Inspirational Black Men and Women in Medicine: Dr Richard Silvera of Mount Sinai Hospital On 5 Things You Need To Create A Successful Career In Medicine

An Interview With Jamie Hemmings

We need diversity in medicine so that we can prepare for the future. We have a physician shortage and there are many parts of our country that do not have access to enough or the right kinds of providers. If we continue to only see certain groups as future doctors, we simply will not be able to keep up with the needs of our communities. We need more providers in general and we, as a society, need to broaden our idea of who could be a doctor and who could be a leader to get there.

In the United States today, black doctors are vastly underrepresented. Only 5% of physicians nationwide are black. Why is it so important to have better representation? What steps can be taken to fix this discrepancy? In this interview series, we are talking to successful black men and women in medicine about their career, their accomplishments, and how others may follow their path. As a part of this series, I had the distinct pleasure of interviewing Dr. Richard Silvera of Mount Sinai Hospital.

Born and raised in New York City, Dr. Richard Silvera, M.D., is an infectious disease specialist at Mount Sinai Hospital. Currently, Dr. Silvera is researching new ways to detect anal cancers using new technologies. In October 2021, Dr. Richard was selected to receive the Bristol Myers Squibb Foundation’s Robert A. Winn Diversity in Clinical Trials Career Development Award (Winn CDA), which is one of two awards in the Robert A. Winn Diversity in Clinical Trials Award Program (Winn Award Program) that aims to increase the diversity of patients enrolled in clinical trials.

Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit more. Can you tell us a bit about your childhood “backstory”?

I am a first-generation American; my mother is from Belize and my father is from Jamaica. I had the common experience of families who have recently come to the United States that placed a major focus on education. There was an expectation that we would find some way to serve others and try to leave the world better than we found it. It just took me a little while to determine how I would do that.

Can you tell us a story about what brought you to this specific career path?

My career path has been a bit unusual, but in retrospect there is a common thread. I studied literature in college. I loved teaching and found literature was a great way of getting to understand other people’s perspectives. In my last semester, I took a class on representation of infectious disease in text and was introduced to AIDS literature. It blew me away — the medical, social, political, and economic complexity of it. As a young gay man, I also very much saw myself in these stories; in all but a few circumstances these could be my story.

After graduating, I tried to find a way to wed my love of personal stories and my passion for HIV work and found that in clinical research and public health. These fields allow us to distill the universal elements of individual stories to find underlying truth to help communities. I did some very rewarding work on research but realized I wanted to design and ask the questions, which led me to medicine and infectious diseases, which has given me the skills to lead research studies. The Winn Award Program has been a major step along that path as its goal is to give people who traditionally are not part of the world of clinical research entry to the field.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

As silly as it is, a quote that has followed me throughout my work is from a game I played as a teenager. The game advised “give freely of your knowledge, but wrap it up like a precious gift.” That really informed my career. I want to make sure all the things I’m learning, all the knowledge I have, is given freely to my students, my colleagues, and the communities I serve. But I also want to treat that knowledge reverently and with respect. The information and trust patients and research participants give us is sacred and I have to continue that. It is a delicate balance to walk but I really feel that is the goal of academic medicine.

Can you share the most interesting story that happened to you since you began your career?

This is a recent story, but I’ve experienced it in different versions throughout my career and I think it really highlights why it’s so important to increase diversity not only in clinical research, but medicine in general.

One of my patients is a young, black man. I saw him for a routine primary care visit and he complained about these strange bumps he’d been experiencing and that no doctor he’d seen had been able to help him. He was very distressed. He’d gone to urgent care and seen a few other providers who just reassured him that it probably wasn’t dangerous. As an Infectious Disease doctor, he asked me to take a look. When he showed me the back of his neck I knew exactly what he was experiencing: razor bumps. I’d also experienced this while getting haircuts. I think most black men have. I got to reassure him, not just as a doctor but also as another black man and share both medical knowledge but also some community knowledge about this common experience that folks who traditionally are in medicine may not share in. It brought us closer together not just as doctor and patient, but as two black men with a common experience.

There are so many experiences like this specific to our own backgrounds and cultures and having these things in common with the patients we care for is so important. No class or book can capture all this; we need health care and research staff who come from a variety of backgrounds and cultures to bring that knowledge into the clinic room and research planning room.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

Three traits that I think have led to my leadership successes are listening, empathy, and compromise. There is no “correct” way to lead; we need both diplomats and firebrands. These are the things that have worked for me.

When I say listening, I mean both things people say and things they don’t say. All the different ways people communicate. If you’re a leader you need to understand what the people you are working with are saying to you and they often won’t send it to you in a clear email. You have to really actively pay attention.

Empathy is one of my most powerful tools as a physician, as a researcher, and as a leader. Whenever someone makes a choice I don’t agree with, I always try and imagine their life, the things that brought them to that decision, and the competing factors in their lives that were at play. You need empathy to lead and to care for patients otherwise you are only making plans for or leading yourself. Leaders serve the people they are leading and to be effective you have to be able to see their perspective as well as your own.

Particularly in medicine, compromise is absolutely necessary. Medicine has numerous stakeholders and to accomplish something you have to build a common ground. This is a really challenging tightrope to walk as you have to maintain your ideals while somehow working in the very real, very complicated world. This is why we need both firebrands and diplomats. Firebrands to remind us what we’re reaching for and diplomats to help us take steps to get there.

Thank you for all that. Let’s now shift to the main focus of our interview. This might seem intuitive to you, but it would be helpful to articulate this expressly. Can you share three reasons with our readers why it’s really important for there to be more diversity in medicine?

I think there are numerous reasons why diversity in medicine is extremely important, but these three stand out in my mind.

First, as I described in my story above, a diverse medical workforce brings shared experiences, common language, and other ways that connect to patients. These common experiences can help with communication and be a tool to overcome well-deserved medical mistrust that many communities (reasonably) have.

Secondly, medical and medical research leadership needs diversity and the first step towards that is diversifying the medical workforce. I mentioned earlier how our perspectives can better inform connecting with patients; I also think we need those perspectives to inform which research questions get asked, how institutions interact with communities, and health policy. We need those diverse backgrounds on the front lines as well as at the top. I think the Winn Award Program specifically addresses this. There are so many steps along the path to success in medicine you may not see if you don’t have someone who has gone before to tell you about it. Unfortunately, many of us who aren’t second or third generation physicians may not have someone to tell us about those things. The Winn Award Program provides visible, purposeful guidance to train future leaders in academic medicine and make that hidden curriculum visible.

Finally, we need diversity in medicine so that we can prepare for the future. We have a physician shortage and there are many parts of our country that do not have access to enough or the right kinds of providers. If we continue to only see certain groups as future doctors, we simply will not be able to keep up with the needs of our communities. We need more providers in general and we, as a society, need to broaden our idea of who could be a doctor and who could be a leader to get there.

As things stand today, what are the main barriers for black men and women to enter the medical field?

The medical field is a very long, challenging road and there are several barriers which specifically impact black men and women. Firstly, there is a compound interest of prestige and access. Choices you make extremely early on, like even in junior high school, can have impacts down the road. This information isn’t written down, it’s knowledge that is passed down generationally. There are also informal networks: aunts and uncles, family friends, and neighbors in medicine that can help aspiring physicians get experience and make themselves more attractive to institutions. Due to historic disenfranchisement black men and women have less access to that knowledge and access. The Winn Award Program I think is also trying to address this with underrepresented medical students, creating a close-knit network of minorities in academic medicine to actively create those networks.

From your perspective, can you share a few things that can be done by the community, society, or the government, to help remove those barriers?

Ideally, our society needs sweeping changes. We need to truly reconnect with our history, what we define as “good” and “successful,” and who we think deserves to have access to that. That work will take generations, but I do believe it is possible. But we also have to survive and make things better today while we dream about tomorrow. I think the Winn Award Program is a very practical way of making things better today for minority academic medicine researchers and it’s building the network, the capacity, and the skill base to bring that dream for tomorrow a little closer.

What are your “5 things I wish someone told me when I first started my career in medicine,” and why? Please share a story or example for each.

Bring your whole self to medicine. Don’t try to hide away, or make small the parts of you that you think don’t fit. Those are the things that will make you a better doctor.

Don’t tell yourself “no I can’t do this,” there are more than enough people in medicine who will do that for you. Try. The worst outcome is they’ll tell you no, which you were just about to do yourself.

Failure is expected. You will fail things. You need to know that you are good and worthy, not just based on your last exam score.

Do not lose touch with your community! Social support is so important in this grueling field and while your friends and family might not know about mitochondria their support is what’s going to let you know those mitochondria.

Get comfortable with feeling vulnerable. Medicine is extremely demanding and you are often going to be standing with people during the worst day of their lives. The toll that takes is real and the only way to manage that is to acknowledge it. You are going to be as affected by the care you provide as your patients will be.

You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?

This is a very challenging question. I’m going to limit my answer to impact the United States. The practical voice in me says bring true single payer universal healthcare. This would have such a dramatic beneficial effect on so many aspects of our lives and would start to address, but would not solve, health disparities. But I think I’m going to let the idealist in me have this one and say a true racial reckoning in our society. While a well-crafted healthcare policy might practically bring benefits we are never truly going to solve the root cause of so many of the conflicts in America until we stare that history full in the face. I think that would do the most amount of good to the most people.

We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world or in the US with whom you would love to have a private breakfast or lunch with, and why? He or she might just see this if we tag them.

Grace Jones. She has been an inspiration to me for so much of my life. As someone who always felt like an outsider she really showed me that being different can be a source of strength. Not looking like everyone is a feature, not a flaw. Being a Black doctor you’re often the only person who looks like you in the room, and rather than hiding Grace Jones has inspired me to throw my shoulders back, hold my head up high, and own it.

How can our readers best continue to follow your work online?

The best place to follow me is at @rsilvera or my department @IcahnSinaiID on Twitter!

Thank you for these fantastic insights. We greatly appreciate the time you spent on this.