Inspirational Black Men and Women in Medicine: Dr. Toluwalase Ajayi of American Academy of Hospice and Palliative Medicine On 5 Things You Need To Create A Successful Career In Medicine

An Interview with Jamie Hemmings

Be open to new opportunities. They may lead you to new things and amazing careers you never imagined for yourself. I kept myself open to new experiences and am now leading a research project on maternal-fetal health disparities. A topic perfectly aligned with my clinical work with children with serious illnesses and their parents. I would never have imagined such a position existed when one of my mentors suggested I pursue a fellowship in clinical research during my first year as an attending.

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. Toluwalase (Lasé) Ajayi.

Dr. Ajay attended medical school at the University of Kansas, pediatric residency at the University of Kansas Medical Center, and training in adult and pediatric palliative medicine at the Institute for Palliative Medicine at San Diego Hospice. Dr. Ajayi is now a fellowship-trained, board-certified palliative care physician and pediatrician working as a community hospitalist and pediatric palliative medicine physician at Scripps Health, Rady Children’s Hospital-San Diego, and is an assistant clinical professor of pediatrics at UC San Diego School of Medicine.

Throughout all her positions, Dr. Ajayi has held close the importance of continued education and advocacy work, speaking up for those without a voice. As a long-time active member of the American Academy of Hospice and Palliative Medicine, Dr. Ajayi served as a member of the Clinical Education Committee — overseeing the development and maintenance of clinical education opportunities — and Co-Chaired the Academic Hospice and Palliative Medicine Committee. She now serves as the liaison between the American Academy of Pediatrics Section on Hospice and Pediatrics and the American Academy of Hospice and Palliative Medicine.

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”?

When I was seven years old, I immigrated to the United States with my two older sisters and my mother, a Nigerian political refugee. I will never forget how the public health system that I experienced as a young immigrant in the 80s left me feeling less than human. It was then that I knew I wanted to be a doctor, so no child would ever be made to feel the way I had.

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

As I said, I’ve known since I was seven years old that I wanted to work with children and was drawn to pediatrics early in my training. As I learned more about sickle cell disease throughout my medical education, it became clear that there was another disenfranchised population I could serve. I came to the specialty of Palliative Care as an extension of my desire to advocate for those without a voice and those traditionally marginalized in medicine.

I am grateful that I met several important mentors early on in my career, including Dr. Holly Yang, who encouraged me to join the American Academy of Hospice and Palliative Medicine (AAHPM). Throughout my role with AAHPM — and many other positions, including those in health advocacy organizations — I have dedicated myself to improving available educational resources to be more culturally competent and advocate for the needs of marginalized patients.

That seven-year-old girl would be shocked to see me practicing clinically as not only a pediatrician but also a palliative care physician. Really, it makes perfect sense. I understand firsthand the importance of advocating for patients who’ve experienced marginalization in their most vulnerable state. Furthermore, as a Black woman, I have experienced the impact my presence has on my patients of color, which is why — despite the emotional challenges of my work — I continue to advocate for and work face-to-face with our most vulnerable patients.

My advocacy work is two-pronged, focusing on racial disparities in medicine and the lack of research on pregnant and postpartum individuals. Through my role with the American Medical Association (AMA), I have fought for multiple issues of equity, including advocating for the creation of the AMA Center for Health Equity. As Chair of the Council of Medical Services at the California Medical Association (CMA), I ensured that reports consider issues of equity deeply and concurrently alongside their primary work to position the CMA as a leading voice on improving how medicine works for patients and physicians in the state of California. As the first Black female president of the San Diego County Medical Society, my top priority was collaborating with the school board and various local healthcare systems, physicians and associations to create a centralized pathway program to help improve the recruitment and retention of a diverse physician workforce that matched the patient demographics of San Diego County.

Though I might like to take a more behind-the-scenes, research-focused role one day and am, honestly, occasionally intimidated by my responsibilities as an advocate and leader, I understand the importance of serving, as a Black woman, in these positions. I know that for my patients, being cared for by someone who looks like them can be life-changing. I know this visibility helps create pathways for other people like me.

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

Many come to mind, but one I keep returning to is Philippians 4:13, “I can do all things through Christ who strengthens me.” I keep coming back to this because, throughout my training and career, there have been moments when I have felt the desire to just stop. Step back from everything.

I sometimes feel conflicted, as if I am placed on a pedestal from which I might easily fall but still underestimated and unheard. These thoughts spring from fear, frustration, imposter syndrome — the list goes on. So, when I feel like stopping, I say this to myself. I calm the emotions, and I keep going.

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

As a pediatrician and a palliative care physician, I have no shortage of interesting stories, and there is no way I can pick the most interesting one. I will share this latest one, however.

Two weeks ago, I was the teaching attending for the adult palliative care service and was taking my resident to see a patient who was actively dying. My resident was brown, and the patient’s brother — who was bedside — was an older white gentleman. During the interaction, the man mainly spoke to me as the attending, but as we were leaving, he turned to my resident, bowed, and said, “Namaste.” As I try to hurry us out of the room, the man adds, “I love your country!” I was mortified that I couldn’t protect my resident from this interaction.

During our debrief, he shared that this had not been the first time something like that had happened to him. He told me how many assume he is from one country or another. The rest of the team shared their micro/macro-aggression stories, and we took the opportunity to discuss how that interaction could have gone differently. We tried to make light of the situation and laugh ironically at the commonality of our shared experiences.

The patient’s brother wasn’t trying to be offensive. Unfortunately, he had been. He was also grieving the loss of his sister. So, the question of whether it’s appropriate to engage with the patient on their comment is a no-brainer. However, If I let it go and choose to have my resident not round on that patient anymore, they will miss that educational opportunity.

I share this story to illuminate the many layers here: The Micro and macro-aggressions my peers and I experience every day as physicians of color; how I try to teach and advocate for learners; how I balance my learners’ and my own needs with the needs of my patients and their loved ones; and the many other decisions like this I make multiple times a day.

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?

I would have to say that my three most instrumental character traits are resiliency, determination and openness.

I would credit all three of these to how my parents raised me. I had great role models in my parents and saw what they gave up when they moved to the United States. I can’t imagine leaving your home, thinking you would be back, and then being unable to.

I saw how hard my father worked as a factory worker when he had an advanced degree in computer engineering to support our family. I remember my mother awake and working at all hours of the day — when I would wake up to run and when I returned home from being out with friends. I must add that Nigerians are not shy about giving their children critical feedback. Receiving it didn’t always feel great, but what I learned definitely prepared me for the world.

Mostly, I remember our family celebrating every win and supporting each other at every setback. My traits of resiliency instead of stubbornness are a direct reflection of the love and hard work my parents and sisters put into raising me, and I am grateful for that.

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 see too many patients living in healthcare deserts while my physician colleagues experience barriers to serving under-resourced communities. As a mentor, I hear from students and residents who want to return to their historically marginalized communities but can’t because of financial and practical barriers, most especially their massive educational debt.

My passion for serving my community has driven me to engage in leadership and advocacy roles on a local, state and national level. To me, understanding the intersecting socio-psycho-economic context of patients’ lives — including historical and contemporary mistreatment and discrimination — is of the utmost importance for physicians. This is especially the case for those serving marginalized, seriously ill and pregnant individuals who have been historically underserved and have experienced discrimination at their most vulnerable.

It is my most fervent hope that through my continued research and work, my peers and I can inspire change in the standard of care provided to patients to increase the effectiveness of clinical care across racial and class demographics.

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

The main barriers for black individuals to enter the medical field are,

1. Awareness of the opportunity early on in their educational journey.

2. Having easily accessible mentors.

3. Financial access to attend medical school and apply for residency positions.

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?

In my opinion, the most meaningful steps to eliminate this discrepancy and historical underrepresentation of Black physicians include,

• More equitably funding medical schools nationwide to reach prospective Black physicians in even the most underserved communities.
• Engaging with Black youth early and often on the importance of a medical career to address the leaky pathway to becoming a physician.
• Increasing mentorship opportunities to bridge more connections between Black doctors and clear the pathways for prospective Black doctors.

When it comes to better caring for Black patients, unconscious bias has always been present in medicine. Though I believe all physicians set out to provide high-quality care, many are poorly trained to serve a diverse population of patients and thus, unable to identify and challenge the ways in which their care disservices patients. Moreover, the pandemic has hurt physicians’ bedside manners, exacerbating existing distrust of physicians by many marginalized, but especially Black, patients.

One of the most important things I can do is continue to serve as a physician face-to-face with Black patients. It is in seeing and knowing a Black physician that Black patients, old and young, will develop deeper trust for medicine and cultivate a more diverse population of future physicians.

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.

First, it’s okay to be you. There will be times when you might be tempted to be someone other than your authentic self. Yet, you’ve gotten where you are precisely by being yourself.

Secondly, it’s ok to ask for help. I sometimes think that the way we train in medicine perpetuates that we, as doctors, must know everything. That if we don’t know the right answer, we are less than. That sets us up for failure because none of us succeeds on our own. We all need help, and it’s okay to ask for it.

Third, you don’t have to be ashamed of your failures. This is a tough one, and this will take time to understand. I have always struggled with standard testing, and this shame held me back from asking for the help I needed. I was embarrassed by what I thought was a personal defect, but which is, in fact, not all that uncommon. As it turns out, once I was able to talk about my struggle and ask for the help I needed, I was able to get to the place I am now — a place where I can help others who are struggling just like I did.

Fourth, there is more than one way to get to the path you want. My story and the many varied stories of my colleagues are proof enough of this.

Last, be open to new opportunities. They may lead you to new things and amazing careers you never imagined for yourself. I kept myself open to new experiences and am now leading a research project on maternal-fetal health disparities. A topic perfectly aligned with my clinical work with children with serious illnesses and their parents. I would never have imagined such a position existed when one of my mentors suggested I pursue a fellowship in clinical research during my first year as an attending.

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? You never know what your idea can trigger. :-)

I would love to change how healthcare systems operate to better serve those most negatively impacted and suffer the most from a poor healthcare system. The providers with boots on the ground hold the most power to fix this discrepancy and should be able to enact change with as little red tape as possible.

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.

I would love to have a meal with Oprah. I had the opportunity to see Oprah interview Michelle Obama during the last stop on her book tour. That interview and conversation were so engaging, informative and inspiring. Listening to these two giants speak about their insecurities, a little bit about their lives, and share their stories was like sitting at the table with two aunties. Just listening to them share pearls of wisdom about life.

I leaned in as they spoke about how we needed more research on Menopause for women of color. They both talked about going through the change and how much information is needed, as this just isn’t discussed in our community. I couldn’t agree more. When I think about my research and the work my team and I do on maternal-fetal health, I know this is a direction I want to add to their platform.

I would love to have brunch with both, but if I had to pick one, I would choose Oprah. After coming to the states, she became one of my only pieces of exposure to Black women on daytime TV. I would love to learn more about her and the evolution of her career.

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

Readers are welcome to follow me on Twitter @tajayiMD. To read about what I am up to medically and personally and learn more about my interests and active research, visit my personal website: www.laseajayi.com.

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