Contribute Try STAT+ Today

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.

advertisement

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.

advertisement

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.”

  • The answer is in our history! Post slavery, we sought education, we were not welcomed, thus we built our OWN institutions of higher learning. Integration as nice as it sounds was the solution to OUR (Black People) problems. It has been statistically proven that black people are not less intelligent as other races, we learn differently. Yes we are all apart of the human race (after the systematic dehumanization of Africans in 15th and 16th centuries which classified us as primates; it took centuries for whites to accept the idea that blacks were actually human beings)but we learn, differently. Our experiences are different. If these predominantly white institutions are unable to accept us, teach and mentor us; cultivate our talents and gifts, then we should build up our own. There are HBCU’s with medical schools. Several of my former students have graduated from Xavier and have gone one “intentionally” to study medicine at a HBCU institutions. At some point we have to stop ingratiating ourselves to those that don’t want us at the table. Per the article it is clear that there is a pool of clientele and patients in need of Black Doctors that can work to eradicate health issues that are prevalent in the black community.

  • Dr. Kum,
    I’m sure you do not remember me, I am the Executive Director of My Sister’s Keeper, the successor of Jackie Hill.
    I read your article and saddened to realize that nothing has changed when we look at the disparities of health care for Black individuals and the abhorrent treatment of our medical professionals. Stay Strong, Dr. Kumi.

  • This piece is fantastic and verbalizes many of the thoughts I’ve had for a long time. Especially so pronounced when students have intersectional identities, ex. black queer or South Asian queer/low income students. I’m a student at Northwestern University’s Feinberg School of Medicine and we see many of the same issues with the portraits, for example. Thank you for this piece, I’ll be sharing it with faculty/staff & students at Northwestern.

    Yours,
    Archie

    • Should just ban portraits in public buildings. Mosques have ban pictures for long time. Very beautiful.

  • One should never give up in something they believe in.
    If everyone did there would be no winners.
    You know this to be true.

    However, you should be commended for your efforts.
    Thank you,
    JB

  • A molecule makes skin and hair have dark pigment. It’s more in black people, but it is also in moles and freckles? It’s just a molecule. Different races have different skin color and different features. We all go back to Adam and Eve. I believe the Bible is true.

  • Dear Uche,

    I can only hope that in the non-academic setting you will still be able to work on improving the health of other black Americans. I would note that 6% of the workforce in medicine is much better than the lowly (my estimate) of 1-2% in science. It is possible that medicine has syphoned off some of our best candidates and it will likely continue to be a pipeline issue and unfortunately, will probably continue. But it does seem to be especially difficult in the absence of a mentor (and role model) if not also a protector. Thank you for your efforts and your willingness to put in 9 years. Best wishes, Bill

  • Is there a ranking system that reports institutions that are making progress? A grading system would reward institutions welcoming to all students, making progress in minority health outcomes, and creating an equitable working environment. It may also light a fire under institutions who are reinforcing racial inertia or through inaction are perpetuating the problem.

  • “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.” When all is said and done a large component of getting accepted to medical school is academic achievement. For a variety of reasons Black students have lower academic achievement rates than white and are therefore accepted to medical schools at lower rates. Are the medical schools guilty? Would you prefer a doctor treating your child to be a certain skin color or the most intelligent well educated doctor available? The problems are very complex and the current cult of victimology does nothing to help solve them.

    • Carlos, your pointing to intelligence as being reflected through academic achievement is a common misconception. Test scores predict ability to pass other tests, not necessarily to provide high quality care. I’m sure we can all recall instances in which book smarts have not translated into good experiences or outcomes with physicians, but if you have doubts, feel free to look into it further. I would start with the SATs roots in the promotion of eugenicist theory.

    • Of course academic achievement reflects intelligence, it’s just that intelligence isn’t the only factor that determines academic success. From a practical standpoint, we will always need some sort of comparative metric to assess students, particularly with fields like medicine where we want the best and brightest, and complaining about the existing metric does little good unless you have another, more accurate one to offer.

      Regarding eugenics, IQ and SAT scores did originate from that movement, as did Planned Parenthood- sometimes decent ideas can come out of terribly misguided ones.

    • “Test scores predict ability to pass other tests”

      Also, the ability to pass tests seems like a pretty fundamental skill for getting through medical school.

    • Ms. Crawfield, I’m not sure what point you are advocating. My argument is supportive of the author’s. I believe having a diverse workforce of physicians is important in providing the best quality care. You point out that passing tests is important to getting through medical school. It certainly was in my experience, but our current system as noted in the above article is producing maternal and neonatal deaths at rates much higher in some groups than others. This is extremely important to me as an OB/Gyn, mother, and woman of color, and I hope is important to everyone. Our system is clearly failing some patients and needs changing. You ask for a substitute to the current system rather than criticizing alone; perhaps instead of taking organic chemistry and physics (rarely useful in medical school or in medical practice) we should have an apprentice system and promote trainees with better patient outcomes rather than promoting the person who can successfully solve equations, or worse, the student whose parent can afford tutors and prep courses to boost test scores. I don’t have all the answers, but I know what I see taking care of women during what should be one of the most exciting and beautiful human experiences. Aiming for equal outcomes for all people when we are talking about maternal and neonatal survival is a bare minimum expectation, and something that I hope we can all agree on.

  • This disturbs me greatly, to hear such blatant racism. Our world is a colored world filled with many intelligent people from all walks of life and should be embraced and welcomed. The medical community is one that absolutely needs to step up to the plate and take a deep look at what they are doing and not doing! If a person is qualified they should be given the opportunity to advance and assist in all avenues. Medicine is very specialized and people who have the intelligence and gift to give in this area should NEVER be shunned away do to color, gender, or religion period!! Time to Wake up and not tomorrow, now!!

  • This is going back 25 years so maybe things have changed, but incoming Black students in both Med School and Pharmacy School received special attention in the form extra academic help whether they needed it or not and others did not receive such help whether they needed it or not. Everyone knew this and the students were even “given” special patches to make them feel better but what all this really did was set up resentment from those who didn’t receive special treatment set them apart from the beginning! Being that this is the first IMPRESSION that non-Black students have of their “peers” and future colleagues, is it ANY wonder that this stereotype carries on into their careers? Who does this hurts the MOST? The BLACK students that DIDN’T need the help! Maybe the focus should be on why is it ASSUMED that all Black students NEED help and all non-Blacks do not. Could it be our failed public schools &/or the lack of parental involvement in their children’s education (applies to ALL races)? The fact that in the lowest 14 public High Schools in Baltimore that one (1) student was proficient in math? Or that the 2019 class valedictorian of a Detroit HS needed to take remedial math as a college freshman? Or that Black students as a whole need more remedial classes in college and have a higher dropout rate because they weren’t as qualified to begin with but were put in a position where they were set-up to fail? Or that Black students that DO excel get made fun of by other Black students for “acting white?” Maybe the Jewish & Asian students do well because there is a CULTURE of placing an IMPORTANCE on education. The REAL problem is the INSISTENCE on equal outcomes and NOT an insistence creating equal opportunities! If you want to have a colorblind society, start with addressing the ROOT causes of the problem and the “problem” itself will eventually dissapear. You cannot “force” the problem to dissapear just because you “want” it to. Sorry, the world doesn’t work that way.

    Granted this is all anecdotal, but my wife (a physician & white) was chair of the “Cultural Diversity” committee 2X w/no compensation, she personally sees a wonderful and talented Black Doctor that she loves, and has a wonderful and talented Black colleague who is a partner in the practice where she is employed. Surely racism exists in the field, but maybe instead of simply being “because,” it’s for reasons you don’t actually have either the courage &/or the understanding to address head-on.

    • Harsh but partially true.

      Be the change that you seek.

      I expect more from folks who have the intelligence to achieve membership in this profession but its not intelligence or wanting to be stronger some folks are damaged

      I will not fault them for the experiences that they had prior to arriving at these schools and institutions but I will ask them to take responsibility for healing themselves

      Seek first to understand an then to be understood

      A bit harsh

Comments are closed.