After Hurricane Katrina, Princess Dennar made history as the first Black woman to run a physician residency program at Tulane University.

In 2020, she made history again, this time by suing Tulane for racial and gender discrimination. Her white male bosses had “subverted” and “actively undermined” her leadership for years “to force her to resign,” she alleged, and young Black women training under her were suffering the consequences.

As protesters demanded justice after George Floyd’s murder, as cities tore down Confederate statues, as health agencies declared that racism kills, Dennar hoped that she could force one of the oldest medical schools in the Deep South to confront its dark past. And maybe she could call attention to her profession’s failure to reflect the people it cares for. Just 5% of doctors and 3.6% of medical school faculty members nationwide are Black, compared to 13% of Americans and 60% of New Orleanians.

By going public with their collective experiences, Dennar and her trainees set out to test the reach of America’s supposed racial reckoning. They would learn firsthand how difficult institutional racism is to prove — and even harder to fix.

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According to Dennar, her boss, Jeffrey Wiese, undermined her authority by controlling her trainees’ schedules and threatening to shrink her program while mandating use of an algorithm that effectively shut out applicants from historically Black schools. She also accused the medical school dean, Lee Hamm, of failing to protect her from that alleged discrimination, making inappropriate remarks about her race, and retaliating against her for complaining. Seven of her Black residents, nicknamed the Tulane Seven, told the university that Wiese overburdened them with difficult shifts and deprived them of opportunities given to white residents. One of the seven launched a discrimination lawsuit of her own. So did a third Black woman.

Concerned about “serious allegations of racial bias and discrimination,” a national accreditor put Tulane on probation, jeopardizing its license to train residents. A survey revealed that many others on campus saw their leaders as detached from “the reality of gender and racial inequities” — and prone to punishing victims of harassment and racism. And a viral social media campaign inspired applicants to boycott. All of this made the Black women hopeful that progress could be on the horizon. Now it is up to Tulane to see that it happens.

In February 2021, with her lawsuit pending, the university removed Dennar, 46, from the directorship that was once her dream job. Despite being demoted, she could still be a force for good, she told me as we walked through the French Quarter that October. “Why do I stay there?” she said, looking at me through cat-eye frames. “Because I think there’s still work to be done.”

Two months later, she left for good.

In August 2008, Dennar walked into Hamm’s office for her job interview — one that, in her telling, set the tone for the next decade-plus. Hamm, a kidney disease specialist trained in Alabama and Texas, had at that point been a professor for 16 years and the medicine department chair for three. Within the next five, he’d become dean.

According to the lawsuit Dennar later filed, Hamm told her, “I’m afraid that white medical students wouldn’t follow or rank favorably a program with a black program director,” before adding, “We’ll be comfortable with you sharing a position as co-director” with Tracy Conrad, the white male outgoing director. Hamm has denied making these remarks.

Stunned, Dennar found herself babbling about how she would raise the board-exam pass rates, she recalled. On the drive home, she cried.

Still, she couldn’t say no to the offer. Here was a chance to be the leader she’d always craved, a mentor to a new — and more diverse — generation of doctors.

It took more than a year for her to become the sole director in title, she said, even though she was doing 100% of the work the whole time. (Conrad died in 2014.) But the power struggle had just begun. Since her med-peds trainees divided their time between two specialties, Dennar knew she needed to collaborate with the stand-alone pediatrics and internal medicine programs while ensuring that their unique needs and goals were being met. As the internal medicine residency director, Wiese was a critical partner. As the head of graduate medical education, he was also her boss.

Shortly after Dennar took full control of the med-peds program, Wiese started requiring residency directors to use a rating system he developed, known as Atlas, to measure applicants based on factors like their test scores, class ranking, and the perceived quality of their medical school, according to her lawsuit.

On a list ranking 151 institutions, according to a 2015 Atlas spreadsheet I obtained, Meharry Medical College was the highest-ranked historically Black medical school at 104, followed by Morehouse School of Medicine and Howard University College of Medicine at 120 and 121. Anyone from a school in the 100s would face a significant statistical disadvantage for that reason alone, according to the spreadsheet’s formulas.

Wiese considered Atlas an “objective” screening tool, according to an email quoted in litigation. Dennar found it discriminatory.

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Former medical residents said they came to Tulane to right those kinds of injustices, a mission that Dennar prioritized. Believing that doctors should care for their community in every sense, she sent her trainees to volunteer at homeless shelters and educate shoppers at Walmart health fairs.

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All six residents in the med-peds class who would graduate in 2018 were women of color, the first time that had ever happened at the medical school. Four of them, including Okeke, were Black.

In contrast, none of the pediatrics- or internal medicine–only residents who finished their training in 2018 were Black, according to data provided by Tulane in litigation. Six pediatrics residents were white and two were Asian. In internal medicine, 26 of 29 were white.

Residency is a potentially exploitative experience all around, critics say, where young physicians are routinely overworked, earn $64,000 a year on average, and have little bargaining power. But this crucial training period before becoming independent, fully certified practitioners can be especially hard for women and racial minorities. One survey of nearly 7,700 emergency medicine residents found that 60% of women experienced gender discrimination and 35% of nonwhite respondents faced racial discrimination. In a 2018 paper, Black, Hispanic, and Native American residents recounted patients who mistook them for janitors and colleagues who grabbed their hair and saddled them with fixing diversity-related problems.

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But caring for patients of the same race can be a lonely burden. “Maybe you feel like some of the people on your team aren’t seeing these patients as whole people,” said Damon Tweedy, an associate professor of psychiatry at Duke University School of Medicine and the author of Black Man in a White Coat: A Doctor’s Reflection on Race and Medicine. “How do I navigate the fact that my supervisor might say things I think are problematic, but I’m just the person who’s junior and I’m trying to move up the ladder?”

Okeke said she felt alienated by some of her coworkers. According to her, a white supervisor would ask questions like “Who amongst us is more likely to get sarcoidosis?” — which disproportionately affects African Americans — and point at her in a room of doctors-in-training: “You are.” The same thing happened with sickle cell patients, she said. “As long as it was a predominantly African American disease, he always made it his business to point me out and say, ‘You’re the one to get this.’” (Okeke declined to name the physician. Another med-peds resident, Veronica Johnson, recalled Okeke telling her about these discussions.)

Melissa Watts, another classmate, recalled an internal medicine physician who incorrectly insisted he had worked with her two weeks prior. She concluded he must have confused her with another Black resident. “Y’all seem to know Michael from Billy from Sean, come on,” Watts said.

She and other Black women felt certain that their white colleagues treated them differently, and they tried to prove it in part by quantifying disparities in their work schedules. But mapping systemic racism onto calendars would be harder than any of them anticipated.

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Wiese and Tulane have maintained that residents across the programs got the same amount of demanding rotations, even if their schedules weren’t identical. Wiese has said that other administrators, namely the chief residents, were the ones who created the schedules and communicated with Dennar. “I had nothing to do with individual schedules,” he said in a deposition, adding that his only role was to annually “review it from a financial perspective.” Scheduling, he said, was obligated to prioritize the hospitals’ needs. “The hospitals that pay for these positions own these positions,” he wrote in one email, “and the University merely has stewardship over how they are assigned.”

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Time and again, Black med-peds residents said they were told that their desired shifts were taken, or that they were needed on the wards more.

“No matter how much you tried to advocate for yourself,” Johnson said, “it just never worked out in your favor.”

Okeke, Watts, and Rachel Clark, a third Black trainee, said they were unable to complete a required “one-month experience in the emergency department” — car accidents, gunshots, and the like — “during the first or second year.” Shifts labeled “ED” and “ER” are not listed on their schedules until midway through their final year, and none had four weeks of it.

Tulane and Wiese argued that they were given their full time, just partly in differently named shifts that involved admitting ER patients to other parts of the hospital. But Dennar and the current internal medicine residency director have argued that this was not true emergency training, because doctors weren’t triaging wounds. Dennar said that she certified Okeke to graduate out of deference to Wiese — but “I have concerns that she was not given the equitable educational experience as to her white male counterparts,” she said in a deposition.

One night early in her residency, Okeke said, she took a group of applicants to a party at Wiese’s mansion in the oak-lined Garden District. After their host opened the door, he introduced himself to the prospects — and to her.

“He started shaking my hand,” Okeke said. Because Wiese didn’t seem to recognize her, she concluded that he must not know she was a current resident. She remembered trying to laugh off the awkwardness she felt: “Dr. Wiese, you’re so funny.”

Black med-peds residents tended to have one of two impressions of Wiese, according to seven of them whose time at Tulane spanned a total of 13 years. Some said their interactions were nonexistent, or brief but positive: One remembered him as “very cordial and pleasant.” But others said that Wiese never called them by name, to the point that it was offensive. “He never acknowledged my presence,” said Chioma Udemgba, who graduated in 2020. “It’s a small thing, but it speaks a lot.”

In her lawsuit, Okeke cited the handshake and other, similar interactions as evidence of Wiese treating her unfavorably because of her race. Wiese denied that he racially discriminated against her. Tulane’s attorneys argued that there was “nothing objectively offensive about these events.”

Nonwhite physicians are much more likely than white physicians to leave a job due to what they say is discrimination. At academic medical centers, which combine clinical care, research, and teaching, underrepresented minority faculty members have little mentorship, report facing racial bias, and have lower odds of being promoted, studies show.

Emergency physician Uché Blackstock, formerly of New York University’s medical school, said racism and sexism drove her to leave the faculty in 2019. (An NYU spokesperson said, “We are wholly committed to fostering an inclusive workplace and take all allegations of racism and sexism with the utmost seriousness.”) Pediatrician Benjamin Danielson resigned from a Seattle clinic in 2020, citing racism in its parent organization, a concern that an investigation found to hold merit. (A Seattle Children’s Hospital representative said that it is pursuing a new equity plan as a result.)

That same year, Aysha Khoury alleged that she was suspended, then let go, from Kaiser Permanente’s medical school after leading a student discussion about racism in medicine. An email told her that her suspension “was prompted by a complaint about certain classroom activities,” according to a lawsuit she filed. (A Kaiser spokesperson said, “We strongly disagree with Dr. Khoury’s characterization of events or any assertion that she was removed from her role because of anything to do with race or racism,” and that Kaiser encourages faculty members to share their experiences about those subjects. The spokesperson said the company could not elaborate on Khoury’s claims due to the pending litigation.)

“We’re not at decision-making tables,” Khoury said of Black doctors. “We’re not treated the same way. We’re not as protected in the same way as our counterparts.”

But proving that this kind of treatment is illegal discrimination can be deeply challenging.

While at Tulane, Okeke said she was constantly taken off shifts or asked to be taken off shifts to cover for others. “Every time they needed someone, I was pulled,” she said. She claimed the internal medicine chiefs denied her request to block out time for a rheumatology research conference — while their own residents seemed to have no problem getting such trips scheduled — and that she had to find replacements for her shifts herself. When she wanted to train at an out-of-state hospital for a month, she said, she was told she must use vacation time to get paid, even though a white resident in internal medicine told her that he didn’t have to use his off days to get paid for a rotation outside Tulane.

Tulane’s attorneys argued that there was no evidence that “any of these ‘slights’ related to her race or gender,” and that Okeke was overlooking other factors that could explain the differences. They said that there was no evidence that she was disproportionately called on for backup — schedules made public in litigation do not reflect such last-minute changes — and that there was “only one time” she had trouble getting coverage for herself. They pointed out that the internal medicine resident was in a global health track that paid for him to do research abroad, and that half of her time away got funded in the end.

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