Systemic racism is an issue everywhere in the country, and the medical field is no exception. From how Black doctors are treated to who graduates from med school, the time for change is now.
The New York Times recently ran an article detailing the difficulties faced by several of our colleagues, women physicians of color, based on their publication in the Annals of Emergency Medicine entitled: “Addressing the Elephant in the Room: Microaggressions in Medicine.” In it, they discuss the subtle put downs thrown their way by patients, colleagues, and supervisors as they progress through training in an unforgiving medical educational system.
Earlier this month, the Journal of the American Heart Association retracted an article “Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019” due to several “misconceptions” about the training and qualifications of Black and Hispanic physicians by the lone author of the piece. Writing that the “current model for racial and ethnic diversity [in medical education] is practically untenable,” the author sought to manufacture proof that Black and Hispanic candidates were often less qualified than physician candidates from other backgrounds. In issuing the retraction, the Editor-in-Chief of this prominent medical journal regretted publishing an article which, upon further review, had been stripped of its “scientific validity.” However, the damage to physicians of color to blatant racist tropes and microaggressions occurs every day.
Black men in white coats, such as ourselves, are often dismissed as having lower skill sets or lesser funds of knowledge; our medical decision-making is too often questioned. This is in part due to negative stereotyping of Black men in society but also because of the lack of images of successful Black men in fields such as medicine.
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At the dawn of the twentieth century, the profession of medicine was in its infancy – filled with a hodgepodge of studious healers, snake oil salesmen, and outright quacks. Medical schools littered the country without any semblance of standardization, permitting graduates to function without a guarantee to the public that their cures wouldn’t be worse than the diseases which they were called to treat. It might even seem that in today’s pandemic crisis, with the plethora of physicians willing to cash in by pushing unproven treatments such as hydroxychloroquine for coronavirus, that quackery is still alive and well in American medicine.
Abraham Flexner, in his iconic 1910 report, sought to eliminate quackery and to standardize medical education in North America. The Flexner report ultimately raised the bar for all physicians. But what most today fail to recognize is that institutions serving Black physicians, and subsequently the health of Black populations, would be decimated by Flexner’s work.
Supported in part by the American Medical Association (AMA), an organization which outright banned Black physicians from becoming members in its early days, the report ultimately led to the closure of more than half of the existing medical schools as well as 5 of the 7 institutions training black physicians. Only two, Meharry Medical College in Nashville, Tennessee and Howard University in Washington, DC, would remain.
Written during the era of Jim Crow and segregation, Flexner’s words, while recognizing the value of Black Americans, embraced the philosophy of separate but equal in regards to medical education and public health. “The pioneer work in educating the race to know and to practise fundamental hygienic principles must be done largely by the negro doctor and the negro nurse,” he wrote. People, including physicians, in that era did not want the co-mingling of Black physicians with white patients.
The segregationist attitudes embedded in the AMA and in medical education have left generational scars in our profession that persist to this day. The vast majority of Black physicians remain educated in one of four historically black institutions, Howard and Meharry, the two to survive the Flexner report, and Morehouse School of Medicine and the Charles R. Drew University of Medicine and Science, both founded nearly 40 years ago. In 2015, these four institutions produced 17% of all Black physicians among 179 medical schools across the country. On average, 6 Black medical students remain scattered across each of the other predominantly white institutions among classes that typically exceed 100 students.
In a field historically lacking diversity, where about 2% of the physician population was Black in the 1960s, the figure has improved anemically over the decades. Currently, only 6% of medical school graduates are Black. And even more shocking, in our lifetimes, the number a Black men in medicine has remained shockingly stagnant. In 1978, more Black men were accepted to medical school than in 2014, despite the fact that there are now more medical schools and more seats offered across all those institutions.
Studies show that racial concordance leads to better physician-patient communication. Might this translate into better health outcomes? A recent randomized study suggested that such racial concordance might improve the life expectancy gap between Black and white Americans by about 8 percent. Therefore, should we not work harder to tear down systematic barriers to achievement for young Black men and women striving to enter the medical profession?
Unfortunately, our medical institutions have adjusted to systemic racism at a glacial pace.
The first Black person in the AMA House of Delegates would not exist until 1950. Hospitals were not desegregated in large part until financing from Medicare in 1965 came with stipulations to proclaim that separate but equal was inherently inequitable.
And as evidenced by the paper from our colleagues on microaggressions, racism remains prominent in medicine today whether it takes the form of qualified Black female physicians overlooked for promotions by white CEOs because they don’t “look the part” or the Black male physicians who have racial slurs hurled at them by patients for just walking into the trauma bay.
In our personal lives we have had to live these situations. Once, when comforting a father who had just lost his son to a shooting, one of us had to empathize with a man who was repeatedly exclaiming: “Those niggers killed him!” How does one deal with the need to comfort the family of your patient, another father who has unexpectedly and violently lost a child, while shouldering the indignity of having to absorb words of hate tossed around with impunity?
It is not uncommon for Black men in medicine to be perceived as someone other than the physician – the team leader who makes the critical decisions in medical emergencies. We have personally been mistaken for support staff, such as the environmental services workers, the medical technicians, and the food delivery personnel, who help us to heal our patients. These everyday microaggressions from colleagues and patients nag at us all the while we offer “the nod” of recognition to our fellow Black men and women who always seem to manage to provide us with the due respect of our earned title: “Doc”.
How can we, Black physicians, remove the racist structures that have been ingrained in the foundation of our profession for hundreds of years? We know too well that diversity and inclusion committees are insufficient to accomplish the task if not coupled with a fervent passion for anti-racism, institutional support, and financial backing.
It is impossible to make meaningful change if all we do is shuffle Black medical students around the country into educational institutions with “critical mass” while never increasing the overall numbers of Black men and women who still comprise only 6% of our medical schools. And we certainly cannot disrupt a racist culture as long as those at the top of the pecking order continue to maintain their dominance and exert their influence from behind the cloak of suits and ties.
Racists don’t wear sheets when they are seated in the C-suite, in the boardrooms of hospitals and medical schools, or editorial boards of medical journals in this country. So it is up to our allies in those rooms to recognize evil where it exists and purge it from the culture of medicine. It is also our responsibility to call out racism as we see it, much like prior generations have done before, in order to continue to uplift the generations to come.