When Deborah Dyett Desir, MD, begins her tenure as president of the American College of Rheumatology (ACR) in 2023, she will be one of only a handful of women to have held that position, and the first woman of color.
Desir is an associate professor of clinical medicine (rheumatology) in the Section of Rheumatology, Allergy & Immunology in the Department of Internal Medicine at Yale School of Medicine (YSM). After Desir, Yale MD ’80, completed her fellowship training at YSM in 1987, she worked as a rheumatologist at a staff model HMO. In 1993, she started a community rheumatology private practice in Hamden, Conn. The practice grew to include three sites, including in Branford and Milford. Desir joined the YSM faculty in 2019. She is the medical director of the Yale Rheumatology Clinic in Hamden, where she cares for some of the same patients she first saw more than 30 years ago.
Q. You’ll begin your term as 2023-2024 ACR president next year. What do you hope to accomplish?
A. There are important, ongoing issues that I plan to address during my tenure. For example, we have a huge workforce shortage in rheumatology. Across the country, in every state, there are not enough rheumatologists to care for both children and adults suffering from rheumatic diseases. There are eight or nine states without a single pediatric rheumatologist. The ACR is currently developing innovative solutions designed to increase the workforce and I plan to support and expand these efforts. Recruiting and keeping physicians engaged in professional organizations is a challenge throughout organized medicine. I believe that it is important to increase and also diversify our membership, and ensure that all rheumatologists know that there is a place for them in the ACR. The demographics of our membership should reflect that of our population.
Q. You’ve been practicing clinical medicine for three decades. What excites you about going to work each day, and what is most challenging as a rheumatologist working with patients with painful inflammatory diseases such as arthritis?
A. Going to work each day affords me the opportunity to help people. This is why a became a physician. During my professional lifetime, the treatment of rheumatic diseases has been revolutionized with the advent in 1998 of biological medications. More than 20 years later, it is still exciting to be able to offer patients life-changing treatments. The most challenging thing for me is working within the U.S. health care system, which, at times, makes it exceedingly hard to get patients the services they need. I've had patients sitting on the exam room table crying because they could not obtain the medications that they need because of cost or insurance denials. It’s frustrating to have such effective medications to which so many don’t have access.
Q. You shared a story recently about how some of your patients have sought a second opinion from a white male rheumatologist. How do you deal with that?
A: I think about patients differently than I do colleagues, friends, or people I meet. There are behaviors that I would tolerate from a patient, but never tolerate from others. I believe that patients must develop a trusting relationship with their caregivers. I extend a lot of leeway to patients so they can get to that point. In answer to your question, the patient invariably returns saying, “He says you were right.” For me to resent that, or to hold that against the patient, does not help the patient -- and it's my job, or rather my calling, to help patients.
Q. How did you deal with microaggressions early in your career?
A. I had my first child when I was a resident. I was a nursing mother, and back then, the best breast pumps were in the postpartum unit. One day, I walked into a patient’s room to get a pump, and she looked at me and said, "I'm not done with my lunch yet." And before I could say anything, the lactation specialist said, "Oh no, no, no. That's one of our nursing doctors." But the patient’s assumption was this Black woman must be from dietary services. I could relate a litany of similar interactions, but I feel it’s more important to express the following message to faculty and attending physicians: It is imperative that attendings and faculty stand up for colleagues, especially medical students and trainees when they encounter these situations. Silence is complicity.
Q. During your career you’ve held many leadership positions including president of the New Haven County Medical Association in 2019-2020, and co-chair of the Connecticut State Medical Society (CSMS) legislative committee. You currently are the secretary for the American College of Rheumatology and the Rheumatology Research Foundation. What values are most important to you as a leader?
A. I value trustworthiness and frankness. I don't like to spend a lot of time figuring out what you mean. Just tell it, truthfully, like it is. I admire the ability to listen in a leader, as well as the ability to foster collaboration. I think a leader also needs to foster the development of others. A leader should not try to take credit for everything; humility is very important.
Q. What are the most impactful ways to address disparities in health care?
A. When we talk about health care disparities, it seems like we tend to blame the patient for poor outcomes. We use phrases such as this patient is economically disadvantaged, doesn't have insurance, is not compliant, doesn't have transportation, etc. This approach ignores the problem of implicit bias inherent in our health systems. If you look at the mortality statistics for new mothers, they are higher for women of color in every socio-economic group regardless of employment, insurance status or wealth. The issue is not only limited access because of lack of insurance, but is an issue of bias in how patients are perceived and treated based on race and ethnicity. One of the most well-known Black women in the country almost died in the immediate postpartum period because no one was listening to her. [After giving birth to her daughter, tennis star Serena Williams, who has a history of blood clots, had trouble breathing. But as Williams shared in an article in Vogue magazine, a hospital employee did not initially take her concerns seriously.]
This is a bias towards women of color. You're much more likely to listen to somebody that you can identify with, as in, this could be my mother, this could be my sister. But if you can't make that empathetic leap, your ability to care for the patient may be impaired.
Q. You’re a member of the Theta Epsilon Omega Chapter of Alpha Kappa Alpha Sorority, Inc. as well as the New Haven Chapter of Links, Inc. and the New Haven Chapter of Girl Friends, Inc. What do these organizations mean to you?
A. I should probably say a few words about each of these organizations of professional African American women.
Alpha Kappa Alpha Sorority, Inc. (AKA) was founded in 1908, which boggles my mind because even attending college was a challenge for young women of any color or ethnicity in 1908. AKA is a historically Black sorority and an international organization. Being a member of an historically Black sorority or fraternity is a lifetime commitment. As you know, Vice President Kamala Harris is a member. AKA is an amazing organization with the mission of “Service to all Mankind.” My aunt, sister, daughter, and niece are members. I am honored to be a member. We support and help each other. We are an active service organization. Our chapter is involved in mentoring young girls, voter registration, COVID-19 education and a host of service initiatives in the New Haven Community. We also award a number of four-year college scholarships to deserving students each year.
The Links, Inc. was founded in 1946. It is one of the nation’s oldest and largest volunteer service organizations of professional women of African descent. Its core values are friendship, integrity, honesty, service and legacy. My mother was a Links member and a charter member of her chapter.
I'm also a member of The New Haven Chapter of Girl Friends Incorporated. The Girl Friends, Inc. was founded in 1927, during the Harlem Renaissance, and its name is self-explanatory.
These organizations are source of pride, help, comfort, joy and laughter. “It has been said that service is the rent that you pay for your room here on earth.” These women are my sisters. I think that explains it all.
Q. Your Links chapter was active in the New Haven community during the COVID-19 pandemic. What was that like?
A. At the beginning of the COVID pandemic, our Links chapter formed a rapid response committee, which I chaired. We are a small chapter, but we delivered more than $70,000 worth of masks to the community at a time when it was very difficult to get masks.
We provided masks to schools, to foster care agencies, and to living facilities for senior women. We also bought thousands of dollars of grocery store food cards that we gave to families who were economically impacted by COVID. When vaccines became available, our Links chapter partnered with the Omega Psi Phi fraternity. We hosted two webinars, to give accurate information about vaccines, to combat misinformation, and to answer questions so that people could make informed decisions about vaccination. I mentioned Omega Psi Phi fraternity, Inc., but must mention that my father was a member of Alpha Phi Alpha, Inc. fraternity, which was the first historically Black fraternity, founded in 1906 at Cornell University. [Desir’s father, Benjamin I. Dyett, MD, graduated from Howard Medical School in 1954. He was a family practitioner for 40 years in Westchester County, New York.]
What was very striking to me during these webinars was a chart that Gary showed that had blue circles for every community COVID outbreak. [Desir is married to Gary V. Désir, MD, vice provost for faculty development and diversity at Yale University, chair of YSM’s Department of Internal Medicine, and Paul B. Beeson Professor of Medicine.] If you looked at Whitney Avenue, a predominantly white residential street, there were very few blue circles. If you looked at Dixwell Avenue, a predominantly African American residential area, there was a sea of blue. We tried to impress upon people that the disease was affecting people in the minority community in New Haven at disproportionally high rates. The fraternity that sponsored the webinar had told me, "Your job is not to tell people to get vaccinated; your job is to give them information." I hope that they forgave me, but at the end of the webinar, I said. “I am just going to put on my mom hat, y’all need to get vaccinated.”
My chapter of AKA also formed a rapid response committee early in the pandemic which I co-chaired. We delivered masks, health information, grocery food cards, support for senior citizens and a host of other community activities early in the pandemic.
Q. What do you enjoy doing in your free time?
A. Family, family, family. Our three grandchildren are my heartbeats and the delight of my life. I also enjoy taking long walks with my husband on Martha’s Vineyard, our home away from home. We will be married 43 years in August. We met during our first year of medical school at Yale over a cadaver in anatomy class.
I love to read, and am also an avid indoor and outdoor gardener, and a member of the Garden Club of New Haven. I have 150-160 houseplants including several prize winners. Gary and I also have been ballroom dancing for more than 20 years and this is something we really enjoy. A few years ago, we won 1St prize (three perfect 10 scores) performing a samba during a Dancing for Life event to raise funds for organ and bone marrow transplant.
The Section of Rheumatology, Allergy and Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more about their work, visit Rheumatology, Allergy & Immunology.