I was working at the nurses’ station in the emergency department when the elderly man in Room Four smiled at me.
I had noticed him watching me sometime between my third and seventh trip to the department. It was near the end of a long day about halfway through my neurology training, and I’d spent it crisscrossing the hospital to see a multitude of patients, sprinting from one stroke code to the next and responding to the ceaseless buzz of my pager.
I paid him little mind and tried to finish my work. I just wanted to get home, eat something, and go to sleep.
I finished my paperwork, checked on my last patient, and turned to leave when the man caught my eye.
“Excuse me,” he said. “I don’t mean to be nosy, but are you a doctor?”
I looked at him warily and said, “I am.”
“May I shake your hand?” he asked as he reached out his hand. He had tears in his eyes as I took it. “You don’t know what it means to me to see young Black people doing good things. You don’t understand what I had to go through. How we all got beaten. How far we had to go just for you to be able to do what you’re doing. Thank you.”
I could have worked all night after that.
I am a Black Latina physician. That is a rare combination. A little more than 2% of the 950,000 practicing physicians in the U.S. are Black women, and 2% are Latinas of any race. Early in my academic career I got used to being the first, the other, or the only Black or Latinx person in my classes.
Fortunately, my idea of what a doctor looks like had been shaped early. The physician who made the biggest impression upon me was my grandfather. Tata had grown up in an impoverished Black community in Matanzas, Cuba, but earned his M.D. at La Universidad Superior de Ciencias Medicas in Havana. Unable to find a residency position due to his race, he left the island in the early 1950s for New York. He trained at Harlem Hospital and then practiced primary care in underserved communities and prisons in southeastern Virginia. My own pediatrician, a Black man who provided me with compassionate, comprehensive care, served as my other early role model. These men were my Black physician archetypes. I knew that if they could be doctors, then I could too. I held tight to their images each time someone told me I couldn’t.
When it came time for me to choose a medical school, I wanted to attend a university that prioritized serving underserved communities. I went to Howard University College of Medicine, one of the nation’s few historically Black medical schools. Founded in 1868, Howard has trained many of this country’s Black physicians. Classes continue to be largely composed of underrepresented minorities: students from across the African diaspora along with non-Black Hispanics/Latinxs, Native Americans, and others from groups that have been unrepresented in medicine.
After doing my undergraduate work at predominately white institutions, coming to Howard was like coming up for air. Black and Latinx physicians were everywhere I looked. Alongside them, other professionals of color — nurses, allied health practitioners, and support staff — worked to care for the community. Being Black in health care was normalized, respected, and celebrated.
The school not only encouraged advocacy on the community and federal levels, but expected it of students. Education about health issues that disproportionately affect minorities, including the effects of systemic racism on health, was ingrained in the curriculum.
I came out of Howard with a strong foundation of medical knowledge, particularly related to the social determinants of health, and an equally strong support system of classmates, mentors, and other health professionals of color.
With graduation came a reality check. I moved on to residency programs that were diverse (for residency programs) and hospital systems that served predominately Black communities. Yet the social determinants of health weren’t as much of a focus in our lectures. There seemed to be less involvement in community outreach and advocacy. And hospital leaders seemed to be more hesitant to speak out about injustice, medical racism, and events like the deaths of Trayvon Martin, Michael Brown, and Sandra Bland.
Black and Latinx physicians, nurses, and staff, particularly those in positions of power, were harder to find. I made friends with a few other residents from underrepresented groups, but 80-to-120-hour workweeks separated us most days. Once again I had to get used to being the only Black or Latina physician on a team or in a clinic. And when things happened — when a patient asked for a white doctor instead of me, when a white attending used the N-word during rounds, when a white nurse told me she was happy to see Black fathers who were worth a damn — I was on my own.
As a Black physician — as a Black woman — I am often invisible. Black physicians are underrepresented in medicine at all levels: from premedical pathway programs to faculty and leadership positions. Black women are undervalued in medicine. We are less likely to receive NIH funding for our research, our work is less likely to be cited in the literature, and we are consistently paid less than our white and male colleagues. Black people in medicine are undersupported, often face social isolation, bias, and outright discrimination, and have limited support, mentorship, and sponsorship throughout our careers.
Thankfully, some people did see me. These were often the other Black and Latinx people in the hospital. There were, of course, Black attending physicians who set aside time to mentor me. Other Black and Latinx residents who’d nod as we passed by each other in the halls. Black nurses who practically adopted me: who saved me from making bad clinical decisions, made sure I had something to eat, and commiserated with me after hard shifts. Black cafeteria workers who gave me cake whenever I was on call. Black security guards who called me “Doctor” when no one else seemed to remember.
And the patients. Old Black women whose eyes lit up when I introduced myself as a physician. Young Black mothers who told their children “See? She did it. You can too.” Black patients who said: “I can talk to you.” “You listen to me.” “I’m so proud of you.”
A growing number of studies have suggested that a shared racial/ethnic background between physician and patient improves rapport, enhances shared decision-making, improves patient adherence to treatment, and influences health. To put it simply, Black and Latinx doctors are good for Black and Latinx patients.
The reverse also seems to be true. Black and Latinx physicians need community to thrive. We need other physician colleagues who understand the unique challenges of minorities working within racist health care systems. We need nurses and allied health professionals with personal connections to the communities we serve. We need patients. They are why we do what we do.
Being a physician is hard, especially for those from marginalized groups. We understand that health care, the field to which we are dedicated, is rife with individual and systemic racism, among other issues. Black and Latinx physicians work hard not only to make positive changes in the lives of their patients but also to make changes to a system that was not built for us. To build a health care workforce that looks like the communities that we serve. To prepare the next generation of physicians to work in this ever-changing field. To provide all of our patients with more compassionate, comprehensive, culturally sensitive care.
The Covid-19 pandemic has stressed our entire health care system. Black and Latinx physicians on the frontlines are working to save patients, knowing that Black and Latinx communities are disproportionately affected and dying. At the same time, we turn on the news to see Black people being lynched, murdered, and brutalized by police. Though we know how to distance ourselves from our emotions in order to work, it is impossible not to be affected by this. Black physicians cannot separate ourselves, and our medical careers, from our Blackness.
Now more than ever, Black physicians need each other, other Black health care professionals, and the Black community to lean on. But we also need support from our non-Black colleagues. We need you to speak up about racism and injustice in and out of the hospital. We need you to listen to Black patients, cite Black scholars, promote and support Black voices. We need you to check your biases, no matter how uncomfortable it makes you feel. We need you to do the work.
Medicine isn’t something that can be done in isolation. I’ll continue to get up and go to work and go to bat for my patients as long as I am able. And I’ll continue to lean on my colleagues and my community for the support that keeps me going. Even the little things — an old man’s smile, a custodian’s hello, a head nod as we pass by — mean something.
Diana M. Cejas is a neurologist and assistant professor of neurology at the University of North Carolina at Chapel Hill.