Reply

Abstract

I would like to address some of the issues raised in Dr Kuhn's letter in response to my article. 1 I appreciate his letter and the important discussions it will generate.Dr Kuhn and I agree on several things: that the physicians we recruit into ophthalmology should be competent and empathetic, that racial discrimination is harmful and should be ended, and that we should support underrepresented minority (URM) applicants to ophthalmology. Where we seem to differ is the method to accomplish these goals.Dr Kuhn argues that the way to defeat discrimination is to ignore race and ethnicity entirely and hope that inequality goes away. This "color-blind" mentality does not allow us to see and actively address inequalities within our system. As our study and many other studies have shown, ophthalmology as a field is less diverse than other specialties, and we should ask ourselves why. 2 I emphatically reject Dr Kuhn's line of reasoning that implies that this discrepancy is because URM candidates are less qualified or competent than other applicants. There are qualified applicants from underrepresented backgrounds graduating from medical school, but the numbers show they are disproportionately pursuing specialties other than ophthalmology. Furthermore, if our metrics for determining who is qualified for a residency or faculty position result in a workforce that excludes URM physicians, we have to evaluate whether those metrics are objective or necessary. For example, do traditional metrics such as a high board score or attending a prestigious medical school truly determine whether one will be a competent and empathetic physician?The Association of American Medical Colleges advocates for a holistic, mission-driven, diversity-oriented evaluation of residency applicants that considers their experiences, attributes, competencies, and academic metrics. 3 The holistic review process is not a quota system, nor does it lower standardsdit expands them. 3 Race and ethnicity are among the many factors that shape our lives, perspectives, and relationships with coworkers, patients, and the communities in which we practice. 4 For myself, like many other physicians from underrepresented backgrounds, my culture deeply influences my career goals and, I believe, adds value to our field. Indeed, studies show that diversity improves learning