Health care in America is not exactly an egalitarian endeavor. Racially-based disparities in health outcomes and access to quality care endure, and in some cases, appear to be worsening. In 2015, the Association of American…
Health care in America is not exactly an egalitarian endeavor. Racially-based disparities in health outcomes and access to quality care endure, and in some cases, appear to be worsening. In 2015, the Association of American Medical Colleges released Altering the Course: Black Males in Medicine, a report highlighting this alarming fact: Fewer black men were enrolled in medical school in 2014 than had been in 1978.
Writing in the document, Marc Nivet, chief diversity officer of the AAMC noted, “In 1978, there were 1,410 black male applicants to medical school, and in 2014, there were just 1,337. The number of black male matriculants to medical school over more than 35 years has also not surpassed the 1978 numbers. In 1978, there were 542 black male matriculants, and in 2014, we had 515. No other minority group has experienced such declines.”
Why fewer black men are choosing careers in medicine is a complicated and multi-layered problem. Norma Poll-Hunter, senior director of diversity policy and program at the AAMC and lead author on the report, says the disparity often begins from the earliest days of schooling. “We recognized that it was a systemic problem that really starts as early as elementary school for many of our communities of color.”
In addition to a lack of early role models, “economics are a factor, whether that’s access to high-quality education or having the financial means to pursue medical education. Those are barriers,” Poll-Hunter says, adding that some institutions focus perhaps too heavily on certain metrics of success such as standardized test scores, which may favor students from more affluent or white backgrounds.
Plus, it takes a long time — depending on the specialty, many doctors must complete 10 to 12 years of advanced education and training. Poll-Hunter says some students who have the smarts and interest in math or science might opt for engineering or another field where the path to the workforce and a paycheck is shorter and perhaps saddled with less student loan debt.
Even with a good education, the journey to becoming a doctor is long and easily derailed. When students don’t have the right mentors or guidance, some students may get discouraged, she says. “Along the way, there are different opportunities to succeed, but also opportunities to prevent the success of young men of color,” Poll-Hunter says.
Although the report’s findings are sobering, bringing more black men into medicine is not a hopeless task, and many doctors around the country have joined a social media campaign to raise the visibility of black men in medicine and hopefully encourage the next generation of black males to join them.
“One solution was that we need for black men in medicine to be visible and to be mentors” to other black men considering career options, says Dr. Quinn Capers IV, an interventional cardiologist at The Ohio State University Wexner Medical Center and associate dean of admissions for The Ohio State University College of Medicine. “So one day on Twitter, several black male physicians were kind of discussing the problem of a lack of black men applying to medical school and discussing this landmark report from the AAMC,” and they hit on a potential solution: Start a social media campaign using the hashtag #BlackMenInMedicine. “We said, ‘why don’t we flood social media with images of black men in medicine and across the spectrum of their lives?’ In other words, ‘Guys, let’s put up pictures of black men in the operating room as the physician operating, but let’s also put up images of black men playing with their kids at the park and being good husbands, going for a walk, giving lectures — just the whole spectrum of what we do,'” Capers says.
Since the Twitter campaign launched in November 2017, many other black physicians have joined in, leading to “several million impressions just in the first few days, and we’ve continued to do this,” Capers says. The campaign continues to grow and spread to other social medial platforms, all in an effort to reach black men where they are and where they may see positive images that reinforce their own value to society and normalize the concept of a black male physician.
Unfortunately, a smaller number of black male physicians in practice translates into a lack of exposure for many people. Dr. Darrell Gray II, assistant professor in the division of gastroenterology at The Ohio State University College of Medicine, says when he walks into an examination room, often his mere presence surprises patients. “I can’t tell you how many times I’ve walked into a patient room and they’re startled to see me. Whether that’s a good startle and they say, ‘I’m proud of you and happy that you’re my doctor,’ or whether it’s a different kind of startle, it shows that racial bias is still alive and well, and it shows us that we need to do more” to elevate the visibility of black men in medicine.
By showcasing what’s possible for black men in medicine, Capers, Gray and other physicians involved in the campaign hope to help “change the nation’s unconscious bias about black men,” Capers says. “There’s studies that show there’s unconscious bias against black men that is generally negative,” but by flooding social media with positive images of black men, they hope to turn the tide of negative associations and break down barriers.
In addition to the social media campaign, Gray, Capers and many other male doctors of color across the U.S. are actively seeking to connect directly with younger black men to encourage them to pursue a career in medicine. At Ohio State, black male faculty members take part in a quarterly roundtable discussion with their younger counterparts. Gray says every black male student who’s admitted and matriculated is invited to participate along with residents, fellows and faculty. The gatherings serve partly as a social event, but also offer unparalleled opportunity for more experienced physicians to share their knowledge and support to mentor up-and-coming doctors. These roundtable sessions are “about making sure you’re successful so you can graduate and become a successful physician.”
But direct outreach can and should start even earlier. Capers says one effective way of modeling what’s possible to black students is to meet them on their own turf. By visiting high schools and working with students so they become familiar with the concept that black men can be doctors, too, these students see what’s possible and learn what steps they need to take to pursue such a career. In addition, the students come to campus quarterly “to interact with our minority medical students,” Capers says.
Going even younger, Gray routinely visits a local elementary school as part of a diversity partnership program. The program puts doctors, pharmacists, veterinarians, physical therapists and other health care professionals in the classroom to “help teachers deliver content,” Gray says. “The goal is not to ensure that all the students who are in the program become health care providers, but that they become productive citizens.”
Simply showing up and participating while wearing a white coat can send a powerful message to young students about what may be possible for them some day. “I’m from a similar background and I had similar challenges, but I made it, and you can, too,” Gray says. “For a lot of children, it’s important to see that they can achieve that. It seems out of reach if they haven’t seen it.”
Although the focus is on bringing more black men into medicine, Gray says there’s more to these efforts than just black and white. “We’ve also been active in championing women in medicine and [closing] the gender pay gap. So this is not exclusive. It’s a very inclusive thing, and we want to speak up for people who are experiencing challenges along the journey to becoming a black male physician or just a physician in today’s climate,” he says.
It’s early to determine how successful the social media campaign and other efforts to increase the number of black men in medicine will be, but the issue and efforts to address it are garnering a lot of media attention because of the importance of increasing diversity across the board.
First among them is that boosting the number of black male doctors will improve patient outcomes, Capers says. “This isn’t just anecdotes; there’s data that says that physicians who attended diverse medical schools — and this is for physicians of any race — rate themselves as more comfortable treating diverse populations.”
Given that America is becoming an increasingly diverse place with a shortage of doctors across a range of specialties, a doctor who’s comfortable working with any patient who walks through the door is a valuable asset. “Of course we want our graduates to feel comfortable treating patients of all backgrounds,” Capers says, and it seems “there’s something about sitting in the classroom next to your classmate who’s a different race, a different sexuality or a different religion and interacting with them or being in a study group or discussion group with them that makes you more comfortable when you encounter a patient who comes from that background,” he says.
In addition, patients who share the same background with their doctors are more likely to comply with doctor’s orders. A recent study completed by the National Bureau of Economic Research showed that black male patients were much more likely to comply with a doctor’s orders for preventive screening and vaccinations when that doctor was also a black man. “The dearth of black men in medicine is a crisis because we know it impacts patient health outcomes,” Gray says.
Capers adds that “if you’re seeing a physician and they are familiar with your language or culture, that takes away your fear and anxiety,” noting that often, even when an interpreter is present, important information and nuance can be lost in translation.
There can also be a comfort factor grounded in shared experience. “Much like women often will prefer a woman OB-GYN and men often but not always will prefer to have a male urologist. People tend to want to have doctors who share their background,” Capers says. Groups that have been oppressed or mistreated may be more willing to trust a health care provider who shares that background. “Those to me are very good reasons for us to enhance diversity in the medical workforce,” he says.
What’s more, doctors who hail from communities that have been historically underserved by the medical profession are more likely to practice in an underserved area. “Every single time it’s been studied, doctors who specifically come from communities that are underrepresented in medicine — most people will define that as Hispanics, African Americans, American Indians and Native Alaskans and Pacific Islanders — those doctors tend to treat underserved, disadvantaged populations.” Therefore, “it makes sense that we’d want to recruit people who’ve shown that it’s in their hearts to go into the communities and care for our poor, disadvantaged and underserved populations,” Capers says.
Lastly, Poll-Hunter says that ” research shows that more diverse classrooms contribute to greater civic-mindedness and cognitive complexity,” so the mandate for diversity is not just among the students, but for faculty, too. “Diversity in the faculty in particular contributes to a range of pedagogical strategies. Diversity enriches the learning environment,” which can lead to novel approaches that reach more patients and improve outcomes. “As faculty, they’ve enriched the learning environment, and as scientists they’re more likely to pursue areas of research that focus on health disparities as well,” which could help level the health playing field for all.