P

lenty of rivers flow from the Black Lives Matter movement. Criminal and economic justice are the most obvious of these. Here’s one that hardly touches the public consciousness but that also matters: Our nation needs more black doctors, especially black male doctors.

Why? Because the talents of young black men who would make outstanding doctors are being wasted since so few make it into the medical profession and because black people need far greater access to culturally connected physicians who understand their lives and their challenges as much as their clinical needs.

A little more than a year ago, the Association of American Medical Colleges sounded the alarm, reporting that there were fewer black males applying to and attending medical school than in 1978 — this in a nation that doesn’t have doctors to spare and whose minority population has ballooned over the last 40 years. The overall number of minority physicians, including black female physicians, is increasing, though not as rapidly as it should.

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This is a big problem for black Americans. We aren’t saying that only black doctors should treat black people. But black people should be able to find black doctors when they want them.

Here’s why, best articulated by Dr. Damon Tweedy, a psychiatrist and author of “Black Man in a White Coat”: “When I have been particularly successful at treating black patients, it has often had less to do with any particular talent on my part than with my patients’ willingness to bring up the racial concerns that troubled them.”

Cultural competence plays an important role in communication that goes far beyond diagnostic skill. It encompasses the knowledge, skills, and attitudes required to bridge cultural, ethnic, and linguistic gaps between patients and providers. It’s not a once-and-done module or in-service training but a lifelong pursuit.

There are consequences to cultural incompetence. In one study, black patients nearing the ends of their lives received much less empathy from white physicians than from their black counterparts, despite receiving the same factual information. In an even more disturbing study, half of the medical students at the University of Virginia falsely believed that black patients’ blood coagulates faster than that of white patients and that black people have more tolerance to pain than whites.

Underrepresented minority physicians are more likely to serve in underrepresented minority areas, and there is a glaring doctor shortage in hundreds of communities where black people live. Data also show that black male physicians are more likely to work in primary care, where there is the greatest need, than in specialty care.

There are very achievable solutions for turning around this shortage of black male doctors. At the most formative stage, K-12 education should be equal opportunity education for all children in our country. In reality, most black children go to highly segregated schools. Compared to other schools, segregated schools have lower per-student spending, teacher quality, and educational resources, and higher levels of neighborhood poverty, crime, and violence.

At the undergraduate level, we need to expand financial aid for black males and pursue creative financing strategies that don’t foreclose medical school as an option before young men can even begin it. We should also do what many undergraduate colleges and universities are doing: de-emphasizing standardized test scores that, above a certain threshold, provide no evidence that one individual is more equipped for medical school than another.

But the problem is not about recruitment alone. It’s also about remediating the lack of black physicians in leadership positions in our nation’s hospitals, universities, and clinics. African-American men represent just 2 percent of male full-time faculty at MD-granting institutions. This sends the wrong signal to young, aspiring black students who see a dearth of role models. This also misses the opportunity to influence the future pipeline of the medical profession.

The Black Lives Matter movement has succeeded in creating a platform to raise up the voices of young black men and women who can be our next generation of social justice leaders. Now it’s time for policies and practices in the United States to do the same in the health sphere. Leaders in federal and state government, as well as in academic medical centers, must support the health of black Americans by empowering young black men and women to be doctors if they have the talent, will, and passion to succeed.

The specialized knowledge learned in medical school has a limited shelf life; the science behind it will inevitably advance. New treatment options and approaches will emerge. But what will not change is a doctor’s ability to lend dignity to others, to give compassion in a time of vulnerability, to act ethically, and to help others in need. These characteristics are not the province of any single ethnic group. But we need more black doctors because black lives do matter and black doctors are best suited to make that case as clinicians today and as role models for tomorrow.

David R. Williams, PhD, is professor of public health at the Harvard T. H. Chan School of Public Health and professor of African and African-American studies at Harvard University. Fitzhugh Mullan, MD, is professor of health policy and pediatrics at George Washington University, a former director of the National Health Service Corps, and author of the book “White Coat, Clenched Fist: The Political Education of an American Physician” that documents his work in Mississippi as a medical student in the civil rights movement.

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  • The shortage locations and situations are created by health policies and insurance payer policies regarding payment. Areas with too few physicians or clinicians are created and maintained by payment designs. Basic Health Access Failure 101 is the combination of payments too low, costs of delivery too high and getting higher, and complexity increasing. Care where needed is complicated by populations concentrated in complexity and immersed in deficits of local resources and social determinants.

    Housing is a key determinant of shortage situations. These populations concentrate together in lower cost of living and lowest cost housing. Concentrations of patients with Medicaid, Medicare, Veteran, high deductible, and worst paying insurance plans result in too few dollars to support local workforce. Interventions involving origins, preparations, medical school, residency training, loan repayment, and special funding support have not changed the payment designs involving the maldistributions of hundreds of billions of payment dollars – preventing resolution of lowest concentration settings by any intervention.

    For decades we have seen the promotion of more and more graduates as a solution with numerous permutations. A 12 times increase in nurse practitioner graduates, a six times increase in physician assistant graduates, and substantial increases in various physician sources have yet to address deficits.

    Resolution of deficits of positions and team members requires funding more positions and more team members in more places. This takes payments higher for primary care and mental health and basic surgical services. Primary care needs a doubling from 6% to 12% of annual health spending. Mental health needs a similar increase. Both increases must be specific to the lowest workforce concentration counties paid less for the basic services six different ways (state, region of state, smaller practice, type of payer, worst contracts, Pay for Performance).

    When the training expansion distractions are removed along with the insurance expansions distractions and the measurement expansion distractions, we could specifically on more dollars to support more team members to deliver more care and in more higher function ways. If you get beyond the distractions, it is quite easy to see the dollars going everywhere else as set in place by decades of designs and designers arising from top concentration settings.

  • Fittlesticks!!! Really! So, here I am an African American doctor and a nurse and can’t find a job. I’m not 30…but I’m not 80 either!

  • Cultural competence in services can be nurtured through an instilled awareness of specific cultures and through cultural adaptation of interventions that are evidence based. In this way, services, individuals and their families can draw strength from their cultural background and increase resilience.
    OUR GLOBAL POSITION STATEMENT; CULTURALLY ADAPTED INTERVENTIONS IN MENTAL HEALTH –
    http://careif.org/culturally-adapted-interventions-in-mental-health-global-position-statement/

  • One of my colleagues, a black medical student with the build of a football player, was recently stopped by the mother of one of our pediatric patients as we were leaving the room one day. The woman, who was African American, said to her eight-year-old son, “See, honey, one day you can be a doctor too!” and I watched as the little boy smiled up at my colleague, eyes full of respect. So yes, we need many more black doctors to be heroes for the next generation.

    • That is so refreshing to read!

      The problem is definitely the lack of role models, and the need to be able to relate to more people with authority. If the leaders of the world have no similarities to an individual, it’s harder for them to believe that they can lead as well!

  • The problems with access are about designs that result in 45% of physicians and over 50% of health spending specific to 1% of the land area in 1100 zip codes with just 10% of the US population. This leaves very little spending (6%) to deal with primary care at 55% of encounters a year. This leaves very little workforce at only 21% to serve 40% of the population in 2621 lowest physician concentration counties – further deprived of services, jobs, economics, and determinants of health with less than 13% of health spending – and further deprived of spending by Pay for Performance, MACRA, ValueBased, and Readmission Penalties since the most complex and least supported Americans are found in these counties.

    These are essentially the Red Counties on popular maps plus the predominantly Black, Native, and Hispanic rural counties – uniformly forgotten in designs of health, education, and more by state and federal designers for decades. Stop meaningless health and education measurements to help keep more dollars in these counties to support more team members and to enhance their morale and productivity. They might even be able to improve in higher primary care functions.

    Until leaders actually change designs to support the team members where needed, they should not use deficits to promote their own training and other agendas that distract from real solutions. No training intervention can work until there is a substantial change in the financial design to pay much more than cost of delivery for primary care, mental health, and basic services. A good start would be paying the same for the same service, not six degrees of lower payment as currently exists.

    People need real help and real care, not decades of promise after promise. The lives of 50% of Americans matter and the few percent in charge of designs need to understand this and stop designs that increase the numbers and proportions left behind.

    Why not focus on real determinants of health, education, economic, and societal outcomes?

  • It is difficult to track by race/ethnicity as data is often missing from physician databases, but you can track origins in predominantly black counties as of the AMA Masterfile of 2013. The admission level to medical school was 3 to 4 times less. As far as serving these counties of origin and presumed background to really match up empathy and understanding, only 25% were found in this same type of county as physicians. This increased to 46% return for those fewer (14%) who chose family medicine. Internal medicine has been a popular choice but fails for return or for staying in primary care. Only choice of broadest generalist gives physicians a real chance to return to serve people of origin. Specializing essentially gives up the opportunity to serve specific populations as a physician as specialists must see the full range of origins as inherently part of a viable specialty or subspecialty practice. Generalists have a choice, or did. Others are part of largest systems. Wiping out self employed physicians takes away even this opportunity. It is possible to do loan repayment, but one can debate the efficiency of a temporary and costly program.

  • The problem is not race but cultural competence and qualifications. Behavior is modifiable and teachable. Keep BLM/politics out of medicine.
    Why did half of the U of V medical students have the false belief of differences in coagulability of blood and tolerance to pain? Someone should investigate their physiology/biology professors or department for their erroneous teaching or textbook errors. For HALF of the students to have this falsehood, the ORIGIN of this falsehood should be determined and then have this misconception promptly corrected.
    Fortunately, this nation has a new, excellent, exemplary role model: Dr. Ben Carson. His success should be promoted and touted in the press, in the schools, and in the lives of those who need hope to excel and enter into the medical profession.

    • Agreed, Ben Carson is a hero to people of all races and ethnicities. BLM has no place in medicine; racial health disparities does but BLM is not related whatsoever.

    • Ben Carson is role model for who??? Most young kids of African descent don’t even know who he is let alone care for him , he’s not a role model in any inner city communities … try again

  • We need more doctors period. Black, white, men, women, minority or not. It seems race plays a bigger impact in admission to schools than the qualifications that would ultimately matter, and race really shouldn’t be a deciding factor. Encouraging young people should definitely be happening more, where you started doesn’t determine where you’ll finish.

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