After forcing myself out of bed, I made it to my rounds with less than a minute to spare. It had been only three months since I started seeing patients and teaching trainees at a major academic medical center, and already I was feeling overwhelmed.

I had discovered that my assigned 1 1/2 days of clinical duties in a psychiatric clinic actually required three days of work to oversee the care of more than 100 mostly poor Black and brown patients. Many had substance use disorders and very serious mental illnesses. As a woman of color, I wanted to serve them well because they seemed to trust me more than their prior providers. That meant I often found myself working far into the evening. In addition, as an attending at a major teaching hospital, I had numerous other obligations. On paper, I had my dream job. In reality, I often felt dragged down.

Not much earlier, while in residency, I dreamt of becoming a leader in the field of diversity education, hoping one day to be a dean of diversity or a dean of students. I had become the go-to person in my academic medical community for lectures on bias, consultation on diversity curricula, guidance on working with minority patients, and more. I also published research papers and narrative articles to educate my community about diversity. Though demanding, I loved this work. I truly believed that academia could support patients, providers, and communities of color with the help of engaged stakeholders like me.

Only things did not go as Id planned.

While working in the psychiatric clinic, where I was the fourth attending in almost as many years, I had two other jobs: I led efforts to develop a social justice curriculum for the Department of Psychiatrys residency program, and I served as the director of the standardized patient program for the School of Medicine, which involved recruiting and training laypeople to act as patients for students learning to become physicians. I often felt overworked and unsupported.

I had become the go-to person in my academic medical community for lectures on bias, consultation on diversity curricula, guidance on working with minority patients, and more. ... Though demanding, I loved this work.

Through all this, I also wanted to continue to serve as a mentor to Black and brown medical students, residents, and colleagues, sharing any professional guidance I could offer. Soon, they began to come with their personal, gut-wrenching stories of discrimination. I even found myself in a position of having to decide whether to report a former supervisor who was now a colleague.

I felt terribly alone. So few of my colleagues shared my identities: Im a Black, queer woman, and many of them were White men. As a new faculty member, I often felt unable to turn to my prior sources of social support given that they were now technically my subordinates. And I bore the stress of feeling other outside work as well. I was frequently the only African American when I went out to a restaurant, and the national sociopolitical climate felt increasingly hostile to people like me.

The stress was longer than a moment or moments it was endless. It started to affect my ability to function well. I lost track of emails, and I tossed and turned most nights. My immune system became weak from all the stress. I got the flu, twice.

So, I decided to leave.

As long as the culture discouraged asking for help, didnt fully value those who focus on innovative diversity education, and failed to provide sufficient support to minority faculty, I would never feel truly safe. I knew members of my medical community appreciated me and my work, but unless they intended to use their privilege to prevent Black and brown faculty from leaving, it was not worth it to stay.

Although it was the most difficult decision I have ever had to make, I know it was the right one.

I felt terribly alone. So few of my colleagues shared my identities: Im a Black, queer woman, and many of them were White men.

Yet I continue to feel like I abandoned my Black and brown patients, trainees, and colleagues. I cry when I learn of the distress of my friends and former colleagues. Often when we catch up, I cannot help but feel re-traumatized by their experiences and weighed down by a heavy sense of guilt for leaving. Im also terribly sad that nonminority allies dont speak up or provide them with support.

I have since found a relationship with an academic institution that feels safe, but I still struggle. I continue to see patients and handpick teaching opportunities. I cautiously choose diversity efforts that allow me to go beyond conversations about implicit bias and really get into the complicated nature of systemic racism. Meanwhile, I find myself hoping for progress in academic medicine, though Im not completely optimistic.

Senior physician-leaders of most academic communities continue to look the same, unlike the rest of the United States, which is becoming increasingly diverse. Senior leadership in many places also continue to express support for diversity without actually providing real support for diverse faculty, educational initiatives, or institution-wide policies that foster inclusivity and equity.

Often, academic medicine focuses on implementing effective medical education for trainees and thats important. But medical schools and teaching hospitals need to do much more to create a culture of inclusivity at every level across the entire institution.

They need to create clear, strong policies that support employees from racial and ethnic minority backgrounds. Then they need to train all staff in those policies, support reporting of breaches, and make sure to enforce the institutions rules and values.

Medical schools and teaching hospitals need to do much more to create a culture of inclusivity at every level across the entire institution. Verbal support is not enough anymore.

Institutions also need to make long-term investments in hiring and promoting faculty of color, providing administrative support for faculty of color, and funding diversity education at levels comparable to that of other initiatives.

All this needs to happen not just during newsworthy moments of controversy, legal action, or protest. What happens when the public shifts its attention away? More importantly, what happens to those who need initiatives that never get implemented or that run out of funding in a few years?

We need real change with strong policies and programs backed by solid funding for them. Verbal support is not enough anymore. If we dont make these changes, minority members like me who once hoped to help educate trainees and support patients will leave as they find they cannot shoulder the burden alone.

Kali Cyrus, MD, MPH, is a practicing community psychiatrist in Washington, D.C., an assistant professor at Johns Hopkins University School of Medicine, a founding member of Time's Up Healthcare, and a diversity consultant.

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Why I gave up my dream of leading diversity efforts in medicine - AAMC