The 'Leaky Pipe' of Diversity

What makes an anchor institution? How does UCSF build upon not only itself, but also reach beyond and strengthen the community in which it resides?

These questions were central to the 12th Annual Chancellor’s Leadership Forum on Diversity and Inclusion on April 25, which focused in part on the “leaky pipeline” — the loss of diversity that occurs as one moves through tiers of educational and/or career advancement.

“Our goal is to make UCSF representative of our city and of our state in which we live and these efforts require continuous engagement by all of us,” Chancellor Sam Hawgood said in his opening remarks.

The forum this year marked a more momentous shift in UCSF recognizing a need for self-improvement, pushed by strong voices dedicated to diversity, inclusion, and outreach.

The statistics demonstrate this need — for our underrepresented minority (URM) learners, 2018 demographic data show that African-Americans comprise only 5% of the student population, only a 1% increase since 2010, and Hispanic learners have seen just a modest increase of 3% to 11% in that same timeframe.

URM numbers in staff mirror those of the learner population. In faculty demographics, numbers are even lower, made up of 3% and 6% of African-American and Hispanic faculty, respectively.

These disparities are exacerbated in higher levels of staff management and executive leadership, where there is a consistent trend of “leaks” in URM representation: in the highest (M4) level of staff management, URMs are nowhere to be seen.

Women, who maintain 50% parity in faculty and represent the majority in staff and learners, also become a minority in senior management.

Notably absent for another year were statistics from non-binary and transgender individuals.

In reading these statistics, Renee Navarro, Vice Chancellor of the Office of Diversity and Outreach, concludes that we aren’t where we need to be as a healthcare institution that will be serving increasingly diverse populations.

Plugging the Pipeline Leaks

To combat this stagnation, Dr. Navarro highlighted a number of initiatives across the UCSF community:

On the level of senior management, several members of the staff leadership, along with other UC leaders, have participated in creating a guide (Leading with Diversity: UC as a National Model for Cultivating Diverse Leaders) with recommendations for diversifying UC leadership.

For students, more programs have taken a holistic approach to recruitment and admissions, noting that different life experiences bring value to a class and as practitioners.

Notable gains have been made in Graduate Medical Education, where efforts have resulted in matching up to 29% URM residents in the program.

Investments such as the Advancing Faculty Diversity Grant have provided a much-needed recruitment resource for faculty, and faculty advisors have been trained in best practices for strategically recruiting a diverse faculty pool.

For staff, support has been provided through events like the Staff Resource Day and the voices of staff RCOs have been brought to the Council for Campus Climate, Culture, and Inclusion.

The Office of Diversity and Outreach and the School of Medicine also partnered to hold a Diversity Retreat last year to outline UCSF’s vision for diversity and inclusion in the future. They focused on two major subjects:

1) How UCSF can set the groundwork for every member of the university to understand and engage in conversations around diversity, microaggressions, racism, sexism, homophobia, etc.

2) Assessing the individual experiences of the campus community through climate survey administered every three years. A task force has been assigned to investigate and implement each major goal.

As I wrote on the need for mandatory training last year, hopefully the discussions during the retreat move in that direction, bolstered by data from the future climate surveys.

In the area of sexual harassment, UCSF has joined the Action Collaborative on Preventing Sexual Harassment in implementing strategies to reduce incidents based on the report from the National Academy of Sciences.

While UCSF has long-possessed its own alarming data indicating an urgent need for change, this is a step in the right direction.

Support for the LGBTQIA+ community was emphasized through efforts like the Pronouns Campaign, the Trans @ UCSF website, and mapping out gender-inclusive restrooms. For individuals with Disabilities, ongoing talks are being held by the UCSF Committee for Disability Issues to improve accessibility.

UCSF has frequently struggled with developing and enriching spaces for community, and this holds true for its Multicultural Resource Center.

Fortunately, investments are now coming to fruition with renovations of the Parnassus MRC and the construction of an MRC at Mission Bay, no longer siloing the space strictly to one campus.

Encouragingly, Dr. Navarro also recognized the impact of student voices, which have been calling for changes in curriculum to be non-discriminatory and non-oppressive for years.

Student efforts were spotlighted including the Student Leadership Forum on Diversity and Inclusion and the formation of the Interprofessional Diversity and Equity Alliance (IDEA), a group of students across all schools and programs dedicated to bridging diversity initiatives and resources among the diversity leadership (if you are a student interested in this group, please contact at aaron.mattingly@ucsf.edu).

Following her report, Navarro deferred to the leadership panel to discuss outreach initiatives and the pipeline in greater detail.

The panel began with Don Woodson, MEd, Director, Center for Science Education & Outreach (CSO), who spoke on the successes of the center.

The CSEO engages in a number of programs and activities that support, prepare, and motivate individuals that are underrepresented and disadvantaged. And Woodson stressed, these are longitudinal efforts.

“I don't mean they came to an event and we waived to them and they walked back out. I mean we have worked with them, had multiple touch points with them over a two-to-four-year period working with those students to make sure they are prepared,” Woodson said.

Of the 16,000 students involved, 94% went on to higher education, and 64% chose a college major in a healthcare field when only 22% indicated an interest in their freshman year, showing that the pipeline-driven programs are immensely effective.

As with many diversity-related efforts, a barrier is always funding, and Woodson noted that many of the programs rely on grants that run out.

“It’s Important that we start thinking about where do we really want to put our funds to move the future forward for the young people in the community that we have at UCSF, and we truly want everybody here to be involved,” Woodson said.

Joseph Guglielmo, Dean of the School of Pharmacy, spoke of similar successes and challenges for UCSF’s Post Baccalaureate Program, a joint effort between the schools of Dentistry, Medicine, and Pharmacy to better-prepare those with bachelor’s degrees for careers in healthcare.

The program, which specifically targets the disadvantaged and underrepresented, boasts a 75% acceptance rate for post-baccs pursuing a health profession in School of Dentistry and 95% acceptance for students in both the School of Medicine and Pharmacy.

Despite these numbers, the cost of entry is high, with students taking on $33-44,000 in debt for their single post-bacc year.

The School of Pharmacy, at least, has taken on the burden of half of these costs for those seeking a profession in pharmacy, demonstrating one example of Woodson’s call to invest in the future.

Interestingly, Dr. Tung Nguyen, a diversity leader in the School of Medicine, tried to minimize the idea of a pipeline in his report. To Nguyen, a scarcity of potential URM applicants is a myth.

“I don't really want to hear the word pipeline when comes to this. There are lots of people there. What are we doing with them to make sure we get here?” he said.

His report first focused on the SF Building Infrastructure Leading to Diversity (BUILD) Program, dedicated to increasing diversity in biomedical research through the recruitment and mentoring of URM students and faculty.

The program identifies and recruits URM trainees and encourages their career development through highlighting strengths, addressing stereotype threat, and matching students into labs for research experience.

“The principle for the SF BUILD is simple,” Nguyen said. “If you want URM people, you don't go to places where they aren’t and find them, you go to where they are and find them.”

His sentiments carried over to the faculty level, where he emphasized the massive deficit in URM faculty in basic sciences — just 4 out of 210 at UCSF.

To remedy this, Dr. Carol Gross and Dr. Michael Penn are leading an initiative to recruit more URM faculty in the basic sciences, signed off by leadership throughout UCSF with a large money allocation.

Still, Nguyen stressed a continued need for a strong investment of resources into URM recruitment, or else change will not happen.

“If we are looking at our faculty diversity and we are saying that it’s pipeline problem, I think we got the wrong problem, because the Phds are out there,” he said. “What we are not doing is hiring them.”

Rounding out the tiers of career advancement, Cynthia Chiarappa, Vice President and Administration to UCSF Health, spoke in detail of the work done by the UC Coro Leadership Program regarding the senior management group (SMG), 200 members of leadership across the UC system, work that led to the guide, “Leading with Diversity: UC as a National Model for Cultivating Diverse Leaders”.

Based on these findings in the guide, Chiarappa assured that many recommendations are already being applied: requiring diverse search committees with diversity training and equity advisors, requiring diversity statements from candidates, and requiring diverse candidate pools.

On the accountability side, the guide suggests the development of inclusion-focused criteria around SMG leaders and performance evaluations, with a strong emphasis on standardized, transparent reporting.

With movement on these recommendations, Chiarappa is hoping we finally turn talk into action.

To cap off the panel, Dr. Howard Pinderhughes returned to the idea of an anchor institution. As he defines it, “anchor institutions are institutions into a community that have the capacity to help create wealth and health of the surrounding community.”

Although the previous panelists covered one aspect of an anchor institution, outreach, Dr. Pinderhughes spoke of a unique strength of UCSF: its infrastructure.

As the second-largest employer in San Francisco, UCSF wields great economic power, and Pinderhughes believes that the university can better-utilize this power to prop up the underserved communities in the area.

In re-orienting itself as an anchor institution, UCSF will provide employment, business, and investment opportunities to people that are most impacted by health inequities, most vulnerable, and most difficult to employ.

Yet for all of these opportunities, these same disadvantaged groups may be ill-prepared to take advantage of them. Doing so, Pinderhughes asserts, will require pipelines beyond what was discussed during the forum — pipelines built from partnerships within the community.

“We can do way more and at a time when we are losing our core black and brown communities out of the city of San Francisco, we have potential to be an anchor for those communities, sustain them, maintain them and promote their health and well being,” he said.

Questions and Non-Answers

During the Q&A portion of the event, a few questions singled out some particular flaws in the format of the forum.

Carlos Zuazo, a biomedical science student, began with a story: a first-generation son of service workers, Zuazo’s family nearly had to leave the state after the foreclosure of their home during the 2008 financial crisis; however, through full-time contracts at institutions that extended benefits to family, they avoided relocation.

Thus, Zuazo was able to continue down the pipeline through college, taking advantage of grants and post-bacc programs that supported his success.

“With all that in mind, how would you reconcile if you were me of this moral dilemma — of attending a university that praises you and for all of these academic achievements while in the same breath slashing policies that allows you to achieve this success on the basis they are I’ll quote from UCOP ‘selfish and unreasonable’?” he said.

After an awkward silence, Nguyen asked Zuazo to restate the question.

“If you were me seeing how these workers are being in ongoing negotiations and forced to leave their homes as Howard mentioned,” Zuazo said, “how would you reconcile sitting on the sidelines as this happened while you benefited from those programs that are being cut, and possibly preventing future students like yourself first generation from even making the most of these programs that you offer in the first place?”

Both Pinderhughes and Nguyen responded respectably, which can effectively be summarized as “be the change you want to happen.”

This exchange shows a pattern I’ve seen at every Chancellor’s Diversity Forum I’ve attended in the past.

As an annual event with nothing resembling it for the rest of the year, the forum represents a single point of entry to publicly ask questions to UCSF leadership, but there is an incongruity with the questions and the panelists tasked to answer them.

Each forum centers on a specific theme — this year is the leaky pipeline, last year was improving staff equity, and the year before was reacting to the new political landscape.

And each year, panelists selected for the theme are given questions clearly aimed for executive leadership, resulting in unsatisfactory answers and unaddressed issues.

Zuazo’s rhetorical questions seemed to be aimed at those in charge of cutting the programs from which he benefited, but the people more equipped to answer were either not present or willing step to the podium.

This problem was especially apparent following a question by Lisa Schwartz, a nursing student and member of the Associated Students of the School of Nursing.

Schwartz asked (in addition to a question about reporting harassment and discrimination), “if there are efforts to reallocate funds that go primarily to school of medicine students to try to support all school’s students, because that's a big way that we can help with inclusion throughout the entire university.”

Following another awkward silence, the panel deferred to Navarro. After speaking on the first part of the question, she attempted to address the second.

“Reallocation of resources… Deans? Chancellor?”

After a long moment of silence, Navarro gave her best effort, noting that all the schools have various initiatives for supporting the students, and that the Office of Diversity and Outreach supports all students through its resource centers.

I am not writing this to shame Navarro, who genuinely gave her best answer to the question, which was valid: The Differences Matter initiative, consistently used as one of UCSF’s triumphs in promoting diversity and inclusion, is aimed primarily at clinical teachers and students within the School of Medicine, and the newly-established Latinx Center of Excellence is focused on the pipeline to becoming a physician, to name a few exclusive efforts with large amounts of investment.

Shouldn’t we do our best to offer equivalent support for all students?

This question of resources was for top leadership, but Navarro was left out to dry.

It is obvious that the UCSF community needs a space where it can truly be heard, where leadership is able to step up and answer these complex questions.

There are too many concerns across students, faculty, and staff to be contained within 30 minutes of an annual event that encapsulates just one part of the diversity and inclusion picture.

I propose an annual Diversity Town Hall in addition to a Diversity Forum, where UCSF’s Deans and Chancellors are actually available to answer the community’s questions adequately.

We deserve time and space to air our issues, as the current status-quo of the forum is unfair to both the panelists and the audience.

If you agree, I encourage you to bring this idea to your leadership to help make it a reality.

This year’s forum represented great strides in UCSF affirming its dedication to community — we need to maintain this momentum both outside and inside the university if it will become the exemplary anchor institution it has the potential to be.