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.”

  • Thank you Pat Roy for introducing me to Uche Blackstock. It is way too easy for white people (like me) to be complacent about the murderous effects of racism.

  • I applied for a neonatology position at Temple 32 years ago. They had like 20 faculty members, majority white and male, some women, one jewish. After I was interviewed all of them, they offered me a follow up, like developmental clinic. I really wanted to work as a neo, I had a postgraduate training at UCSF in San Francisco and another at Baylor in Houston, one of the leading neo centers in USA and 10 years of experience in Monterrey, Mex, where we introduced NICU care at a government and a private hospitals. So, of course I refused it.

  • I have reviewed all the posts in this thread relating to this significant issue resulting in several observations.

    Primarily, we cannot continue to fault society or institutions for the lack of black applicants to medical schools because these programs are going all out to recruit minority students, but with very limited success. This raises the question as to why this lack of response from black applicants?

    The lack of black applicants to medical schools parallels the lack of black applicants to other physical and biological science, engineering & mathematics doctoral programs, although schools offering these degrees are bending over backwards to recruit minority students, specifically blacks.

    The high rate of black male dropouts from undergraduate degree programs is another serious problem.

    The experience of the author of this article projecting blame entirely for discrimination, the lack of blacks applying to medical schools. mentorship, promotions, and overt discrimination appears to be a skewed inherent world view that is not congruent with the reality, in that any indication of discrimination in any form against within the medical srablishment (as well as other academic and public contexts) would immediately be condemned, while those culpable of such actions would be severely censored and disciplined.

    What appears to be evident, is that many of the problems and slights perceived by this author, are issues that society cannot “cure” because it’s an issue that the black community as a whole needs to recognize and honestly assess. The objective would be to attempt to evolve a plan of action to equip minority students, beginning at an early age, with the academic skills, mindset and self efficacy to succeed and to cease blaming society or institutions for their lack of positive progression in academia. Nothing will change until this self reflection and action occurs.

    • Well said, Jerry.
      As I mentioned before, even the historically AA med schools can not fill their classes with AA students.
      This is a fact.

    • I am not clear as to what you attribute your observations. The author of the article is pointing out that even after graduating from top institutions she feels she has a very difficult place in academia as a Black woman. Your observations do not relate to her situation. The very fact that you ascribe this as a problem for the Black community to solve tells about the deep as the ocean, a tragic divide along racial lines in this country. It only strengthens the view that White privilege considers dem Blacks as tge other.

    • “The objective would be to attempt to evolve a plan of action to equip minority students, beginning at an early age, with the academic skills, mindset and self efficacy to succeed and to cease blaming society or institutions for their lack of positive progression in academia.” To the extent there aren’t enough students of color to recruit to medical school, I’d blame our education system, not a lack of desire on an individual basis. Consider the fact of where students of color start off in our society compared with white students. School districts where the majority of K-12 students are students of color receive $23 billion less in funding than majority white districts. I grew up in a well-funded, majority white school district, and if not a majority than a vocal minority of parents were apoplectic anytime there was talk of fair school district funding, rather than the property tax-funded system that keeps public schools in wealthy compared with poorer areas so far apart. Of course, the parents always would say things like, “throwing money at the problem won’t solve it,” which was ironic, considering how much money was “thrown” into my education and those of my peers (to which I’m grateful). (Source for study about funding: https://www.usnews.com/news/education-news/articles/2019-02-26/white-students-get-more-k-12-funding-than-students-of-color-report)

    • Did it occur to you that the poor primary and secondary schools in the mostly Black and Latino districts in this country are not the failings of those who attend them but are by design of those in positions of power? I am very tired of hearing how the Black community should do this and that to “improve” themselves. We are all in the American community, but it seems so many people want to just blame “those people” for being poor, or undereducated, or antisocial, as if those things happen in a vacuum.
      The real self-reflection needs to be those with the actual political power to effect change, but they are busy gas-lighting the rest of us into thinking that being poor or non-white is a personal failing.

  • This issue has bothered me for 45 years. In Cleveland in the late 60s we thought it would be fixed by now. But we had only two black fellow students( both who have become leaders in medicine). In the residency I attended in we have had three black residents. Two from Nigeria and one from Canada. What is getting in the way of African Americans getting to medical school ? We need colleagues from all races and genders. How can we inspire, support, and lead and follow such students and leaders of the future ? And what am or have I done wrong on this issue?
    What is wrong with awarding scholarship based on need for support? And what is wrong with giving academic tutoring or whatever also based on need ?

  • You beat me to it. I was thinking the same as I read the article. Why do I see people bending over backward to help black colleagues when all I hear is how they are discriminated against and how the medical field is just a racist/sexiat organisation when they explain why they haven’t been promoted like others, perhaps better at what they do.

  • While I certainly agree with the author, that medical colleges are discriminating against Black physicians, I would like to point out they discriminate against women physicians, against physician teachers, against older physicians, and on and on. Having grown up with a very successful academic physician father, who was asked to step down as Chairman, because of his age, I’ve seen it first hand. As an academic physician myself, I’ve noted time and again, it’s more about the money and prestige one brings to the institution, rather than the teaching and healthcare one provides.

    • If society discriminated against white males to the point where you no longer have your privileges and actually really had to prove yourself (without the money and support of your family, etc), I am sure you would not tolerate someone like you making your argument . . .

  • I think black people would feel proud about their achievements if they got rid of affirmative action. Right now, feeling that they were given an advantage (via affirmative action) even if they happened to be quite good can make them feel second rate. When Asians do well, they feel good about themselves even though they are a minority (because they were not given an advantage, but did well on their own).

    • Asians most definitely have their own affirmative action, as do white students. They are automatically assumed to be good in certain subjects, never questioned whether their test scores are their own or the result of cheating, and are stereotyped as industrious, model students, no matter the reality.
      Black students, on the other hand, are assumed to be affirmative action, which to many people means an advantage rather than a leveling of the playing field. It is assumed they could not be where they are because of their own hard work and intelligence.
      The recent educational testing frauds have shown us that many, many white students are where they are because of manipulating the system.
      So please don’t tell me how Black people should feel proud if they didn’t have affirmative action. We are quite capable of deciding our own feelings about such matters.

  • Very interesting perspective. Thanks for giving life to your story here with a wider audience.

  • This story sounds very much like many people of the past trying to break a segregated society. We must invite everyone to succeed. When they succeed, America succeeds.

Comments are closed.