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A decade ago, the Department of Health and Human Services made “to achieve health equity, eliminate disparities, and improve the health of all groups” one of its goals for Healthy People 2020. It didn’t come close.

Black Americans continue to experience some of the worst health outcomes of any racial group. Black men have the shortest life expectancies. Black women have the highest maternal mortality rates. Black babies have the highest infant mortality rates.

Diversifying the health care workforce to reflect patient populations is one solution. But that is a tall order when health care work environments can be unwelcoming and discriminatory to Black health care providers.

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While I write from the physician perspective, similar issues are relevant in nursing and other health care-related professions.

In 2003, the Institute of Medicine’s landmark report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” described the need to increase the proportion of minorities in the health care workforce to address health care disparities. At the time, 3.3% of U.S. physicians were Black, while Black people represented 13% of U.S. residents.

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Nearly two decades later, we haven’t come that far: only 6% of physicians are Black, while Black people still represent 13% of the U.S. population.

Academic medical centers are where medical students learn to become physicians and faculty members engage in cutting-edge education, research, and clinical care. But these centers are not upholding their commitment to maintaining diverse, equitable, and inclusive environments for Black students and faculty. There are many reasons for this.

Black faculty members have cited lack of mentorship and sponsorship, barriers to promotion and advancement, and lack of supportive — and sometimes hostile — work environments as factors in their attrition from academic medical centers. In addition to the typical obligations of academic faculty, they are often expected or told to execute “diversity” efforts such as chairing diversity committees, mentoring minority trainees, and the like, and then are rarely recognized or compensated for this invaluable work.

I find it ironic that Black faculty members are unfairly tasked with the complex and overwhelming chore of remedying the structural outcomes of centuries of institutionalized racism that we did not create in the first place.

Last month, I made the difficult decision to leave my faculty position at an academic medical center after more than nine years there because of a toxic and oppressive work environment that instilled in me fear of retaliation for being vocal about racism and sexism within the institution.

I never thought I would leave. My presence and work was significant to my patients, students, and colleagues. But I could no longer stand the lack of mentorship, promotion denial, and work environments embedded in racism and sexism. I also realized it was imperative for me to speak truth to power and that I could have a larger impact through carving a path of my own by forming a company to equip health care organizations with the tools to support a diverse workforce and to provide equitable care to each and every patient.

It’s a shame that I and many of my Black colleagues are leaving academic medicine. We would have ultimately cared for more Black patients, taught and mentored more Black trainees, and performed more critical research to eradicate health inequities.

Black medical students also face considerable challenges. Studies have shown that they report social isolation as well as experiences of racism perpetuated by both peers and faculty members. A recent study demonstrated racial bias in how medical school faculty members described Black students in evaluations compared to non-Black students.

Another study confirmed that the selection process to the prestigious Alpha Omega Alpha honor society, which can play a significant factor in medical students’ future professional success, was embedded with bias, severely disadvantaging minority students. The lack of Black faculty results in fewer potential mentors and role models for Black students and contributes to a leaky pipeline for minority trainees.

I’ve personally seen the impact of my own presence as a Black faculty member. I vividly recall that after giving a lecture four months into the school year, a Black female first-year medical student eagerly waited after the class to tell me how proud she was that I was her first and only Black lecturer.

Even the physical environments of academic medical centers can convey exclusionary messages to students and faculty members. For more than a century, the hallways and auditoria of many such centers have displayed portraits of white men who were accepted into medical schools under racist admission practices and even some who participated in and profited from slavery, colonization, and the oppression of Black people.

Students at Yale School of Medicine have described the school’s portraiture as a “visual demonstration of the school’s values, which they identified as whiteness, elitism, maleness, and power” and noted that “the portraits exacerbated feelings of being judged and unwelcome at the institution.”

Fortunately, some academic medical centers have begun to reconsider how the symbolism in these portraits can influence how minority students and faculty members experience these environments. Last June, Brigham and Women’s Hospital, one of Harvard Medical School’s teaching hospitals, removed the paintings of former department chairs, almost all of whom were white men, from its main auditorium and dispersed them to other parts of the hospital as part of its broader diversity initiatives to improve the sense of belonging among the hospital’s workforce.

If academic medical centers and their leaders cannot adequately support Black students and promote Black faculty, then they will continue to leave. I was not the first to leave such a center and I will certainly not be the last. These centers, as exemplars of clinical, educational, and research innovation, shoulder the responsibility of ending health inequities and creating environments where Black students and faculty members can not only survive but thrive.

Academic medical centers must begin to recognize and rectify the historical and current impact of racism on the health care workforce. Their leaders should listen actively and respond accordingly to the concerns of Black faculty members and students, adopt an anti-racist philosophy, and, through a lens of racial equity, intentionally commit the time, effort, and resources required to dismantle the structural racism and white supremacy embedded in their current institutional cultures.

If not, then Black Americans could be in even worse shape when Healthy People 2030 rolls around.

Uché Blackstock, M.D., is the founder and CEO of Advancing Health Equity.

Hear Blackstock talk more about racism in academic medicine on an episode of the “First Opinion Podcast.”

  • “Only 6% of physicians are Black, while Black people still represent 13% of the U.S. population.”

    According to the AAMC, 12.8% of physicians are Asian, while Asians only represent 5.6% of the US population. So what does this mean?

  • “Only 6% of physicians are Black, while Black people still represent 13% of the U.S. population.”

    According to the AAMC, 12.8% of physicians are Asian, while Asians represent only 5.6% of the US population. So what does this mean?

  • Nothing new, happens even if U are a labourer. Most whites want to rule the earth, lol, that they fucked. Let the dickheads keep segragating cause we all gonna suffer what mother earth is going to throw at us. These rednecks might suffer more with their translucent skin rather than a real human that has black skin. Lol stay out of the sun, I suggest crawl back under ya rock and hide like a little snowflake. Lol DICKHEADS don’t even care for their own offspring when it comes to sustainable planet for LIVING. Again,…dickheads

  • “Racial Equity and Structural Racism” to which her organization speaks seems to show me merely someone else jumping on the bandwagon of Political Correctness and Victimization FOR PROFIT! Merely click on the website and a company can pony up money for discussion and lectures on WOKENESS and how bad we are as a society of racism,sexism and for profit-ism ( except for the groups that intend to profit from guilt-ism. I don’t buy it. There is no country with the opportunity and freedom as ours.

  • Seriously, our country elected a Black president. I’m sick and tired of hearing about racism, and I’m sick and tired of hearing about racism from those who are less qualified. Work harder, get better grades, better SAT scores, better MCAT scores, and you won’t have to worry about the color of your skin. If you spent the time you waste complaining about racism and instead used that time to improve your qualifications, you might end up like Dr. Ben Carson. He didn’t whine, he just busted his ass to rise through the ranks.

    • Yes. That’s it. Elect a biracial president and racism is officially obsolete. That’s EXACTLY how it works in the good ol’ U S of A. What a joke.

      And you have NO IDEA what her SAT and MCAT scores were. But go ahead with your bias and assumptions. You’re exactly the kind of people who are a part of the problem. And to make it worse, you have NO CLUE that that’s the case.

  • Dr. Blackstock, I am so excited to read this article!! I have been in the process of building a program to train underrepresented physicians on the business of medicine to increase equity and ownership in medical practice and reduce the disparities in our communities.

    Please take some time to check out our latest on demand webinar. I’d love to get your feedback!

    Hey! Posted an on demand version of the last webinar. Check it out and pass along when you can!

    “Are you an emerging or established physician interested in non-traditional practice ownership in the digital age of healthcare?… Checkout our Free On-demand Webinar Now!!………”Starting An Innovative Medical Practice in Today’s Digital Economy” —>

    https://youtu.be/bCYiNQWH9us

  • White DOCTORS FEAR A BLACK DOCTOR MAY BE SMATER THEN THEY ARE OR HAVE RETAINED MORE INFORMATION ABOUT PATIENTS ILLNESS THEN GIVE BETTER MEDICINE TO WHITES THEN BLACKS THEY ASSUME BLACKS ARE SELLING THERE MEDICINE OR THAT THEY SHOULD SUFFER IN PAIN WHILE THEY GIVE WHITE PATIENTS WHAT EVER THEY WANT I HAD OPEN HEART SURGERY HAD 5 CLOGGED ARTERIES UPON LEAVING I HAD TO ASKED FOR PAIN MEDICATION WHEN THE WHITE AND BROWN PATIENTS GOT MEDICINE UPON LEAVING PRESCRIBED BT THE SAME DOCTOR IN FRONT OF ME [email protected]

  • “Nearly two decades later, we haven’t come that far: only 6% of physicians are Black, while Black people still represent 13% of the U.S. population.”

    Another words, in your humble, scientific opinion, it’s important to impose quotas on how many of each race there should be in an industry? If that quota does not match your standards, then the entire industry is racist.

    If blacks score less on their MCATs and SATs, this is not their fault. It is racism. The computerized grading system is racist.

    Are you a good doctor just because you are black?

    • I know nothing about the doctor and nurse side, but I do know about the patient side. There’s nothing that makes me madder than some black nurse bumps a black patient to the front of the noncritical line just because they are black. I’ve turned several into their bosses on exit surveys.

    • >Are you a good doctor just because you are black?

      No, but if you’re black *and* a woman, you’re unequivocally better!

    • > Are you a good doctor just because you are black?

      No, but if you’re black *and* a woman, then unequivocally yes!

    • I have had better results and more empathy from black doctors so yes I would like to see quotas. I don’t want any chance of being seen by a racist Or biased doctor for medical care.

  • I would encourage readers and commenters to follow the link above to learn about Dr. Blackstock’s new initiative: Advancing Health Equity. I would *discourage* commenters from making judgments about another person’s lived experience (it is not the same as your own), especially when it is supported by relevant research.

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