BOSTON — When LaShyra “Lash” Nolen was learning about how to recognize signs of Lyme disease in a class at Harvard Medical School, a fellow Black classmate pointed out that all the examples featured people with white skin. ”How would I recognize these on someone’s skin who looked like mine?” her classmate asked.
“The professor just said, ‘Well, it would look more purple, but honestly — I can’t really tell you.’”
The exchange made Nolen, now a third-year medical student at Harvard and founder of the community health care organization We Got Us, reflect on the ways that medical education treats whiteness as the standard in patient care — and on the racism that Black doctors and medical students frequently encounter.
“It’s difficult for patients to acknowledge the fact that we’re medical students and [they] can’t fathom the fact we’re going to be future doctors,” Nolen said at a STAT Summit panel on Wednesday. She and other panelists were there to discuss the dearth of Black doctors in medicine: While Black people make up over 13% of the U.S. population, only 5% of doctors are Black.
One reason for the lack of Black doctors today can be traced back to the century-old Flexner Report, explained panelist Alden Landry, assistant dean at the Office for Diversity Inclusion and Community Partnership at Harvard Medical School. The report, commissioned by the American Medical Association and the Carnegie Foundation to raise medical standards, resulted in the closure of over half of North American medical schools in the early 1900s, including five of seven Black medical schools. Had those schools remained open, the U.S. could have seen a 29% increase in graduating Black physicians in 2019 alone, according to one estimate published in the journal JAMA Network Open.
Landry also raised the question of why the number of Black men accepted to medical school has declined between 1978 and 2014, despite the number of seats in medical schools growing. He pointed out that the root of the issue goes all the way back to local public education.
“K-12 education is so disparate based on your lived environment, the tax base that you’re coming from, from the town that you live in, the opportunities that are available to you as a high school student engaged in advanced level courses,” Landry told told panel moderator Usha Lee McFarling, who wrote for STAT earlier this year about how Black doctors are forced out of residencies at far higher rates than white doctors. Students may be interested in pursuing careers in medicine, he said, but “the lack of opportunities in that K-12 space” remains an obstacle.
Eighty percent of incoming medical students come from the top two quintiles of family income, said Landry, which means that the majority of students who become doctors also grew up with the resources he mentioned.
“The issue of entering medicine is an issue of access,” agreed Nolen, who is also the first Black woman to serve as president of the Harvard Medical School student council. “Because as a first-generation medical student, in order to be competitive to apply to medical school, I had to find shadowing opportunities. But what does that look like when no one in your family or in your circle is in the health care field?”
Nolen went on to discuss how the systemic racism that leads to a lack of economic opportunities for low-income Americans can get in the way of the medical school application process. ”My family and I are originating from Compton, California, which is a low-income community, and I didn’t have anyone to really help guide me when it came to the financial challenges that came with applying to medical school,” she said. Nolen continued:
“You’re looking at over a $100 [fee] per medical school you apply to. Then on top of that, you have to think about your flights for when you get into these schools for interviews, and then you have re-visits. And then on top of that, you think about having to pay for the MCAT, which costs $500. That’s not including the prep for taking the MCAT. So really it becomes a race of who has the funds and the resources to even be a competitive applicant for medical school.”
Mytien Nguyen, an M.D./Ph.D. student in Yale School of Medicine’s immunobiology department, grew up in a low-income, biracial Vietnamese-Black immigrant household and has studied the experiences of historically excluded groups in medicine. “We found that students from marginalized backgrounds are more likely to experience mistreatment and discrimination based on their race, gender, and disability status as well as exclusion from opportunities like honor societies [like] Alpha Omega Alpha and research mentorship and opportunities,” Nguyen said. Those effects only get worse for students who are identified with more than one marginalized identity.
These negative experiences not only impact the path of marginalized medical students, she said, but also affect younger generations. Nguyen’s younger brother, after witnessing her experiences, has come away with a very negative perception of the field.
As the Supreme Court looks likely to rule against affirmative action at U.S. schools, Landry said that he “wholly expect[s] to see a dropoff” in medical school admissions of students from marginalized communities, given what happened at University of Michigan and University of California schools after similar policies were eliminated there.
As for solutions to the lack of Black doctors, Nguyen said that eliminating the financial barriers that may prevent some applicants from opting into medical school would be a start. “Right now, medical education is an individual investment,” she said. “I think we need to make it a societal investment.”