We’ve all heard it before: there aren’t enough Black doctors because of a “pipeline problem.” Too few Black students apply to and get into medical school, the story goes. But what if that’s not the full truth? What if the real issue isn’t at the entry point—but buried deeper inside the system itself?
According to Dr. Shanelle Wilson, a urologist/urogynecologist and pelvic surgeon, the root cause of Black underrepresentation in medicine might not be a lack of access—but a system-wide problem of gaslighting.
In her powerful article for STAT News, Dr. Wilson shines a light on how subtle, ongoing emotional abuse—gaslighting—drives a disproportionate number of Black medical trainees out of residency programs. Despite representing 14% of the U.S. population, only about 5% of physicians are Black. While pipeline programs and initiatives to recruit more Black students into medicine have been around for decades, they haven’t solved the problem. One major reason? Black residents make up nearly 20% of those dismissed from training programs before completing them.
That’s not a numbers issue. That’s a cultural one.
Gaslighting is a form of psychological manipulation in which a person is made to question their own memories, perception, or sanity. In the medical workplace, it can look like:
Having concerns dismissed as “overreactions”
Being told racism isn’t a factor in a clearly biased situation
Being scrutinized for minor errors while others’ mistakes go unnoticed
Being told you’re “not resilient enough” when reacting to unfair treatment
For Black trainees in medicine—many of whom already battle imposter syndrome and stereotype threat—these moments aren’t rare. They’re routine. And they chip away at a person’s confidence, sense of belonging, and emotional well-being.
As Dr. Wilson describes, gaslighting often preys on those trying their hardest to prove they belong. “Anyone can experience gaslighting,” she writes, “but Black physicians are especially familiar with the technique as one manifestation of implicit racial bias.”
Here’s how the pattern typically unfolds, based on Dr. Wilson’s experience and research:
A Black resident makes a mistake—no different than any other trainee might.
That mistake is broadcast to others: co-residents, attendings, even ancillary staff.
She is placed under heightened scrutiny. Every action is watched more closely.
Naturally, more “errors” are found—not because she’s less competent, but because more eyes are on her.
These additional incidents are used as “evidence” that she’s struggling.
This is known as selective attention bias: when you look harder for something, you’re more likely to find it—even if it’s happening at the same rate for everyone else.
Under this scrutiny, the resident becomes anxious, second-guesses herself, and over-corrects. That behavior—hesitation, double-checking, lack of confidence—becomes more fodder for criticism. She’s told she lacks autonomy or appears unsure.
And the cycle continues.
In contrast, non-Black residents often experience a very different journey. Their mistakes are seen as isolated incidents. Their growth is encouraged. Their potential is assumed.
This bias plays out in high-stakes clinical environments. In surgical specialties like urology—Dr. Wilson’s field—trainees must demonstrate increasing skill, confidence, and speed. But under the stress of being constantly judged, some Black trainees never get the chance to perform at their best.
To make things worse, Black residents often try to compensate by becoming the “perfect team player”—volunteering for unfavorable shifts or avoiding confrontation. But these sacrifices can lead to further setbacks, like missing out on key learning experiences or underperforming on exams.
When it comes time for evaluation, these residents are often judged by committees made up of senior physicians. Ideally, this would be a chance to flag unfair treatment. But too often, these meetings fall prey to groupthink: once one evaluator expresses concern, others follow suit to maintain harmony, not fairness.
If the resident brings up bias or racism, it’s often brushed aside or reframed—more gaslighting.
Dr. Wilson recounts her own painful experience during her fellowship training, where she studied under a chair named after J. Marion Sims—a surgeon infamous for conducting experimental surgeries on enslaved Black women without anesthesia. Although the chairmanship has since been renamed, the legacy was clear to her.
“I found it painfully ironic,” she writes, “that the program that trained me to provide quality and compassionate care for women also honored this brutal and racist surgeon.”
This type of contradiction—being asked to uphold values of compassion and excellence in an environment steeped in historical and ongoing racism—is deeply disorienting. And yes, it’s another form of gaslighting.
Black residents often hesitate to report mistreatment. Speaking out can invite retaliation or further scrutiny. Even human resources—meant to protect employees—can be ineffective when power dynamics are involved.
That’s why Dr. Wilson recommends Black trainees keep detailed, dated written records of evaluations and interactions. She credits such documentation with helping her remove negative evaluations from her state medical board record. She also urges trainees to request regular written feedback with concrete examples of growth—not vague or subjective critiques.
But she acknowledges how exhausting this is. “This approach places the onus on the already burdened and burned-out trainee,” she writes. The system expects the most vulnerable people to protect themselves from harm it continues to create.
Real change won’t happen unless residency directors, department chairs, and faculty members take responsibility. The people who train doctors also shape the culture of medicine—and they are the gatekeepers to who gets to stay and succeed.
Dr. Wilson outlines several actions institutions can take:
Implicit Bias and Rater Error Training: Teach evaluators how their own perceptions influence ratings.
Concrete Evaluation Criteria: Require specific examples for below-average ratings.
Pre-Meeting Prep: Have committee members complete bias training and name two positive traits about each trainee before discussing concerns.
Accountability: Ensure faculty document how they’ve tried to help a struggling trainee improve.
None of this is about lowering standards. It’s about applying standards equitably. And it’s about ensuring talented Black physicians aren’t pushed out of medicine before they ever get a real chance.
Dr. Shanelle Wilson’s story is one of resilience, but it’s also a cautionary tale. Black doctors aren’t leaving the field because they aren’t capable. They’re being pushed out by cultures that gaslight, dismiss, and devalue them.
If the medical establishment is serious about health equity, it must first look inward. Until faculty and institutions are willing to name and confront the reality of gaslighting, diversity efforts will remain performative, and Black communities will continue to suffer the consequences of a system that won’t protect those who could heal us.
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