What happens to black health care professionals in the new economy, where work is insecure and organizational resources are scarce? In Flatlining, Adia Harvey Wingfield exposes how hospitals, clinics, and other institutions participate in “racial outsourcing,” relying heavily on black doctors, nurses, technicians, and physician assistants to do “equity work”—extra labor that makes organizations and their services more accessible to communities of color. Wingfield argues that as these organizations become more profit driven, they come to depend on black health care professionals to perform equity work to serve increasingly diverse constituencies. Yet black workers often do this labor without recognition, compensation, or support. Operating at the intersection of work, race, gender, and class, Wingfield makes plain the challenges that black employees must overcome and reveals the complicated issues of inequality in today’s workplaces and communities.

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“Wingfield demonstrates how the focus of workplace racial interactions should be shifted to include not only what is done to black employees but also the work that is done through them. This should be reviewed by anyone at the management level, regardless of the business sector.”

Marcus H. Crawford, MD, Fellow of the American College of Surgeons

“I know of no other book that so clearly explains how race, class, and gender shape the experiences of black professionals.”

Christine L. Williams, author of Inside Toyland: Working, Shopping, and Social Inequality

“Raises serious questions about how race, gender, and class intersect at the workplace in the relationship between service providers and their clients.”

Nancy DiTomaso, author of The American Non-Dilemma: Racial Inequality without Racism

Flatlining advances our understanding of race in the U.S. workplace and is a must-read for anyone who seeks to comprehend the economic and social realities facing African Americans in hospital settings today. Adia Harvey Wingfield’s investigation into how black professionals in the healthcare sector experience racial outsourcing shows the limitations among far too many organizations in how they think about diversity, equity, and inclusion. Her interview-based evidence leads to the conclusion that to meet the needs of the diverse communities who rely on their products and services, organizations need to start by intentionally focusing on creating a racially diverse and inclusive workplace.”

Heather Boushey, Executive Director, Washington Center for Equitable Growth

Recent Media about Flatlining: Race, Work, and Health Care in the New Economy

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Adia Wingfield and Joe Madison – “Flatlining: Race, Work, and Health Care in the New Economy”

SiriusXM News & Issues

Joe Madison invited sociology Prof. Adia Wingfield, from Washington University in St. Louis, to discuss her book “Flatlining,” an honest and in-depth examination of what it means to be black and working in health care today.

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Neoliberalism, Black healthcare workers and the outsourcing of racial equity

This is Hell

As public hospitals and care centers tout the value of racial diversity, the actual labor required to serve communities of color is passed onto Black workers, often without additional resources, support or compensation.

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Racial Outsourcing

The Kathryn Zox Show

What happens to black health care professionals in the new economy, where work is insecure and organizational resources are scarce? 

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Real diversity or “racial outsourcing”?


What happens when a company says it values diversity but doesn’t do the work needed to live up to that value?

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Unraveling complicated issues of inequality in workplaces, communities

The Source

New book, ‘Flatlining: Race, Work, and Health Care in The New Economy,’ studies ‘racial outsourcing’