Protecting Our Futures in Medicine: Thriving in the Last Mile

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Article by Jessica Grinspan

It’s a statistic that rings both stark and unsettling: Though nearly 14 percent of U.S. individuals identify as Black or African American, the same group comprises only 5 percent of active U.S. physicians.

And for Black women in America, representation in medicine remains slimmer still — they account for only 3 percent of the entire U.S. physician workforce.

But that’s where Stella Safo, MD MPH comes in — she’s one Black woman doctor who has beaten formidable odds. And now, Safo has made it her mission to repair the broken pipeline, one cohort of clinicians at a time.

Making it the Last Mile

Safo is a Ghanaian immigrant, Brooklyn-based HIV primary care physician, and the founder of Just Equity for Health (JEH) — a company she launched in 2021 “to think about how we utilize education, advocacy, and care model design to improve healthcare delivery for groups that have been historically marginalized in medicine,” she explains.

For Safo, dismantling health inequities is an overarching goal, but equally important is the fight to retain minoritized groups as healthcare workers.

The problem, Safo highlights, is how women-of-color doctors are being pushed out of the medical field early in their careers, whether through discrimination, harassment, or other contributors to a hostile work environment.

“It’s so clear to me that a lot of times, many individuals in medicine — especially Black physicians, women physicians — we make it into the medical field, and then we struggle to stay in the medical field,” Safo explains. “So the last mile is where things often fall apart.”

From Surviving to Thriving

Such was the impetus for Safo’s latest JEH effort, a workshop series she calls Thriving in the Last Mile (TILM), designed to help fledgling physicians prepare for challenging healthcare spaces.

“TILM is really a response to the reality that something is happening when we get to the last mile of medicine — when we get to be residents and training physicians, when we get to be young attendings — that’s pushing us out of healthcare,” Safo describes. “I certainly experienced it myself; and now I’m thinking about how we offer solutions and make it better for people so they can get into healthcare and not just survive, but they can thrive.”

While TILM is open to all medical trainees, Safo notes that her target audience is doctors in training who are also women of color, particularly Black women. “We chose those groups because we felt it was important to really offer our messages that are curated for some of the special circumstances and challenges that those groups, in particular, experience,” Safo says. “It’s meant to create a safe space for us to have some of the conversations we need to have…to be able to thrive in our careers.”

Mastering the Playbook

So how does TILM empower new doctors to thrive, not just survive, in medicine’s ever-demanding last mile? The key, Safo says, is to help trainees understand “the playbook that unfortunately is used to drive people out of healthcare.”

“What I have seen is a lot of people will come to me and describe a set of circumstances that’s either outright discrimination or toxicity, and they won’t know how to navigate it,” Safo explains. “So what TILM offers are examples, tools, resources for how to be aware of if you’re in a bad situation — a toxic work environment — and then what resources may be available to you to do that successfully.”

Following the workshop session, Safo invites attendees to a private online platform where they can share resources, seek help in challenging situations, and validate each other as they navigate their complex careers. “But the whole point of [this effort] is to offer you the playbook of, ‘How do you survive and thrive in medicine?’ and, ‘How do you do so as a woman of color who is early in her career?’

Transforming Trauma

Safo’s quest to transform the last mile of medicine is inspired by her own poignant journey, a journey that was fraught with obstacles early in her career.

“Part of the reason why I created the TILM series is because I went through a very toxic work environment in my first job out of residency, and it was really damaging to my psyche,” she recalls. “It caused me to have physical illness. It destroyed friendships, both professional and personal, and it made me question at one point if I was going to leave healthcare altogether.”

For Safo, medicine had been her deepest passion, her love, since way back in the third grade — “so the fact that I hit this kind of ‘brick wall’ of discrimination, and thought about leaving medicine altogether, really shook me,” she describes. “But instead of leaving, I actually decided to fight.”

And fight she did. In 2022, along with eight other healthcare workers from her institution, Safo launched a federal lawsuit for gender, age, and race discrimination against their former employer. “That process really radicalized me because it showed me there’s a playbook that institutions use against us, against healthcare workers, that they want to get rid of or they want to challenge,” Safo says. “And so TILM, for me, came from that experience of saying, ‘What would young Stella have utilized and have needed to do better than she did now?

“I think young Stella would have really benefited from the TILM series, knowing the playbook, knowing how to survive, knowing that she had a network. I think that would have made a huge difference in her understanding of how to navigate a toxic environment — and could have impacted my career differently,” Safo thinks back. “So that has galvanized me to offer that to others — something that will hopefully support and protect them and allow them to, again, not just survive in medicine, but to really thrive in medicine.

“My long-term vision is to have a community, a thriving community of people who have gone through this, to teach each other this information, who support each other if their colleagues are going through something tough,” she says.

Apply to TILM

Curious to join the next cohort of clinician thrivers? Apply for the next TILM workshop here: https://bit.ly/49sKHaF, or scan the QR code below!

For questions or to request more information, please reach out to research@justequityforhealth.com.

Article by Jessica Grinspan.