Finding My Voice

According to the U.S. Census Bureau, Asian Americans have been the fastest-growing racial group in the United States over the past two decades, with an estimated 22.9 million Asian Americans comprising 5.7% of the U.S. population in 2019. Asian Americans are a diverse group tracing their roots back to more than 20 countries in East, Southeast, and South Asia. Often considered together with native Hawaiians and other Pacific Islanders, the Asian American and Pacific Islander (AAPI) community in the United States represents many ethnicities, languages, religions, histories, geographies, and cultures. Asian Americans and Pacific Islanders occupy a fraught space in the racial fabric of this country. The “model minority myth” posits that AAPIs in the United States have attained high rates of educational achievement and financial success and implies that they therefore must not be subject to discrimination. However, there is a long history of anti-AAPI racism in this nation, from the 1882 Chinese Exclusion Act barring immigration of Chinese laborers to the forcible internment of Japanese Americans duringWorldWar II. Since the start of the COVID-19 pandemic, there has been a rising tide of anti-AAPI racism and xenophobia. Between March 2020 and February 2021, the Stop AAPI Hate reporting center received 3795 reports of hate incidents directed at AAPIs that included verbal harassment, shunning, and physical assault. Sixty-eight percent of these hate incidents were reported by women. In recent weeks, there has been an alarming number of vicious attacks targeting AAPIs in cities across the country. Furthermore, in Atlanta onMarch 16, 2021, eight persons—including six Asian women—weremurdered at three Asian-ownedbusinesses. The following day, I felt compelled to break my silence on my own experiences with racism in a series of tweets. I was especially driven by anguish and fury when initial reports of the Atlanta shootings attributed the suspect's motivation to a “sexual addiction,” highlighting how AAPI women can be targeted by both racism and misogyny. As a child, I lived near Detroit during an era of rising tensions against Japanese automakers that led to the 1982 beating death of Vincent Chin, a Chinese American man. I was regularly kicked, punched, and called “Chink” on the way to school. Yet, because I was one of only two AAPI children in the entire elementary school, I believed this was just the price to pay for being different. Media portrayals have often stereotyped AAPI women as submissive and exotic, and as a young adult I endured the leers of men telling me they “like Asian women.” I eventually realized that physical and verbal attacks were a common experience among my AAPI peers. However, the fact that these experiences were so common only served to impress upon me that there was no need to discuss this further and no point in doing so. We had all experienced racism, and there was apparently nothing to be done. Only recently, when the National Basketball Association announced it would investigate racism directed at player Jeremy Lin, my own astonishment made me realize how deeply I believe that anti-AAPI racism is ignored and dismissed. Even as I entered the field of medicine, racism persisted. Patients and classmates expressed surprise that I speak English “so well.” Professors and attendings told me, “You are too quiet,” “You all look the same,” and “I can't keep your names straight”—endless reminders that we never quite fully belong. Most AAPIs have been repeatedly asked the question that insinuates exclusion: “Where are you from?” If I respond that I was born in Texas, the inevitable reply is, “No, I mean where are you really from?” When I became an attendingmyself, I heard in teaching workshops that quiet students are problematic. The perception that AAPI medical students are quiet rather than thoughtful can lead to bias, especially in clinical clerkships when attendings' evaluations are largely subjective. From my personal experience reading letters of recommendation, I can attest that AAPI students are, indeed, frequently described as quiet. Although a growing number of studies is addressing gender and racial/ethnic biases in letters of recommendation, data on AAPI students are lacking. The model minority myth further serves to obscure the reality that many subgroups in the AAPI community face significant barriers to equity in medical education. Asian American and Pacific Islander students represent the second-largest racial group among entering medical students (22.9% of matriculating students in 2020) and are therefore not considered underrepresented in medicine; however, aggregating all AAPIs hides the fact that some AAPI subgroups, particularly those with roots in Southeast Asia, are underrepresented. Laotian, Cambodian, and Indonesian applicants together comprised less than 1% of AAPI applicants to medical school between 2018 and 2019. Burmese, Thai, and Hmong subgroups were not even counted. The model minority myth perpetuates sometimes dangerously high expectations among AAPI students and nullifies individual effort by reducing hard work into a single stereotype that “all Asians receive good grades.” This myth can also have the detrimental effect of pitting AAPIs against other minority groups, preventing a united stand for equity regardless of race and ethnicity. As faculty, AAPIs face hurdles to advancement in academic medicine. The Association of American Medical Colleges' 2020 Faculty Roster reveals that AAPIs make up 23.4% of assistant professors, 20.6% of associate professors, and only 14.2% of professors. Asian American and Pacific Islander women in academic medicine face intersecting barriers—the “glass ceiling” and the “bamboo ceiling”—that magnify these disparities. Although the percentage of AAPI women (11.2%) is similar to that of AAPI men (12.1%) at the rank of assistant professor, there are more than 2.5 times as many AAPI men (10.2%) as AAPI women (4.0%) at the rank of professor. Among internal medicine departments, 12.8% of chairs are AAPImen, but only 1.1% areAAPIwomen. Considering all AAPIs as a monolithic entity also disguises substantial differences in socioeconomic status and