, you make better plans because you have less omission that some people might not even think about because you are incorporat- ing everyone's diverse experience. Diversity is extremely important when addressing solutions to complex health issues and disparities." Dr. Laroche said he was among the first wave of Black medical students integrating in medical schools. "When I went to Cornell Medical College, 10% of the class was African American men. I thought we had overcome the hump and were in the process of diversifying the medical workforce with that. But there's been a regres- sion that's taken place over the subsequent time with reverse discrimination claims being made and institutions backing away from affirmative action and a more holistic approach for candi- dates." Dr. Laroche said there has been too much reliance on standardized testing, which he thinks has cultural and societal biases. Dr. Wil- son also expressed a similar sentiment, saying that while there are likely many reasons for a lack of diversity in ophthalmology, one is the increasing importance of United States Medical Licensing Examination (USMLE) scores. "Most residencies use a score cutoff to determine who gets interviewed, and the cutoff continued from page 21 References 1. Zhang X, et al. Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys. Am J Ophthalmol. 2012;154:S53 –62.e1. 2. Xierali IM, et al. Current and future status of diversity in ophthalmologist workforce. JAMA Ophthalmol. 2016;134:1016– 1023. 3. Lett LA, et al. Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties. PLoS One. 2018;13:e0207274. Relevant disclosures Laroche: None Nivet: None Wilson: None Xierali: None

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