Research says that children start to contemplate their future career aspirations around third grade. So if you have not seen an African-American physician by the third grade or even by the time you leave elementary school, how likely are you to believe in the possibility that you could become one?
Does the notion of “you can’t be who you can’t see” partially explain the current imbalance in the medical industry? The truth is, most of us have been to a doctor in our lifetime. Whether it was a toddler check-up to get shots or checking our teeth for cavities, we are not strangers to the medical community.
1 in 5 adults in America visits the ER yearly. If you were one of the unlucky ones to make that trip, do you remember having a black ER physician take care of you?
While there are many reasons for this large disparity, we must examine the matter within the scope of visibility.
In that case, I’m sure most of us can count on one hand or maybe not, the number of physicians of color that have treated us.
Where is Black Visibility Most Prominent?
There are certain sectors where black visibility is prominent, notably the NBA, NFL, and of course, Hip-Hop.
A young black boy grows up seeing Lebron James or Steph Curry and instantly see professional potential reflected in them. A young black girl gleans motivation from seeing Michelle Obama as the forecast to higher education.
Hip-hop artists are notorious for chronicling their struggles of inner-city living and their unsuspecting ascension to a new braggadocious luxury lifestyle. Although a lot of their audience can’t relate to transitioning into a higher tax bracket, they can surely relate to their humble beginnings.
The depiction of black excellence in society is relegated to the sports and entertainment industry, but why isn’t it mirrored in the medical community?
Is the Medical Industry Racist?
Statistics show that African Americans comprise 13% of the US population, whereas African-Americans comprise less than 4% of physicians in America. Black medical students comprise only 7% of medical students in the United States.
While the lack of representation in itself is not proof of discrimination, there have been major historical barriers of entry in the field of medicine.
Ever so timely, there is currently a popular hashtag campaign on social media running that was generated by Dr. Earl Campbell, MD, a Chief Gastroenterology Fellow at Yale.
#FromThreeFifthsaPerson campaign is highlighting the historical progress people of color have made in America in terms of representation. If you’re not familiar with the Three Fifths Compromise of 1787, it refers to a constitutional convention where state delegates debated how slaves would be counted in the census to determine legislative representation and taxation. The compromise reached was to count slaves as partial humans — “three fifths” of a human to be precise.
Thus, a slave was valued at 60% of a person in society, although they were not allowed to vote.
Dr. Cambpell explains the relevance of this historical moment…
“I started this hashtag campaign, because, amidst so many troubling stories in the media these days, I wanted to share reminders of where we’ve come from, our progress, our capabilities, and our true worth. We’re not only whole human beings but whole professionals. I encourage my brothers and sisters of ALL professions to join in on this movement, and let’s spread positivity.”
Let’s look at a brief timeline of the color line in medicine through the years.
Early 1800s Medical schools in America were closed to Blacks in the South and to a lesser degree in the North. Because of this, the first African-American physicians received their medical degrees abroad.
1847 David J Peck becomes the First African-American medical school graduate of Rush Medical School in Chicago.
Harvard admitted its first 3 black students in 1850 but their admission was later rescinded after violent protests from white students. Yale didn’t admit African Americans until 1853.
1895 There were 385 African-American doctors, only 7 percent from white medical schools.
1868–1904 Seven medical schools for blacks were established.
1905 There were 1,465 African-American doctors, only 14.5 percent from white medical schools.
1910 The Flexner Report on Medical Education was published and served as the catalyst for the closing 4 out of the 6 black medical schools, leaving Howard and Meharry by 1915.
1944 Beatrix Ann McCleary becomes the first African-American woman to be admitted to Yale School of Medicine.
1965 The Voting Rights Act was passed and only 3% of physicians in America were black.
In 2019, that number has only increased by 1%.
While most medical school programs now admit diverse applicants, do they have a greater obligation to recruit students of color to make up for excluding them in the past?
Is Apathy leading to Attrition?
According to a 2019 Medscape Report, the top three reasons for national physician burnout, depression and suicide is attributed to extensive documentation, long hours and lack of respect from administrators and colleagues. A survey of nearly 7,000 U.S. physicians, published last year in the Mayo Clinic Proceedings, reported that 1 in 50 physicians planned to leave medicine altogether in the next two years, while 1 in 5 planned to reduce clinical hours over the next year. When you consider these facts compounded with racial bias and discrimination amongst colleagues, upper management and even patients, it is no wonder why black physician attrition rates exist.
These biases and misplaced self-doubt start at the level of medical school and residency training. Dr. Calvin Lambert Jr. a Brown University graduate said: “I was unnerved by the idea of ‘forcing’ myself to fit into a culture that was seemingly the antithesis of who I am”.
The outcome of a study published in the Journal of the American Medical Association showed a commonality of micro-aggressions experienced by post-medical school graduates aka Residents. Many recalled being mistaken as the support staff despite donning a white coat, stethoscope and ID badge while having their names constantly interchanged with their black co-residents.
It has been well documented that black physicians face bias in and out of the workplace as well. Notable examples include the Black physician on a Delta flight who’s license was questioned as she proved herself to save a sick passenger. Other examples were detailed in a New York Time’s article of physicians sharing that patients stating they spoke to an “intelligent janitor” as opposed to being seen by a doctor. From being treated as “the help” to being in leadership roles where they’re forced to go through extremes to appear “less aggressive” is the peaks and valleys of black physicians.
Dr. Anthony Watkins, an African American assistant professor of surgery at New York-Presbyterian/Weill Cornell Medical Center in New York City recounted “When he walked into the operating room, they started telling him what needed to be cleaned,” Watkins said. “He told them, ‘I am the surgeon”.
One can only imagine the energy expended to endure such circumstances in the workplace. It makes you wonder how often black physicians internalize all of these grievances. This can lead to contemplating new career terrain, one where you are on equal footing with colleagues in regards to humanization and respect.
Is Classism to blame?
At this point in time, the economic gap that has been influenced by racist policies/structures may be more of an issue than discriminatory attitudes held by the people in power today. Generally speaking, the road to medical school in America is quite challenging and competitive, to say the least. Yet, and still, medical school admissions represent a systematic barrier for minority students.
Medical school matriculation is a two-part system consisting of completing required college prerequisites and taking the Medical College Admissions Test, also known as the MCAT.
While there are only two main entities between gaining admission, they comprise an enormous deterrent of non-standardization.
For one, not everyone can afford to go to college or at least without simultaneously being a full-time employee. 56 % of black high school graduates enrolled in college in the year after graduation, compared with 70% of whites, according to 2008 data from the College Board.
Non-Hispanic White populations in this country are far less likely to be of lower socioeconomic status than populations of color. The poverty rate for Whites is 8.7%, whereas the poverty rate for Blacks and Hispanics is around 39.5% as per the 2017 Census.
As a premed mentor, I encounter many underrepresented minority undergraduate students. They often express that their work schedule greatly interferes with their school and study schedule. Consequently, their grades have suffered. The truth is, if your GPA is not competitive, your chances of getting into medical school are slim, no matter how great your extracurricular activities and passion reign through your application.
The MCAT is another barrier to getting African-American students admitted, regardless of GPA. I’ve seen countless students who’ve had amazing grades but non-competitive MCAT Scores, be subsequently rejected.
The MCAT is a standardized exam that tells admissions committees how well you can take a test that assesses high yield foundational science information.
So, what obligation does the medical community have to make up for the past?
In a paper published last year in the Annals of Internal Medicine, Inginia Genao, Yale’s graduate medical education director of diversity, equity and inclusion, identified how the MCAT imposes a burden of increasing diversity in medicine. Dr. Genoa alluded MCAT underperformance being correlated to economic disadvantages and societal stereotypes that undermine underrepresented minorities from successful application cycles.
One’s success on the MCAT, like many standardized examinations i.e the SAT, correspond to the number of practice questions completed. Practice questions come in the form of expensive question bank software or prep courses. The most popular of them being Kaplan, Princeton Review, and Next Step, which can run you $2000-$ 15000! For those wanting a more personalized edge, some applicants hire private tutors starting at $200 per hour.
With the average black household income of $40,258 annually and $774 weekly, it’s no wonder this disenfranchisement exists.
From a historical perspective, white applicants descend from generations of people who have been the gatekeepers of medicine, coupled with the economic advantage of access to the most valuable resources and mentors. If the MCAT continues to be a prominent barrier to successful matriculation, its relative dissolution must be considered to help increase diversity inclusion efforts in medicine. Admission trends are changing, but to see the complete dissolution of the MCAT as an evaluation criterion may be a difficult feat.
According to the aforementioned article, “To eliminate the MCAT as an admissions standard, the U.S. government would have to file a lawsuit showing that the exam has “a disparate impact on the basis of race,” according to the paper, which would mean the test ran afoul of Title VI of the Civil Rights Act”.
Such a proposition in the current political climate is looking pretty bleak.
What obligation do we have to inform and support our own communities?
While there have been historical barriers of entry to the field, it is up to us to address our present-day opportunities and invest more in the potential of our own communities. As far as immediately rectifying these disparities, we should be making visibility a major pipeline. Black physicians, medical students, and aspirants should infiltrate schools in our communities with ‘show and tell’ presentations, create a social media presence, and offer ourselves as mentors.
Secondly, we can rely on the network of resources provided by pipeline programs which serve to provide low or no cost MCAT preparation to underrepresented minorities. We also should look to medical schools that are truly committed to their mission of diversifying their medical school classes.
For example, Mount Sinai has a FlexMed program that offers early admission for college sophomores of any major to gain admission to medical school without taking the MCAT. Many Medical schools are offering Special Master’s programs that grant students another chance at medical school, after having a non-competitive MCAT score.
I am a product of that particular pipeline and I am currently ⅜ the way to becoming a black doctor in the US workforce.
How You Can Support Black Medical Students
Finally, I am currently a second-year medical student in New York City and also serve as President of the Student National Medical Association (SNMA) at my medical school. SNMA is an organization dedicated to promoting the scholarship and professional development of current and future minority medical students.
We have just started a crowding funding campaign to raise $5000 to support our annual Black History Month Programming as well as our Annual Medical Education Conference attendance.
On April 17–21, 2019, we’re planning to attend The Annual Education conference in Philadelphia, Pennsylvania. During this conference, we will be trained and exposed to various physician mentors and enrichment opportunities necessary for our advancement as future doctors.
Your small contribution will have a big impact on our lives and our future in the medical industry. We hope you’ll consider making a donation of $10, $25, $50 or more to our Donation Fund Linked Here. Even if your contribution is a smaller amount, sharing this on Facebook and Twitter would be greatly appreciated.
I wrote and published the original article on Medium.com, but it has been adapted to be published here as well.