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Asian American Doctors, Overrepresented In Medicine, Are Largely Left Out Of Leadership

For 15 years, orthopedic surgeon Charles S. Day has been working to highlight the striking lack of diversity in his field, publishing studies showing orthopedics had the fewest Black, Hispanic, and female residents of any surgical specialty.

Day himself is Asian American, a group that's abundant in medicine. But as he dug further, his datasets and personal experiences began to collide. He found that white doctors were more than four times as likely as their Asian American colleagues to be promoted to medical school department chair positions in a wide array of medical specialties, and that Black and brown doctors were more than twice as likely as Asians to be promoted.

In 2019, according to a new analysis by Day, Asian Americans made up 13% of orthopedics faculty at U.S. Medical schools but held just 5% of chairs. When Day looked across a range of specialties, including family medicine and OB-GYN, he found that Asian American physicians held more than 20% of faculty positions but less than 11% of chair positions. He also found near complete silence about this leadership gap.

The issue remains largely invisible because Asian Americans are considered overrepresented in medicine: They make up just 7% of the nation's population but are 20% of its doctors. Asian Americans also are often considered the "model minority" — statistics show that as a group they tend to be healthier, wealthier, and more educated than other racial groups, including white Americans. As a result, the progress and challenges of Asian Americans in medicine have been little studied or discussed.

To be sure, Black and Hispanic doctors are a far smaller percentage of faculty in all specialties than white and Asian American doctors, but analyses by Day and others show a larger proportion of the smaller pool of Black and Hispanic faculty eventually advance to chair positions than Asian Americans.

"I was so blinded to the issue, but as I'm doing the research it dawned on me," said Day, who is executive vice chair of orthopedic surgery at the Henry Ford Health System in Detroit and is a professor of orthopedics at Wayne State University. "I'd been feeling like, huh, I'm not being considered for this position, or that position."

As he spoke to Asian American colleagues about the disparity in recent months, he realized they felt similarly. They hadn't talked about it openly, but told Day they'd been passed over for higher-level jobs several times and knew very few Asian American physicians in top roles within medicine.

"I'm beginning to think it hurts to be Asian American," said one physician who requested anonymity because he is currently seeking a leadership job. "I've been struggling to get any kind of leadership. I've been told many times I have all the talent and the whole package, but I'm just 'not the right person.'"

This gap is invisible in many data analyses. Because they are not underrepresented in medicine, Asian American physicians are regularly lumped with white physicians in many demographic analyses. The racial makeup of U.S. Medical school deans posted by the Association of American Medical Colleges, for example, shows white and Asian American doctors have held more than 90% of medical school dean positions for the last 30 years, which makes it appear there are large numbers of Asian American deans.

But there are not. A study published in 2013 found not a single Asian American medical school dean in the United States between 1997 and 2008.

Peter T. Yu was a surgical resident at the University of California, San Diego, when he led that study. When he interviewed for fellowships and jobs, he said, the absence of Asian American physicians in leadership was palpable. "When you interview, you see the chairs and division chiefs," he said. "Asian Americans are not overrepresented in those roles."

To Yu, the most obvious parallel is the NFL, where the vast majority of players are Black, but Black head coaches are rare. "You can do a hand count," he said. "It's the same in our profession."

When Augustine M.K. Choi became dean of Weill Cornell Medicine in 2017, he was one of two Asian American deans leading one of the country's more than 150 allopathic medical schools, he told STAT. In recent years, Choi said, the number has hovered between five and six deans. "I know, because I know them all," he said.

Barriers to leadership for Asian Americans are also an issue elsewhere in medicine. In its 176-year history, for example, the American Medical Association has had one president with Asian ancestry.

At the National Institutes of Health, a recent study found Asian Americans make up 20% of the permanent workforce but hold only 6% of senior leadership positions. The analysis showed Asian American employees had more obstacles moving up the ladder, with many reporting "the everyday experience of exclusion and invisibility."

It's a problem in business and tech as well. A 2017 report on Silicon Valley found Asian Americans were less likely than any other racial group, including those who are Black and Hispanic, to be promoted. At Goldman Sachs, 25% of the U.S. Workforce is of Asian descent but just 15% of executives are.

In science, disparities also exist in funding rates. A 2022 study of National Science Foundation funding found Asian American scientists, while receiving a large number of grants, were funded at the lowest rate per submission of any racial or ethnic group. A 2012 study showed Asian Americans were less likely than white or Hispanic researchers, but more likely than Black researchers, to receive prestigious NIH R01 awards.

It's no different for biomedicine's most prestigious research prizes, in which more than 90% of awardees are white and less than 7% are of Asian descent, despite the fact that people of Asian descent make up more than 21% of biomedical faculty, according to a study by University of California, San Francisco, physiologist Yuh Nung Jan, who called the numbers "pretty appalling."

In interviews with STAT, many Asian American physicians wondered if cultural norms that promote humility and listening over speaking up and self-promotion diminished their chances for leadership positions and helped keep this issue hidden. But they are becoming more vocal. The recent surge of anti-Asian violence, including attacks on physicians in the wake of the Covid-19 pandemic, has prompted many to speak out about what they see as the bias, stereotyping, and unfair treatment they have experienced.

When Augustine M.K. Choi became dean of Weill Cornell Medicine in 2017, he was one of only two Asian American medical school deans in the country. Courtesy Weill Cornell Medicine

Choi, for one, said he was inspired to co-author a JAMA editorial on the lack of Asian representation in medical school leadership in 2021 after the shooting deaths of six women of Asian descent in Atlanta earlier that year.

For Day, the numbers he's recently revealed dovetail with personal frustration. He was interim medical director of his hospital for two years and interim chair of his department for nearly a year. In his view, his long surgical and teaching experience, his publication record, and his MBA and deep knowledge of hospital finances more than qualified him to lead the department permanently.

He waited patiently as a decision was postponed and then as two outside candidates were brought in. "They were both white, by the way," he told STAT. One of those candidates, without demonstrably more qualifications or experience than Day, was recently chosen for the job, he said.

He was appointed to another position, helping to oversee all specialty care at Henry Ford, but getting passed over for chair has forced Day to consider leaving a medical school and hospital system he loves. He knows his individual experience isn't enough to prove a trend. But numbers from national databases in academic medicine suggest he is far from alone, and that systemic bias may be at play. "You look at the data and you say, 'there's a disconnect here,'" he said.

"We're good enough to be star faculty, division chiefs, program directors, and vice chairs, but not 'good enough' for the next echelon," said Day, who is Taiwanese American. "Working hard and having all kinds of accomplishments may get you into medical school or a faculty appointment, but it doesn't get you into the C-suite."

There's no telling this story without addressing the elephant in the room: Asian Americans are overrepresented in medicine while many people from other non-white racial and ethnic groups are struggling to gain entry into the profession in significant numbers — and come from communities that face staggering health disparities. To Black, Hispanic, and Indigenous physicians — as well as Native Hawaiians and Pacific Islanders who are included under the broader AAPI umbrella but are severely underrepresented in medicine at all levels — the concerns of Asian American physicians may seem less urgent, or perhaps not important at all.

Such sentiments may be one reason Asian Americans have not felt comfortable bringing their concerns forward, particularly now amid the clear racial disparities seen during the Covid-19 pandemic and after the police violence highlighted by George Floyd's murder brought the horrific racism faced by many Black Americans — and Black physicians — into the national spotlight.

The issue is also politically sensitive. Many see the recent debates over affirmative action, with the Supreme Court overruling its use in admission to colleges and medical schools, as pitting Asian Americans against those who are Black and Hispanic.

Asian American physicians interviewed for this article said they felt strongly that physicians from underrepresented groups needed and deserved their support and that the pipeline into medicine needs to be broadened and diversified. But that doesn't mean, they say, that the leadership disparities affecting them should be ignored or that their academic success and hard work should not be rewarded. "It puts Asians in an awkward position" to bring these issues up, Day said.

For Asian Americans, the pipeline to enter medicine is wide open — but it appears to squeeze shut abruptly for many with higher career aspirations.

"We're left out of DEI efforts because we're well represented, yet we have a glass ceiling that people aren't talking about," said physician Richard Pan.

Pan is a pediatrician who trained at some of the nation's top programs and had been moving up the faculty ranks at the University of California, Davis. He went from assistant to associate to full professor, was awarded numerous research grants, and served as interim director of the medical school's pediatric residency program. But there, his upward trajectory ended.

A well-known community leader, Pan then did something unusual for a physician. He ran for office. He was elected to the California Assembly in 2010 and then the state Senate in 2014, serving until last year when he termed out. His legacy was a slate of new laws protecting children's and public health and a reputation for strong leadership. At UC Davis, he told STAT, "I wasn't being offered section chief, or department chair, yet I go out and get elected. When the people vote, I get elected. When it's a club, I don't get selected." He is now running to become Sacramento's next mayor.

The son of Taiwanese immigrants, Pan had wanted to be a doctor from a young age — a decision that pleased his highly educated parents who urged him to do something practical and technical that would make him needed. "Then when you face discrimination," his parents had told him, "those people will have to swallow it, because they need you."

Pan, a self-professed data wonk, is leading efforts to collect and disaggregate data on Native Hawaiians and Pacific Islanders to understand health disparities in those groups. But his effort to get specific numbers on Asian Americans in medical leadership positions has been frustrating. "I've been trying to look at this for several years," he said. "It's really hard to figure out because they put white and Asians together."

The data now trickling out confirms Pan's belief that systemic factors — racism and stereotyping — may be keeping Asian Americans from reaching leadership positions in a host of fields.

A recent study shows the devaluing of the skills and prowess of Asian American physicians may begin early in their careers. In a study of nearly 10,000 internal medicine residents who finished their training in 2016 or 2017, those of Asian descent were assessed by their program faculty to be nearly 25% less likely than their white counterparts to be ready to practice medicine unsupervised; residents from groups underrepresented in medicine were 15% less likely than white residents to be deemed ready. The differences in ratings, the authors wrote, suggests a "global devaluation" of these physicians that may "accumulate longitudinally and prevent career advancement."

The trope going around when he attended medical school in the early 1990s was "Asian Americans are good at tests but they're not good with people," said Pan. "That trope is still going around unfortunately."

Amanda Rhee, an anesthesiologist and associate professor at the Icahn School of Medicine at Mount Sinai, is the inaugural director of the hospital's new Center for Asian Equity and Professional Development. Janice Chung for STAT

STAT spoke to nearly a dozen Asian American physicians who discussed the pain, uncertainty, and confusion they have felt as they have been bypassed again and again for promotions they feel they had earned.

Many said they faced discrimination while growing up, but found success in medical school and their early careers, even in difficult and competitive surgical specialties. "I'd worked my ass off early on and had many accolades, all the doors opened," said one physician, who like some others requested anonymity to avoid harming their career. "As I got to the middle of my career and later, all the doors started to shut."

Many said they doubted themselves, and thought that if they just worked even harder and shined even brighter, opportunities would follow.

"I would think, maybe if I just write another 100 papers, someone will notice me," said the physician, who has received several million dollars in grant funding over the years and has a lengthy publication record. "I made excuses for why I wasn't getting things — I thought I needed to work on my personality, my manner of speaking — that's a very Asian thing."

Others, including Day, said they defy the stereotype of quiet and reserved Asian Americans and possess the assertiveness usually tied to leadership in the U.S. "By the way, I'm not soft-spoken," said Day. But that didn't seem to help. "It's always something intangible — being told, 'You're not quite a leader.'"

Another Asian American physician who requested anonymity told STAT: "I've been told I'm too direct, not subtle enough, that my energy and enthusiasm is overwhelming," he said. "Well, I'm a surgeon. You give me a problem, I'm going to fix it."

The surgeon and many others are frustrated that the decades of hard work they've put in has not taken them further, and said they have started to feel medicine is not the meritocracy they were told it was. "It's shaking up the foundation of 40 years of how we worked," he said. "Why do you not go to parties, spend every weekend in the lab doing research? It's to get to the next step."

Others said they had realized over time, and after many disappointments, that leadership doors were not open to them. They described being sent to satellite hospitals instead of more visible jobs at main teaching hospitals, not being asked if they were interested in leadership, and having promotions delayed or withheld with little reason.

"There are chosen ones and unchosen ones. I learned quickly in my career I wasn't going to be groomed for leadership," said another physician who requested anonymity.

"We've got several strikes against us. We're not getting credit for being a minority. We tend to be shorter. We tend to do our jobs and not complain," he added. "That combination makes us easy to overlook."

"I thought as long as I did a good job, it would be OK, that someone would be looking out for me," said the physician. "I was so naive."

What could be causing the deficit in leadership positions for Asian American doctors? Many who have thought about the issue point to bias and stereotypes as part of the problem, but say the culture of their communities also likely plays a role.

Pan and others said many Asian Americans grew up in households where they were urged to study hard, keep their heads down, and not make waves. "In my own culture, that would be seen as too aggressive [to push for a leadership position]," he said. "We're supposed to be humble."

James Kang is a spine surgeon who chairs the department of orthopedic surgery at the Harvard-affiliated Brigham and Women's Hospital in Boston. When he sits in a room of the 50 or so department chairs, he said, he's the only Asian American in the room. It's the same when he's in a meeting of his hospital's top leaders. "I have said, 'It's strange to me that I'm the only Asian face in this room of 180 people,'" he said.

Kang is about to become president of the American Board of Orthopaedic Surgery. He'll be the first Asian American president in the group's 90-year history. It's something he's reflected on — why he's risen to leadership while so many of his Asian American colleagues have not. He thinks it's clear there is subliminal bias, but says "some of this is on us."

Kang was born in Korea, and was taught, as many Koreans are, that gentlemen aren't supposed to talk much, or mouth off, but to listen and behave. "But if you want to get ahead in Western society, you have to give your opinion. You have to show charisma," he said. "A lot of decisions are made based on meetings and how you represent yourself, and a lot of Asians fall short on that."

Kang attributes his ability to cross over to a Western leadership style to the late Freddie Fu, a legendary physician at the University of Pittsburgh Medical Center who was one of the first Asian department chairs in medicine. "He was very charismatic. He talked a lot. He was from business Hong Kong. His father was a billionaire and people just loved him," Kang recalled.

"I lived under that regime and saw how Freddie operated," Kang said. "I learned to speak out and become a leader based on Western culture."

Now, said Kang, he's seen a number of Asian American candidates for top positions that don't interview well. "They're highly accomplished, but they're so quiet," he said. "I want to take them into the other room and say, 'No, you've got to do it this way.'"

"I'm trying hard to be a good role model as Freddy was to me," Kang said. "I tell them, 'Don't go against what your parents told you, but be a little bold.'"

Yu, a Chinese American who led the study on the decade-long absence of Asian American medical deans, said the reasons for the disparities are complex, and that culture certainly plays a role. "I think my experience is fairly common. The push was to go to a top college and there's a strong push to go to medical school, but there was never a strong push for me to become a dean or chair — being a doctor was a pinnacle in my family."

Asian Americans, he said, are very family-oriented. Leaving time to spend with children, and taking care of aging parents, he said, may preclude some from avidly climbing career ladders.

More research needs to be done to understand the role these cultural issues play. A 2020 study of business leadership found that South Asians were more likely to be promoted than East Asians and even more than their white colleagues, though they reported experiencing more prejudice and East Asians were equally interested in leadership. The authors attributed the difference partly to South Asians communicating more assertively.

They emphasized the onus should not be on East Asians to change their behavior, but rather on American organizations to evolve their definition of leadership and recognize that the "group-focused, protection-oriented" leadership style of East Asians could benefit them. "The bamboo ceiling is not an Asian issue, but an issue of cultural fit," they wrote.

"The question is," said Kang, "is it up to us to rise to white standards? Or is it up to them to realize this is a cultural issue?"

James Tsai, who chairs the ophthalmology department at the Icahn School of Medicine at Mount Sinai, is helping teach leadership skills to other Asian American physicians. Janice Chung for STAT

There is some change afoot, perhaps most visibly on the West Coast. Yu, for example, is the chair of the department of surgery at his Southern California hospital, and the department of surgery at UC Irvine where he is an associate professor has an Asian chair as well. More data are being collected, including a study published this March that found a similar Asian American leadership gap in internal medicine as Day found in orthopedics, and that for females of Asian descent, the leadership numbers are far lower than for males.

More conversations are starting within academia. Colby College psychologist Jin X. Goh tweeted this month that "an Ivy League psych dept reached out to me and many of my Asian American assistant prof friends to apply for a SENIOR position. They just didn't have enough POC applicants. They hired a White person at the end." His tweet got 2 million views.

And in what may be the first formal effort to bring more Asian American doctors into leadership, physicians at the Icahn School of Medicine at Mount Sinai recently started the Mount Sinai Center for Asian Equity and Professional Development. The program got its start during the pandemic and the upsurge in violence against Asians, said Amanda Rhee, an anesthesiologist and associate professor at the medical school who serves as the center's inaugural director.

A town hall convened to discuss anti-Asian violence, she said, uncovered the fact that many Asian American physicians felt they were being overlooked for leadership and advancement.

"So many people came out of the woodwork to ask for help," she said. "They said they had nowhere to go to talk about these difficult issues."

That's something Norma Poll-Hunter, senior director for workforce diversity at the Association of American Medical Colleges, has seen firsthand from Asian American physicians when she runs leadership workshops and DEI discussions.

"Oftentimes they ask, 'Am I welcome?' They certainly are," she said. "Many Asian faculty, like their Black and Hispanic colleagues, don't have access to information and networks that white faculty do."

It was clear from discussions at Mount Sinai that many felt overlooked because medical leaders and others consider Asian Americans to be doing well educationally and financially. But that's not always true: A recent study found nearly one-quarter of Asian Americans adults in New York City live in poverty. "That model minority myth leads to a blind spot," Rhee said.

James Tsai is the center's executive adviser. He also chairs the medical school's ophthalmology department, is president of the New York Eye and Ear Infirmary of Mount Sinai, and was recently asked to join the board of the Council of Teaching Hospitals and Health Systems, a group of physician leaders that focuses on national issues affecting medical schools. He is the only Asian American physician in the 20-person group.

Tsai is hoping to transmit some of what he's learned about leadership to others. "I think I made the quick realization that at some point, talent won't get you all the way up," he said. "It's how you position yourself. It's being collaborative."

He has an MBA and said the degree helped him understand "the soft skills of leadership." "It's not the person who's the smartest person in the room who's the leader, it's more the person who can be the conductor, the coordinator," he said. "A lot of Asian physicians who are super talented and with the most achievements don't always see this."

Mount Sinai's center is the first Tsai knows of that is focusing on professional development for Asian American physicians. Center leaders hope to study the issue of implicit bias against Asian Americans and offer leadership training and more formal mentorship. He is eager for similar centers to follow.

Tsai, Rhee, and others want their work to enable a new generation of Asian American physicians to serve as medical leaders. For the many who have been in medicine for decades and never reached the level of department chair or higher, it's likely too late. Said one Asian American physician: "It would have made my dad so proud."

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PAVLIVKA, Ukraine

Amid the distinct smell of burnt grain, it is the piles of mangled fragments of Russian missiles that attest to the importance of one family-owned, small-to-midsize Ukrainian grain storage site.

The facility 75 miles southwest of the Black Sea port of Odesa was targeted by Moscow less than a week ago as Russia stepped up its bombardment of Ukraine's port and agricultural facilities. It was hit before dawn with three rockets, then with two more rockets an hour later.

Warehouses were blasted, machinery melted, and 120 metric tons of dried peas and barley burned.

Beside a wrecked loading platform, two missile tail pieces spill with barley, an incongruent image created by the Russian campaign to crush Ukraine's grain export capability.

The United Nations and many African and Middle Eastern nations, especially, depend upon the vast grain harvest in Ukraine – it produces 10% of the world's wheat and 15% of the world's corn – to feed millions of people.

"We never expected such things to happen to us," says Olha Romanova, who built up the Willow Farm facility from her family's small plot in 1996. "You should count your importance by the number of rockets they send. We can't fit it into our heads; there is no military logic."

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Ukrainian Olha Romanova, owner of a grain storage facility struck by five Russian missiles three days earlier, waits with her workers on the outskirts of the facility during an air raid alert in the village of Pavlivka, Ukraine, July 24, 2023.

Ms. Romanova says the official Russian justification for the strike was so absurd – that a clandestine drone-making factory was hidden in her storage buildings, in the heart of a rural farming community – that she just cried when she heard it.

Today, workers use shovels to separate burnt barley from clean, drag away destroyed vehicles, and load remaining stocks onto trucks – when they aren't marveling at the remnants of the Russian missiles that turned their lives upside down. They estimate that only 30% of the facility is repairable.

"The situation is changing every day," says Ms. Romanova, who notes that the facility will, for the time being, have to "sell from the wheels" – a term that means loading the harvested grains directly onto trucks for transshipment, without storing at all.

And this family business is not alone, as Ukraine struggles to recalibrate its export strategy in the midst of Russian bombardment and a potential blockade.

Since Russia withdrew last week from the Black Sea Grain Initiative – which for one year ensured the safe export of food from Ukraine – it has launched near-nightly waves of missiles and drones against Ukrainian ports and export facilities. On Thursday Ukrainian military officials said a missile fired overnight from a Russian submarine in the Black Sea struck the port in Odesa, killing a port employee.

Ukrainian officials estimate that some 100,000 metric tons of grain (one metric ton is 1,000 kilograms, or 2,200 pounds) have now been destroyed across the Odesa region – including 60,000 metric tons at the Chornomorsk port alone – and the targeting of Black Sea ports and smaller ports on the Danube River has raised doubts about shipping safety.

Grain prices have surged nearly 20% since Russia pulled out of the deal, and U.N. Secretary-General António Guterres called on Russia to return to the agreement because of the impact on "vulnerable countries struggling to feed their people."

"Some will go hungry; some will starve; many will die as a result of these decisions," the U.N. Aid chief, Martin Griffiths, told the Security Council last week.

Alla Stoianova, the Ukrainian official in charge of agriculture for the Odesa region, says stopping the smooth transfer of grain to export facilities early in the harvest season is Russia's main aim. Some 2 million metric tons of grain are ready for export, she says, and another 1 million metric tons are "waiting on farms to be loaded."

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Alla Stoianova, head of agriculture for the Odesa regional government, in Odesa, Ukraine, July 25, 2023. Some 2 million metric tons of grain are ready for export, she says, and another 1 million tons are "waiting on farms to be loaded."

Yet Russia appears to be planning more than attacking grain transfer logistics on land. Moscow announced in recent days that it will consider any vessel attempting to reach Ukraine to be a "potential carrier of military-purpose cargoes" – and therefore subject to attack.

The United Kingdom Ministry of Defense reported Wednesday that Russia's Black Sea fleet had "altered its posture" to blockade Ukraine and to patrol shipping lanes between Odesa and Turkey's Bosporus.

Ms. Stoianova has the estimated losses of grain and export capacity from each Russian strike at the tip of her tongue. She notes that more than $500 million in Ukrainian state funds have been earmarked to insure ships that export grain, even in the absence of the Black Sea grain deal.

And she suggests an additional security measure.

"We are sure that NATO and the U.S. Have the ability to escort ships and protect them" in the Black Sea, she says.

"We definitely received signals of them wanting to help us, but there are some formalities and rules, and players and powers," says Ms. Stoianova. She says Ukraine also understands that NATO has a "long line" of other priorities, and that Ukraine is not yet an alliance member.

"But the situation with Ukraine now is exceptional and is not the same as in other countries," she says. "Today we are literally the protection from aggression for all of Europe, so we really hope this exception can be made for Ukraine, because the consequences can be disastrous."

Russian President Vladimir Putin is convening a summit this week with 21 African heads of state in St. Petersburg (down from 45 at a Russia-Africa summit in 2019 in Sochi), some of whom have complained that Russia's blockade of Ukraine threatens their food supplies. In his speech to the gathering Thursday, Mr. Putin said Russia – also a big grain exporter, which expects a record harvest this year – can fill any gaps and would provide free grain to at least six African nations.

The Black Sea grain deal was originally negotiated by the U.N. And Turkey to ensure that the most vulnerable nations, such as Somalia, Yemen, Egypt, and Afghanistan, received enough food. Indeed, under the grain deal, the U.N.'s World Food Program had grown by this month to depend upon Ukraine for 80% of its global wheat for distribution, up from 50% in 2021 and 2022, according to U.N. Figures.

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Sun shining through shrapnel holes in the roof dapples piles of barley, as Ukrainians salvage barley and peas in Pavlivka, Ukraine, July 24, 2023.

"We produce five to six times more food than we consume; we will not go hungry, no matter what," says Ms. Stoianova. "But what it [a stoppage] means for the world is a question of food security. A large number of people of the world are now not receiving our grain."

Her anger becomes palpable regarding recent Russian strikes that have burned grain supplies at dockside and that she considers cynical.

"Russians don't need Ukrainians; they need our land and resources," she argues. "They don't care about Africans, or other suffering countries. They want control over food security."

On Monday, the Russian campaign crept closer to NATO member Romania. Drone strikes before dawn on the Reni port, on the Danube River, destroyed an estimated 3,500 metric tons of grain waiting to be loaded.

Reni is one of two Soviet-era ports on the Danube that Ukraine has been expanding in order to ship grain directly to Europe by barge, to bypass the Black Sea. In 2022, it exported 16 million metric tons of grain and has now achieved that same volume in the first seven months of this year.

Targeting that port is considered a sign of Russian resolve to disrupt exports from Ukraine, since it lies just a few hundred yards across the river from Romania.

"No one knows what is next; Russia is trying to press European countries, all our friends, to pressure Ukraine to make compromises," says Eugene Postovik, an Odesa-based marine and cargo surveyor with Svertilov Marine Consulting.

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Ukrainian marine and cargo surveyor Eugene Postovik in Odesa, Ukraine, July 24, 2023. He says a far bigger problem than the loss of grain is the damage to port facilities, noting, "It takes one year to rebuild a terminal, to get it to the same capacity."

Immediately after the drone attack on Reni, clients were asking for fresh risk assessments, he says. Romanian President Klaus Iohannis strongly condemned Russian attacks on civilian infrastructure "very close to Romania" and warned of "serious risks" to Black Sea security.

An earlier attack on the Izmail port, also on the Danube, damaged one large crane and hit two storage silos.

Mr. Postovik says that while many people are focused on how many tons of grain are being destroyed in the attacks, a far bigger problem is the damage to port facilities, noting, "It takes one year to rebuild a terminal, to get it to the same capacity."

There is gratitude for the tough statements against Russia at the U.N., but "they are only complaints. We need solutions," he says.

Further inland, at Ms. Romanova's damaged grain storage facility, an air raid siren sounds and 15 or so workers rush to evacuate the site, waiting out the alarm on shaded grass.

"We never did that before," says Ms. Romanova, of heeding the frequent air raid sirens. "But since we have been given a second chance, now we react to each one.

"This damage we can fix, but the most precious thing that can't be replaced are human lives."

Reporting for this story was supported by Oleksandr Naselenko.

How An Amateur Diver Became A True-Crime Sensation

When Carey Mae Parker didn't show up for her son's sixth-birthday party in Hunt County, Texas, in 1991, her family was puzzled but not entirely surprised. Parker was young and had a turbulent life, and they assumed she'd appear eventually. But she never did. Parker's daughter, Brandy Hathcock, was five at the time. She and her two siblings had spent time in foster care; later, they moved in with their grandfather. The household was chaotic, fractured by abuse. "I hadn't heard the term 'intergenerational trauma' until pretty recently, but as soon as I heard it I knew, O.K., that's exactly what I've experienced," Brandy told me.

Brandy was initially led to believe that her mother had abandoned the family, but as she got older she began to reconsider. Maybe Parker hadn't left her children; maybe something had happened to her. Her relatives shared their own ideas: cinematic theories involving drug deals gone wrong, Mexican cartels, crooked cops, and a vast, countywide conspiracy. The uncertainty was "like living with a ghost," Brandy said. "I wanted to give up hope, because that kind of hope is so heavy. I didn't want to carry it anymore, but I couldn't put it down." When Brandy was in her early twenties, she and her aunt, Patricia Gager, tried to fill in the gaps left by local law enforcement, which they said had done little to find Parker. (Gager had informed police in a neighboring county of Parker's disappearance in 1991, but Hunt County had no record of it until 2010, when Brandy filed a missing person's report. The local sheriff's office then began investigating the case.)

A few years ago, George Hale, a public-radio reporter from Dallas, produced a podcast on Parker's disappearance. The program zeroed in on her ex-boyfriend, who, according to local gossip, had dug a large hole on the grounds of his family's septic business around the time she vanished. But the show ended with no conclusive answers. "I really thought I would go to my grave not knowing what had happened to her," Brandy said.

Then, in December, 2020, Brandy's husband showed her a video he'd seen on YouTube. It was made by a group called Adventures with Purpose, volunteer salvage divers who investigated cold cases by searching for cars in lakes and rivers, and shared their exploits with millions of YouTube followers. Brandy spent the evening binge-watching their videos, including one about Nicholas Allen, a North Carolina teen-ager who had disappeared a few months earlier, and whose submerged vehicle and body had been recovered by A.W.P. Divers. The video showed Allen's mother, Judy Riley, standing on the shore of a muddy river, sobbing. "I've known he was here. I've known and I've begged and I've asked, and today you guys got me my answers," she said in the video. This was the third case that A.W.P. Had helped solve since the group was founded, two years earlier, by Jared Leisek, an Oregon entrepreneur. Brandy had often wondered whether the reason that her mother and her car had never turned up was that they were under water. That evening, she sent A.W.P. A Facebook message: "I'm hoping to find out how you determine which missing persons cases you work? My mother and her car have been missing without a trace since 1991."

Two months later, a handful of men from A.W.P. Showed up in Hunt County. Leisek, a restless man in his mid-forties, stepped into a small inflatable boat and cruised alongside the causeway that spans Lake Tawakoni, which was on the route to Parker's father's home. He scanned the lakebed with sonar for hours with another diver, Sam Ginn. Eventually, they spotted an upside-down car. Ginn squeezed into a drysuit and ducked under the surface. When he popped up, he seemed frustrated. "I can't see nothing," he said. "I'm ridiculously cold." But he'd managed to pry off a piece of the car's body. It was pale blue, the color of the Buick that Parker had been driving when she disappeared. Then Leisek went into the water, returning with a bumper. When Gager saw it, she began to weep. Leisek also retrieved a section of a door panel. It had a Smurf decal stuck on it; as a child, Brandy's brother, Brian, loved the Smurfs. In the resulting video, Ginn tells him, "This is more than likely put there by you when you were a kid." Parker's family stood at the water's edge, accommodating their new reality. It seemed that Parker hadn't run off or been murdered, but that she had got into an accident and her car had sunk in the lake, trapping her.

Leisek kept diving, attaching chains to the vehicle. It was dark by the time a tow truck hauled part of the dripping car onto shore. It was Parker's Buick, but her remains weren't inside. Leisek, his hair still damp, shook his head, visibly disappointed. "Unfortunately, today," he told the camera, "we have the answers as to where Carey is at—we just don't yet have Carey home." In the video, which now has more than three million views, he adds, "Thank you for being with us, and, if you've not done so, please do subscribe."

The Internet has added a new dimension to the persistent fascination with crime stories: it has made the genre participatory. Tricia Griffith, the owner of Websleuths, a true-crime discussion forum founded in 1999, encountered the online sleuthing community in the late nineteen-nineties, when she was "incredibly bored" following the birth of her son. The JonBenét Ramsey case was all over the news. "I read something in the paper about a six-year-old beauty queen found dead in her basement, and I thought, Well, that's a misprint. There's no such thing as a six-year-old beauty queen. So I got on the Internet to check it out. And then I was hooked," Griffith said. On Web forums and discussion boards, strangers pooled their expertise to analyze Ramsey's death in far greater depth than the nightly news had. The participants might include a nurse who could offer opinions about Ramsey's injuries, someone who purported to have insider information about her family, and a paralegal who knew how to parse court filings.

These days, the patchwork group of Facebook detectives, crime commentators, self-trained DNA analysts, and curious onlookers has come to be known as the true-crime community. It has helped solve cases and brought attention to wrongful convictions. (After a formerly homeless man who won the lottery was murdered, posters on Websleuths helped find his killer.) But it has also been an engine of misinformation, vitriol, and harassment. (Redditors identified a missing student as a suspect in the Boston Marathon bombing, and his family was hounded relentlessly; it turned out that he had died by suicide.)

When Griffith purchased Websleuths, in 2004, it was "a snakepit," she said. Forum members, angry when others didn't agree with their pet theories, often turned their detective skills on one another: "People would be, like, 'I know where you live,' 'Screw you, I know where you live.' " Griffith instituted content policies—no name-calling; no unfounded rumors—and the tenor of discussions improved. But, elsewhere on the Internet, the moderation was often less strict. Griffith was particularly concerned by what she saw on YouTube, where users could build a brand by discussing dramatic subjects with variable adherence to the truth. When the Covid lockdowns left people stuck at home, hungry for drama, the true-crime community grew in size and intensity. "There were always rumors and crazy stuff going around. But nothing like today," Griffith told me. "People are just accusing people of murder in these videos, and it spreads like wildfire. Because you can make money. It's maddening."

When Jared Leisek founded Adventures with Purpose, in 2018, he didn't intend to solve cold cases. At the time, Leisek was a Web marketer with two bankruptcies on his record, looking for his next opportunity. For fun, he pursued high-adrenaline hobbies like powered paragliding; for edification, he enjoyed self-help-inflected business books and seminars ("Rich Dad Poor Dad"; anything by Tony Robbins). His first experience of the viral potential of crime stories came when he was hired to help produce videos for a YouTuber known as Patty Mayo, who played a bounty hunter capturing fugitives in a staged, partially scripted series. Mayo's videos, which are designed to look like reality TV, have been viewed more than a billion times.

Leisek came up with the phrase "Adventures with Purpose" by using a business-name generator. He thought the name sounded catchy, like something people would want to be a part of. But he wasn't sure what the adventures, or the purpose, would be. Leisek first attempted to build his YouTube channel around powered paragliding, but it was difficult to capture good sound while the glider's motor was running. Then he came across a channel devoted to underwater treasure hunting. Since he was already scuba-certified, he decided to give it a go. He assumed that the videos were staged and planned to do the same. "I went to a yard sale, got a bunch of antiques, and I'm getting ready to put them in the water," he told me. "But, before I do, let me just get in and do a river float and see what I can find. And it was just, like, there's all my content right there."

Leisek enlisted his wife and one of his daughters to film him as he submerged himself in the lakes and rivers of central Oregon and came up with phones, watches, and sunglasses. Although he did his best to make these activities sound like exciting escapades—"Found 2 iPhones and a BABY OCTOPUS while Diving for Lost Valuables!"—his views lagged behind other diving channels. "I'm doing the exact same things they are, with better filming, in my opinion," he said. "But I'm not gaining the traction. They'll put up a video and get a million views for it, and I'm getting, like, three thousand."

Then, in 2019, he found two stolen guns in a lake. "The YouTubers really liked that part of it, seeing the possibility of crime evidence thrown into rivers and lakes," one of Leisek's former diving partners told me. The resulting video became the first by A.W.P. To get more than a million views. In another popular video, from later that year, Leisek used inflatable bags to lift a sunken vehicle from the bottom of the Willamette River and float it down to a boat ramp, where a tow truck pulled it out of the water. It was a bold stunt, and one that appealed to YouTube viewers who appreciated old cars and D.I.Y. Logistics. (At the time, Leisek told me, only about nine per cent of his channel's viewers were women.) Leisek began working regularly with a group of men, including Ginn, a rescue-boat captain in Seattle, and Doug Bishop, a tow-truck driver in Portland. They helped him locate cars under water, pull them onshore, and power-wash them to remove the river gunk.

That fall, Leisek spoke with the family of Nathaniel Ashby, a young man who had disappeared a few months earlier. Ashby's phone had last pinged near a boat ramp leading into the Missouri River. Law enforcement had found multiple vehicles in that part of the river, but decided that conditions were too dangerous to remove them. Leisek offered to do the recovery free of charge.

"Gotta go."

Cartoon by Dan Misdea

Just after Christmas, Leisek and Ginn drove from Oregon to Missouri, where they helped recover the car from a depth of twenty-five feet; Ashby's body was in the front seat. The resulting video, "Solved Missing Persons Case . . . Bringing Closure for Nathan's Family," was viewed more than ten million times. Leisek had assumed that the Ashby situation was a one-off, but the A.W.P. In-box was quickly flooded with messages from people asking for help locating family members. Adventures with Purpose soon had a new and more compelling purpose: finding missing people—or, as Leisek liked to call them, "missing loved ones"—under water. Instead of #scubadiving and #rivertreasure, A.W.P. Posts were now labelled with tags like #coldcase and #truecrime. Leisek bought an R.V., recruited videographers