Gene Expression

Asian doctors are white

About 10 years ago Eugene Volokh wrote How the Asians Became White. I think it’s aged rather well. Volokh starts:

Don’t believe me? A recent MSNBC news headline announced a “Plunge in Minority University Enrollment” at the University of California, with UC Berkeley reporting that “minority admissions had declined 61 percent.” Actually, the total percentage of racial minority students at Berkeley, Asians included, fell from 57% to 49%. If you exclude the burgeoning group of people who decline to state their race, the minority percentage fell only three percentage points, from 61% to 58%.

Fast forward, you see headlines such as Minority doctors in short supply in state. Here are the first two paragraphs:

A new study on physicians in California shows a glaring gap between the number of doctors of color compared with the state’s ethnically diverse population, especially among African Americans and Latinos.

At the same time, the state has a disproportionate number of Asian and white doctors, according to the UCSF study, which focuses on doctor ethnicity and language fluency.

i-0a398e2a928db5c333ba675bd52dc805-CNN_SanjayGupta.jpgThe same mixing & matching. To assert a glaring gap of color one has to de-colorizing Asians. Including Asians makes the gap far less glaring (a state that is about 50% minority with around 40% minority doctors). The general focus of the news report here is pushing the thesis about a minority doctor shortage, so you see the standard deemphasis on statistics which show a surfeit of Asian Americans, but with a precise & clear reiteration of the dearth of blacks and Latinos. The background assumption is of course simple: a world of white and non-white must redress the injustice that the white metes out to the non-white.

Luckily, we have data. You can read the original report (PDF). I did, and placed some of the data below the fold….

For the proportions of some of the minority groups I used Census 2000, though as you can see I couldn’t find the appropriately detailed data for some of the ethnicities. The table is self-explanatory; the higher the value of the rightmost column the more represented a group is among the physicianocracy.

Ethnic diversity of California physicians & reflection of state demographics
    Physicians Population Proportion Ratio
White   61.7 46.7 1.32
Black   3.2 6.7 0.48
Asian & Pacific Isl.   26.4 11.2 2.36
  Chinese 8.8 2.9 3.03
  Indian 6.1 0.9 6.78
  Korean 2.8 1.0 2.8
  Filipino 3.2 2.7 1.19
  Japanese 1.9 0.57 3.33
  Vietnamese 2.3 1 2.3
  Pakistani 0.7    
  Cambodian 0.1    
  Samoan 0.1    
  Lao/Hmong 0.1    
Native American   0.6 1.0 0.6
Latino   5.2 32.4 0.16
  Mexican 2.4 20.54 0.12
  Cuban 0.35 0.16 2.19
  Puerto Rican 0.3 0.3 1

Some of these data are pretty explicable. Indian Americans came to the United States disproportionately as physicians. Many of the offspring of the initial generation followed their parents into medicine. Japanese and Chinese Americans were the archetypical “Model Minorities,” so no surprise they are well represented in an academically demanding profession. The case of the Vietnamese and Hmong are interesting contrasts, and show the power of human capital. Both arrived as refugees, but the Hmong were often marginal and backward even in Laos (they’re from an ethnic minority outside of the lowland Lao Buddhist majority). In contrast, many of the Vietnamese who arrived as refugees were relatively well equipped to make a transition to a modern market economy because the rudiments of these institutions were already extant in South Vietnam. The overrepresentation of Cubans and the equal representation of Puerto Ricans shows that derivation from Spanish language ancestors does not magically make one unable to ascend into the physicianocracy.

The report gives a lot of space to the importance of diversity. Most of you who are ecologically oriented are probably aware of various index of diversities. I’ll use this one:
i-a68e0a2cdd19ce6892f659a67d06e86b-indexofdiversity.png

p = proportion of individuals or objects in a category & N = number of categories. N = 5, where the categories are white, black, Latino, Asian & Pacific Isl. and Native American. The p‘s are simply the proportions above.

Physician’s D = 0.55
All population D = 0.66

The max value of D is proportional to the number of categories (5) equally weighted, so in this case the max is D = 0.80. What does this tell us? California physicians are not as diverse ethnically as the population of the state, but they aren’t that far off. But, the character of the diversity is very different, heavy on Asians, light on Latinos and blacks.

News reports and the paper itself highlights the importance of having doctors of many ethnicities because a doctor of ethnicity X is more likely to service ethnicity X. Additionally, a doctor of ethnicity X is also more fluent in cultural norms and other ethnicity specific details which might be medically signficant on the margins. But that leaves out another part of the picture. Let me quote from a Sac Bee story:

Cruz, 32, is his family’s first college graduate. “I didn’t have a lot of support or mentors,” he said.

Unlike many students who hope to become a doctor, Cruz said he didn’t get top grades in college and failed repeatedly on qualifying medical school exams before becoming prepared for the rigors of a medical education.

I’ll be frank and admit that I don’t think that I get the most bang-for-the-buck when it comes to general practice physicians. I have no problem with being seen by nurse practioners because I don’t think that general practice physicians add that much value, so I wouldn’t be that worried if my initial gatekeeper was someone like soon-to-be Dr. Cruz. But I would want a specialist for more serious ailments to be as good-as-can-be. If I believed my life was on the line I have no great qualms about discriminating against doctors who I think might not be as qualified as they would otherwise have to be because the state of California medical education system is allowing in those with marginal academic backgrounds so that underserved communities are served. People need to remember these sorts of things when they are start scheming about engineering with the levers of society. There needs to be a happy medium, at some point ethnic identity is less salient than competence and cognitive firepower.

These sorts of stories reflect the reality that journalists and the reading public is primed toward simple narratives. In the early 20th century most white Americans were casual racists who took the supremacy and superiority of their race for granted. The literate public ate up books such as The Passing of the Great Race, which extolled the virtues of Nordic Northern European man. Unfortunately, this simplistic narrative had to confront the reality that Nordic man did not build the pyramids or the Great Wall of China, invent the phonetic alphabet or derive the first mathematical proof. The solution was elegant, if ridiculously implausible: all civilizations were founded by Nordics who were later debased by racial admixture.

Today very few white Americans are casual racists, and most take for granted that racism is a sign of low class and bad moral character. Additionally, a solid majority of the white American elite now submits that diversity is Good. Unfortunately the simplistic narrative continues; only inverted. Instead of a complex world where reality sprawls over many dimensions there is a need to box life into as few buckets as possible. The white race is not longer perfect, but it is perfectable, and due consideration to the state of non-whites are the means toward thats perfection. All the world’s a stage, but there’s still only one relevant player.

The Great Divergence of the 19th century ushered in an era where simple narratives fit. Europeans were the most powerful and intellectually vibrant peoples on the face of the earth by orders of magnitude. Prior to this the world was polycentric, with many values espoused by rival polities interlaced and locked together in a dance of great complexity. With the rise of quasi-Communist China, and the waxing of the East Asia realms as a whole, we are likely witnessing the end of the European Moment. But we don’t have a more complex narrative to go along with it….

Comments

  1. #1 VJBinCT
    April 12, 2008

    This parallels to a certain extent how Italians became ‘white’ in the 1920′s. It is interesting to see photos from earlier in the century how dark complected they were portrayed. On the other hand, you generally don’t think of Chinese as ‘darkies’, and I certainly never did, but on a recent trip to China, I saw very dark complected workers doing road work in Qingdao. They were called ‘country people’ by my hosts, but I have no idea what their actual origin might be. I have dark-skinned Polish relatives (perhaps with some Mongol genes). I am pleased to see South Asians (at least in the medical profession) perceived as ‘white’ (meaning ‘regular’ people and not scary brown sorts). Even though the whole discussion is demeaning, you have to admit that it is going in the right direction. Just for the record, my first and only grandchild so far is Chinese-Japanese-Polish-Italian-Lithuanian-English-French. Which is to say why I dislike hyphen-American labels. The poor kid can’t wear a T-shirt that large without getting lost.

  2. #2 razib
    April 12, 2008

    This parallels to a certain extent how Italians became ‘white’ in the 1920′s.

    emphasis on certain extent; white ethnics slowly but persistently worked their way up the class ladder over generations. in contrast, highly educated post-1965 asian immigrants start out at the top quarter of the SES layer cake from inception. race & class cross-cut in weird ways here.

    On the other hand, you generally don’t think of Chinese as ‘darkies’, and I certainly never did, but on a recent trip to China, I saw very dark complected workers doing road work in Qingdao.

    well, let’s not get caught up in complexion in a very literal sense; there are many light-skinned chinese, koreans and japanese who are not white while a more richly olive skinned greek is.

  3. #3 Mike
    April 12, 2008

    Interesting work. I wonder how the “whitening” of certain Asian groups in the eyes of traditionally White Americans could impact the future perceptions of other “dark” people in the eyes of Whites in the future.

    Some say a rigid system of perceptions is what holds certain ethnicities from excelling in this nation. If the perceptions have already started tipping in a different direction, will it start a cycle of feedback until we reach a smiling, happy medium?

  4. #4 ringo
    April 13, 2008

    While we’re at it, how many of those “white” doctors are jewish (or, rather, how many *aren’t*)? As for the “black” doctors, how many are african-american, how many are caribbean, and how many are african/american?

    Then of course there is Bantu vs. San, and Ashkenazi vs. Sephardic and Mizrahi.

    I could go on.

  5. #5 tom bri
    April 14, 2008

    My kids are half Japanese half Northern European. They look as if they could be French, Spanish, or any other dark-complected Euro type. Or Mexican, Middle-Eastern, whatever. You could believe whatever they told you.

    I wonder how many of the ‘White’ Doctors are recent mixes.

    This whole racist discussion (not you, Razib, but the people who try to make political points out of it) annoys me to no end. Genetics is endlessly fascinating for me, but just what does it matter to me where my doctor’s grandparents came from? I have been treated by Asian doctors, in Asia and the US, Indian doctors in America, Latin American doctors in Latin America. Some were excellent, some not and the ancestry simply did not seem relevant.

  6. #6 Maju
    April 16, 2008

    I was thinking that here (Basque Country, Spain) Gypsies (Roma) are generally considered “white” (maybe “off-white”, if you wish, but not so distinct as East Asians or Black Africans). In fact they are often hard to take apart from a Med-looking moreno Spaniard, and in Southern Spain they are relatively well integrated, with diffuse borders about who is Gypsy and who is not. In contrast I’ve read that in Latvia “black” means typically a Gypsy/Roma.

    I think the whole issue can be extrapolated to South Asians: they do not exactly look as West Eurasians or Europeans… but they are not that different either anyhow, specially if compared with other “racial” groups. But this may depend on the subjective/ethnocultural perception.

  7. #7 razib
    April 16, 2008

    I think the whole issue can be extrapolated to South Asians: they do not exactly look as West Eurasians or Europeans… but they are not that different either anyhow, specially if compared with other “racial” groups. But this may depend on the subjective/ethnocultural perception.

    prior to the emergence of conventional european white scientific racism “whiteness” always included west asians. but, there was debate about south asians, some included them and some did not. this suggests the general dynamic that you are talking about. in general, among non-africa populations south asians are closer to west asians & europeans than to east asians. but, they are an outgroup to west asians & europeans.

    (some south asians don’t look so different from west asians or southern europeans, while others look very different and might be confused for africans if not for their hair form. most are in the middle)

  8. #8 Levi
    April 16, 2008

    I must congratulate you on the Sanjay Gupta “Typical White California Doctor” image. Simple but hilarious. I suspect that when I hear people talking about white doctors (or South Asian doctors) that image will pop into my mind.

  9. #9 Luis
    April 18, 2008

    @Razib: that’s what I meant: that South Asians are different (in looks) from West Eurasians but often (it depends on which two individuals you may compare – and with whose eyes) not as strikingly distinct. The picture you posted for instance does not suggest “difference” to me but surely you can find much more “ethnic-looking” South Asians too.

    Anyhow, I’m starting to think that factors that for others are important (like skin tone, unless extreme maybe) are not really that striking to me while other less commonly mentioned elements like non-slanted eyes or elongated faces may be more important when intuitively defining “affinity”. In this sense your “typical white California doctor” looks to me as akin or maybe even more than a hyper-pale white-blond round-faced North European with partial epicanthic fold. Surely that’s not the typical definition of “white” in the USA or elsewhere. But for me is a very valid intuitive grouping.