By Christopher Cai, M.D.
JAMA Internal Medicine, Perspective, June 21, 2021
This was not how I envisioned my residency interview starting. I wipe my sweaty hands on my pajama pants, smile politely and apologize to the camera. “Sorry. Great question…I was born in Los Angeles,”I clarify, after being asked if I was born in China.
At another interview, I am asked about the race of my partner, with whom I am couples matching, and what it is like to be in an interracial relationship. I cannot help but wonder if my White colleagues are being asked these questions. I hope I will get a question about my health policy interests or, at least, the hobbies I had written about on my application. But instead, I am asked whether I would be interested in working with researchers in Wuhan, China.
After these interviews, I feel tokenized, at times labeled not Chinese enough, at times too Chinese. Why did I apologize for my interviewer’s questions? Why did I remain so polite?
I wonder if my experience is tied to the rise in racially motivated acts against Asian American individuals, particularly Chinese Americans, which have risen nearly 150% during the COVID-19 pandemic.1 Later, when 8 women, 6 of whom were Asian, were murdered at a mass shooting in Georgia, my mother and sister called me and told me, “Stay inside. It doesn’t matter if you live in a progressive or diverse city. You never know what people are thinking.”
These experiences have led me to reflect on what it means to be a Chinese American physician. In medicine, many Asian American physicians enjoy privileges that Black, Latinx, and Native American physicians do not. When I walk by a police officer in the hospital, my pulse does not quicken. When I applied to medical school, I had physician role models who looked like me. When I purchased health insurance earlier this year, I did not worry about racially biased actuarial algorithms. These are just a few examples.
Yet Asian Americans still face discrimination. The 1882 US Chinese Exclusion Act made nearly all Chinese immigration illegal; its effects were fully reversed by 1965, allowing my parents to immigrate to the US. Although Asian/Pacific Islander (AAPI) individuals are overrepresented in medicine compared with the general population, we are underrepresented in academic leadership positions.2 Furthermore, some AAPI subgroups, such as Southeast Asian or Hmong American individuals, continue to be underrepresented in medicine,3 Asian/Pacific Islander individuals continue to be inadequately sampled in federal surveys, making literature on AAPI health disparities relatively sparse.4 Indeed, the category Asian/Pacific Islander itself is problematic, because it merges 60% of the world’s population based on a broad marker of geographic origin, lumping together individuals from places as far apart as Pakistan and American Samoa and erasing vast differences in culture, history, and economic opportunity. 5
Asian American individuals are often told we are a “model minority,” or even sarcastically, “next in line to be White.”6 We may even believe this trope ourselves at times. Yet, this stereotype diminishes the diversity in Asian cultures. It tokenizes Asian American individuals as industrious and harmless; we are a “model minority” because we purportedly seek apolitical careers in the sciences that do not challenge the status quo. Finally, it drives a wedge between Asian American individuals and other racial and ethnic minority groups on worthwhile issues, such as affirmative action, reinforcing White supremacy in the process.
As I process these hate crimes, I feel tempted to fall back into my ingrained “model minority” mindset: how could these hate crimes be occurring if I have done what White America has asked of me? Yet, I know this is a harmful and racist idea; although my family hoped to avoid racism in America, “becoming White” is not part of the American dream. I know many of my colleagues in medicine have faced similar, or worse, discrimination. To heal from anti-Asian hate crimes, I will instead be looking to practice solidarity with other people of color in medicine while acknowledging my own privileges and racial biases.
On the interpersonal level, such solidarity may include addressing microaggressions toward colleagues and patients when they occur on the wards. It includes recognizing and actively unlearning the internalized biases that I have accumulated as a medical trainee. Am I undertreating the pain of my Black patients? Am I speaking over my nonmale colleagues during rounds? It means supporting protests against police brutality, which disproportionately affects Black, Latinx, and Native American patients and colleagues. It means sharing, citing, and celebrating the work of all our colleagues who are underrepresented in medicine, broadly defined.
To heal, we must also practice solidarity by advocating for policies that dismantle structural racism in medicine and broader society. Racism affects all people of color, and it will take multiracial coalitions to create policy solutions. As Asian American individuals, we must continue to organize and advocate for affirmative action, more effective regulation of firearms, reparations for Black and Brown communities, universal health care without cost-sharing, and other evidence-based reforms.7,8
Solidarity means recognizing our privileges and our strengths. It means simultaneously acknowledging the ways we benefit from White supremacy and reforming the policies that uphold White supremacy. It means recognizing that all individuals have a moral imperative to be antiracist. It means celebrating and nurturing our own racial consciousness, which White supremacy often asks us to erase in favor of assimilation, survival, and a less painful future for ourselves and our children.
Additional Contributions: I thank Samuel Dickman, M.D., Planned Parenthood South Texas, for his kind and helpful feedback on the manuscript. He was not compensated for his contribution. I also thank my mother and sister for granting permission to publish this information.
Conflict of Interest Disclosures: In medical school, Mr. Cai served as a paid health policy fellow to U.S. Representative Pramila Jayapal and an unpaid board member and paid summer researcher of Physicians for a National Health Program.
doi:10.1001/jamainternmed.2021.2754
References
- California State University Santa Barbara. Fact sheet: anti-Asian prejudice March 2020. Accessed March 16, 2021. https://www.csusb.edu…
- American Association of Medical Colleges. Increasing Asian inclusion in academic medicine and leadership. Accessed March 16, 2021. https://www.aamc.org…
- American Association of Medical Colleges. Diversity in the physician workforce: facts & figures. Accessed April 11, 2021. https://www.aamcdiversityfactsandfigures.org…
- Chen JA, Zhang E, Liu CH. Potential impact of COVID-19-related racial discrimination on the health of Asian Americans. Am J Public Health. 2020;110 (11):1624-1627. doi:10.2105/AJPH.2020.305858
- United Nations Department of Economic and Social Affairs. World population prospects. Accessed April 12, 2021. https://population.un.org/wpp/
- Hong CP. Minor Feelings: An Asian American Reckoning. One World; 2021.
- Bassett MT, Galea S. Reparations as a public health priority—a strategy for ending Black-White health disparities. N Engl J Med. 2020;383(22): 2101-2103. doi:10.1056/NEJMp2026170
- Woolhandler S, Himmelstein DU, Ahmed S, et al. Public policy and health in the Trump era. Lancet. 2021;397(10275):705-753. doi:10.1016/S0140-6736 (20)32545-9
