Representation is key to improving tomorrow’s physician landscape
Dr. Crystal James started her undergraduate career with her sights set on medical school and both researching and practicing medicine — and she’s never veered from the course. Being accepted to Boston University’s Early Medical School Selection Program (EMSSP) as a college sophomore, she says, only deepened her passion and commitment.
“EMSSP fostered an incredible sense of community for me and, I know, for my future medical school peers,” Dr. James says.
The program, she notes, was originally designed to increase diversity among physicians. Today, EMSSP pulls from a consortium of historically Black, Latino, and Pacific Islander colleges and populations. By starting future physicians early in their college careers, EMSSP gradually transitions participants into medical school and its rigors, ultimately unifying classes at BU.
“There’s so much research to support this kind of approach,” Dr. James notes. “When I was in medical school there was so much book learning in the first two years. Now, though — and with programs like this — there’s so much more problem-based and case-based learning. That, I think, helps students learn — there’s more application, it’s more enjoyable, and that makes it easier to remember.”
Her cohort, she adds, also helped one another keep moving forward.
“We were all here, in a new state and new school, and we all had similar challenges and, in many cases, similar backgrounds,” Dr. James says. “I can’t understate the importance of having people in step with you — who have shared experiences and can really relate, especially during intense periods like medical school.”
Resiliency and finding what comes next
Quickly, Dr. James decided she wanted to pursue surgery and began completing relevant coursework while preparing for exams and, ultimately, Match Week — when soon-to-be medical school graduates receive their residency placement offer.
“I hit a snag,” says Dr. James. “My scores were competitive but I wasn’t placed in a residency. It happens every year — residency positions are mostly paid by the government, and there’s only so much funding available. There are always more applications than there are positions. The more competitive the specialty — like surgery — the more potential residents don’t match. Ultimately, it’s a computer algorithm.”
This, though, didn’t deter Dr. James. She took a one-year position at Brown in their surgical residency program, with an eye on filling any residency position that opened up. After two years she left and went to NYU, where she spent a year in their surgical department.
“When I didn’t find a categorical surgery position, I applied to match in a different specialty,” Dr. James says. “I initially got matched in anesthesiology but, right before I started, the hospital abruptly shut down — so I was one of 500 residents at that hospital who, suddenly, didn’t have a job.”
Fortunately, a former program director at NYU spotted a solution: a recently-vacated surgical residency spot in the city. With a robust letter of recommendation in hand, Dr. James applied and was promptly accepted — and was able to move back to her original passion, surgery.
This residency, Dr. James, also helped her find a surprising focus: vascular surgery.
“When I initially started my vascular rotation as an intern, I really didn’t want to do it,” she says. “My initial perception was that these patients were very sick — diabetes, high blood pressure, coronary artery disease, kidney issues. They’re one of the sickest populations you can care for, as a physician. It was intimidating, looking back. But, as I continued the work, I started to come around to vascular surgery. It’s especially rewarding because, in many surgical areas, you don’t see patients again after surgery. But in vascular, they’re your patients, often for the long term.”
That, Dr. James notes, has been one of the highlights of this specialty — making a profound mark on the lives of countless patients with chronic conditions.
“Just to sit and talk to my patients and take care of them over an extended period of time — and to help get them on the right path,” Dr. James says. “Recently, a patient came back to see me about a non-healing wound and we wound up talking about other things — some cardiac issues, specifically. That led to a conversation about taking her medications — I didn’t prescribe it, but it seemed like she wasn’t taking her other doctor’s advice. But because we have this relationship and she trusts me, I know she’s been much more compliant.”
The same goes for patients who are non-compliant in other areas — refusing medications, physical therapy, exercise, and controlling conditions like diabetes.
“I see such a difference and I’m so much more engaged in patient advocacy now,” Dr. James says. “That’s such a powerful piece of our work.”
Speaking up and out for diversity and inclusion in medicine
Looking ahead, Dr. James is eager to wrap her latest research in non-healing wounds and, from there, has an eye on hospital work within an academic center.
“I want to treat underserved populations,” she says. “And I want to support the push for more diversity in the physician space. There are so few Black surgeons already — and the more you specialize, the fewer you see. I want to start a mentorship or exposure-based program — right now my Attending and I are working to launch a mentorship program with middle school students from underrepresented groups and I’m excited to get that off the ground.” Without programs like EMSSP and early exposure to minority doctors and researchers throughout her academic career, she says, there’s a good chance she wouldn’t have found her way to medical school and beyond.
To future physicians and surgeons who want to follow in Dr. James’ footsteps, her advice is clear: don’t be afraid to ask questions — to rock the boat, even.
“It’s OK to reach out to higher-ups and ask about a policy or something you’d like to see changed,” Dr. James says. “I think that’s especially true when we talk about diversity and representation in medicine — or in any field. In my field, there’s definitely a push for inclusion, but it’s not going to resolve itself overnight. So never be afraid to speak up — nothing will ever change if we just sit back and accept them.”