Living a Vicarious White Life: My Experience as A Woman of Color on Rural Rotations

Written by Natalie Crump, PAS II

“It feels like I’m living a vicarious white life!” My husband laughed when I told him how I felt, but over the course of numerous conversations during my time in rural Colorado as a clinical-year physician assistant (PA) student, he came to understand exactly what I meant.  I was being sent to cities in Colorado for clinical experiences that, as a Black woman, I would never have chosen for myself. As a person of color, there is a historical understanding that areas outside of the city should be approached with caution. Often, there is a lack of diversity in those areas which can lend itself to narrower thinking and a resistance to the acceptance of all races as equal— equally smart, equally deserving, or equally human. But there I was, the only brown face for miles. Although my preceptors were kind and taught me well, the patient population I served was not always so welcoming or accepting of a student let alone a student of color—seeing them for a visit.  

This, however, was my reality and I knew prior to beginning my clinical year that this was something I might face. As a student, my obligation is to successfully complete all phases of my training. While I chose Denver as my home base for rotations, the onset of COVID mid-way through my first year and the ever-changing landscape of available preceptors made it more likely that I would be sent to rural areas to complete my core rotations. That time came last fall with successive rotations in rural locations.

Although I understood the nuances that came with living and learning in a rural area as a person of color, the political and social climate of our nation during this time made me even more aware of my position. On the heels of a summer filled with racial and social justice movements and just prior to a historic election, the air at times felt suffocating. Before each patient encounter, I took a deep a breath, reminded myself of the kindness and empathy I sought to embody, and entered the room with the confidence that comes from a deep desire to change the narrative. Even when a patient’s father chose to keep his head low, brandishing a “Make Liberals Cry Again” hat, and refused to interact with me for the first five minutes of his son’s annual visit, I chose to engage with him. I asked him questions to help break down the socially engineered walls that tried to erect themselves between us. I understood in those moments that curating lasting change can only come from direct interaction and a listening ear; sharing stories and finding commonality to help bridge the gap between our lived experiences.

Many of my patients and preceptors will never understand what it feels like to go through medical training as a woman of color. I don’t expect them to understand the undertones and subtleties of the stares or comments I’ve received. Dr. Kehinde Andrews, a journalist and professor of Black Studies at the University of Birmingham in the United Kingdom, expressed what I was feeling so eloquently. In a recent article discussing the racism within the British royal family, he wrote, “The constant feeling of being out of place, undermined and misunderstood takes a daily toll. The term we use in academia is ’microaggressions‘—the paper cuts of racism that have the cumulative effect of damaging our mental health. I felt the sum of these microaggressions during my training in rural rotations, more than any other time in my training as a PA student. It was easy for me to become bitter or resentful. However, I understood the larger opportunity before me: the privilege of expanding the minds and boundaries of those around me through compassionate service and an open heart.

Natalie Crump, PAS II, at the PA Class of 2021’s Orientation Week in 2019

In that vein, I chose to use to my voice and share that experience with the larger RVU community during our recent Diversity, Equity, and Inclusion Summit. I wanted to raise the collective consciousness of RVU students to highlight that even during our training, the experience of a person of color was unique in an effort to draw semblance to what they will encounter as future clinicians when caring for patients of different races, backgrounds, and experiences. I was grateful for that space to vent, to feel heard, and to share.

Moreover, as a Delegate for the American Academy of PAs (AAPA) Student Academy, I actively advocate for the increased training on social determinants of health for PA students across the country as part of my work for the Advocacy and Policy Committee. As the future of healthcare, we students have a unique opportunity to shape the trajectory of our careers and help rewrite the book when it comes to culturally competent patient-centered care.

My experience, I’m sure, is one of many but my sincere hope is that we as students will continue to listen, share, and value the breadth and depth of the human experience to compassionately guide our care of others and our interaction with the world around us.

PAS Crump, second from right, celebrates Black History Month with COM and PA students

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