Black Physicians Research Articles

“All Patients Are Not Treated as Equal”: Extending Medicine’s Social Contract to Black/African American Communities

Phenomenon The social contract is an implicit agreement that governs medicine’s values, beliefs, and practices in ways that uphold the profession’s commitment to society. While this agreement is assumed to include all patients, historical examples of medical experimentation and mistreatment suggest that medicine’s social contract has not been extended to Black patients. We suggest that is because underlying medicine’s contract with society is another contract; the racial contract, which favors white individuals and legitimizes the mistreatment of those who are nonwhite. When Black/African American physicians enter medicine, they enter into the social contract as an agreement with society, but must navigate the realities of the racial contract in ways that have yet to be acknowledged. This study examines how Black/African American physicians interpret and enact the social contract in light of the country’s racial contract by investigating the ways in which Black/African American physicians discuss their interactions with Black patients. Approach This qualitative study reexamines cross-sectional data previously collected in 2018-2019 examining the professional identity formation (PIF) experiences of Black/African American trainees and physicians in the Southern part of the U.S. The goal of the larger study was to explore participants’ professional identity formation experiences as racialized individuals within a predominantly white profession. The current study examines these data in light of medicine’s social contract with society and Mill’s (1997) theory of the racial contract to understand how Black physicians interpret and enact the social contract. Participants included 10 Black/African American students, eight residents, and nine attending physicians. Findings The findings show that Black/African American physicians and trainees are aware of the country’s racial contract, which has resulted in Black patients being historically excluded from what has been described in the social contract that governs all physicians. As such, they are actively working to extend the social contract so that it includes Black patients and their communities. Specifically, they engage in trust building with the Black community to make sure all patients are included. Building trust includes ensuring a consistent stream of new Black/African American trainees, and equipping Black trainees and patients with the skills needed to improve the healthcare within the Black/African American community. Insights While it been has assumed that all patients are included in the social contract between medicine and society, historical examples of medical mistreatment and experimentation demonstrate this is inaccurate; Black/African American communities have not been included. In an effort to dismantle systemic racism in the U.S., medical education must teach about its racist past and divulge how some communities have been historically excluded, providing new ways to think about how to include everyone in medicine’s social contract.

How Should We Respond to Racist Legacies in Health Professions Education Originating in the Flexner Report?

The Flexner Report damaged and marginalized historically Black medical schools, which today produce more than their fair share of Black medical graduates. As physicians, graduates of Black medical schools have confronted head-on the inequities of American responses to COVID-19 that the pandemic has laid bare to the world. Black physicians' leadership roles in American health care and in American communities have informed the reimagination of health care and medical education as just and inclusive.

Examining Parity among Black and Hispanic Resident Physicians.

The US physician workforce does not represent the racial or ethnic diversity of the population it serves. To assess whether the proportion of US physician trainees of Black race and Hispanic ethnicity has changed over time and then provide a conceptual projection of future trends. Cross-sectional, retrospective, analysis based on 11 years of publicly available data paired with recent US census population estimates. A total of 86,303 (2007-2008) to 103,539 (2017-2018) resident physicians in the 20 largest US Accreditation Council for Graduate Medical Education resident specialties. Changes in proportion of physician trainees of Black race and Hispanic ethnicity per academic year. Projected number of years it will then take, for specialties with positive changes, to reach proportions of Black race and Hispanic ethnicity comparable to that of the US population. Among the 20 largest specialty training programs, Radiology was the only specialty with a statistically significant increase in the proportion of Black trainees, but it could take Radiology 77 years to reach levels of Black representation comparable to that of the US population. Obstetrics/Gynecology, Emergency Medicine, Internal Medicine/Pediatrics, and Orthopedic Surgery demonstrated a statistically significant increase in the proportion of Hispanic trainees, but it could take these specialties 35, 54, 61, and 93 years respectively to achieve Hispanic representation comparable to that of the US population. Among US residents in the 20 largest specialties, no specialty represented either the Black or Hispanic populations in proportions comparable to the overall US population. Only a small number of specialties demonstrated statistically significant increases. This conceptual projection suggests that current efforts to promote diversity are insufficient.

Addressing implicit bias in the surgical residency application and interview process for underrepresented minorities

Diversity in the health care workforce remains an elusive goal in the United States, particularly in the surgical specialties. Black, Hispanic, and Native American physicians remain underrepresented in medicine, despite national efforts to increase diversity in the health care workforce.1 Although these 3 racial/ethnic groups comprise one-third of the US population, Black, Hispanic, and Native American physicians constitute only 9% of practicing physicians.2

Palliative Care Attitudes and Experiences Among Resident Physicians at Historically Black Colleges and Universities (SCI914)

1.Describe three aspects of palliative care education among residents at Historically Black Colleges and Universities.2.Identify two areas for improvement in palliative care education among residents at Historically Black Colleges and Universities. Given the shortage of specialists in palliative care, it is critical that all physicians have the knowledge, attitudes and skills needed to provide primary palliative care. This is particularly important for Black physicians who disproportionally care for patients of color who have serious illness. Our study investigates palliative care attitudes and experiences among primary care residents at two Historically Black Colleges and Universities (HBCUs). 1.Describe attitudes towards palliative care among residents at Historically Black Colleges and Universities.2.Describe the educational experiences of residents at Historically Black Colleges and Universities and identify areas for improvement. Internal Medicine and Family Medicine residents at two HBCUs completed a previously validated, online survey assessing attitudes towards palliative care, palliative care teaching and experience, and messages about palliative care. We performed a descriptive analysis of survey data. Among 91 residents who completed the survey (response rate 48%), most (96%) answered that learning about palliative care was moderately/very important. On a 0-10 scale, residents reported less teaching about providing palliative care (5.4 ± 2.3) than about managing sepsis (8.3 ± 1.8). The quality of palliative care teaching was rated lower than the quality of their overall medical education (13% rated palliative care education as excellent/very good versus 70% who rated their overall education as excellent/very good). Respondents reported high rates of seeing and participating in goals of care conversations but received less feedback after leading such conversations (77%) than after performing a paracentesis (88%). Negative messages about palliative care from other physicians were common (74% of respondents reported that other physicians considered working with dying patients only a little/not at all rewarding). Residents at HBCU academic medical centers are interested in palliative care, but opportunities exist to improve both formal and informal palliative care education.

First person profile: Lori J. Pierce, MD: First African American, first female radiation oncologist to serve as American Society of Clinical Oncology president makes equity her theme.

First person profile: Lori J. Pierce, MD: First African American, first female radiation oncologist to serve as American Society of Clinical Oncology president makes equity her theme.

The community of Black women physicians, 1864-1941: Trends in background, education, and training.

We identified nearly 180 Black women who earned medical degrees prior to the start of the Second World War and found information regarding their family and social connections, premedical and medical educations, and internship experience or lack thereof for many of these women. Through their collective history, we observed large-scale trends, especially regarding the importance of "separatist" medical education and declining medical school attendance among African American women in the 1910s as medicine became an increasingly exclusionary profession. While our research uncovered trends specific to Black women physicians, the implications of our research can be applied far more widely to other historically marginalized scientific practitioners. This research reminds us of the longstanding and shifting presence of Black women in science and medicine, despite the enduring popular belief that white men represent who participates in science, both historically and today.

Rebecca Lee Crumpler: first Black woman physician in the USA

A passionate vocation to care for others and a desire to empower her patients drove Rebecca Lee Crumpler (1831–95) to overcome 19th-century prejudice against her gender and ethnicity and qualify as “doctress of medicine” (the term she used), the first African American woman to do so. Crumpler gained extensive experience treating destitute former enslaved people in the southern states after the end of the American Civil War, and published A Book of Medical Discourses: in Two Parts, a practical guide to the care of infants and women's health.

The history of medical education: a commentary on race.

The institution of medicine was built on a foundation of racism and segregation, the consequences of which still permeate the experiences of Black physicians and patients. To predict the future direction of medical inclusivity, we must first understand the history of medicine as it pertains to race, diversity, and equity. In this Commentary, we review material from publicly available books, articles, and media outlets in a variety of areas, including undergraduate medical education and professional medical societies, where we found an abundance of policies and practices that created a foundation of systemic racism in medical training that carried through the career paths of Black physicians. The objective of this Commentary is to present the history of race in the medical education system and medical society membership, acknowledge the present state of both, and offer concrete solutions to increase diversity in our medical community.

An issue of trust—vaccinating Black patients against COVID-19

An issue of trust—vaccinating Black patients against COVID-19

Systemic racism and overcoming my COVID-19 vaccine hesitancy.

On December 19, 2020 I received my first dose of the coronavirus 2019 (COVID-19) vaccine. I had decided only about 10 days before to take the vaccine in the first round, if given the opportunity. My hesitation may come as a surprise to some. As a physician, scientist, and epidemiologist, many may have thought that I would be ready, with my sleeve up, as soon as the Phase 3 clinical trials began. However, long before I was a physician or a scientist, I am a Black woman. As a Black woman, I have borne witness to the very system that says it is ready to protect me with a vaccine, systematically disempower my community, putting many at risk of comorbidity and death. How could I in good conscious then agree to take a vaccine, developed, under an administration that has been nothing short of oppressive to people of color, without reviewing the data myself? Once the trial data became available, I spent several days buffing up on my immunology so that I could better understand mRNA technology. I listened to panel interviews that included physicians of color with expertise in infectious disease. I read the trials’ inclusion and exclusion criteria. I looked at every line of Table 1 to ensure there were people in the trials that looked like the people in my family. I combed over the efficacy data and every adverse event. After my immunology and vaccinology immersion, I walked into that room to be vaccinated with less trepidation in my heart. More than 1 in 470 Black residents have died in Michigan and New Jersey from COVID-19; more than 1 in 410 Latinos in New York; more than 1 in 200 Indigenous people in New Mexico [[1]The color of coronavirus: 2020 year in review.December 23, 2020https://www.apmresearchlab.org/Google Scholar]. The medical community recognized the racial disparity in COVID-19 mortality early in the pandemic. However, it should be clarified that the COVID-19 virus does not discriminate; but our systems have and do. The virus amplified and exposed for all to see structural racism—institutions, laws, policies, and regulations that lead to uneven distribution of education, job opportunities, and criminal justice between races. Structural racism and unequal distribution of the social determinants of health in turn leads to social need—housing and food insecurity, deficits in literacy and social networks. This failure leads to crowded homes, lack of private transportation, and less health care access. These unhealthy environments contribute to disease risk factors like obesity, diabetes, and hypertension which put those subjected to systemic racism at risk for death from COVID-19. The racial disparity in COVID-19 mortality has nothing to do with race and everything to do with structural racism. So despite over 10 years of medical education, I walked in to get my vaccine with some uncertainty in my heart. If you cannot comprehend how my experience of structural racism can overpower a decade of medical education, then you will have a hard time understanding vaccine hesitancy in communities of color. For communities of color to have significant vaccine uptake, it is going to take more than a few photos of medical professionals on social media getting the vaccine. As a medical community we need to have our ambassadors acknowledge our failures in gaining their trust. Unfortunately, this lack of trust is not just the result of residual pain from past atrocities like the Tuskegee experiments. On December 20th, Dr. Susan Moore, a Black physician died of COVID-19 after video recounting her experience with racism at my own institution. Many patients of color, including myself, can describe present-day experiences in the health care system where we have been discounted, ignored, and devalued. As a medical community we need to acknowledge our wrongdoing and commit to training our current workforce to do better in the future. A commitment by our governments and the medical community to distribute the vaccine quickly and equitably to the most devastated communities of color first would go a long way towards relationship building. To continue to highlight the disparities in mortality from COVID-19, yet make no concerted effort to mitigate that disparity is a counterproductive strategy, and will not move relationships with communities of color forward. On January 19th, I was among the privileged, who recieved their second dose of the vaccine gaining 95% protection from this deadly virus. We have lost so many. We must and we can do what is needed to get this vaccine to the vulnerable communities that need it the most. The author has no conflicts of interests or disclosures to report.

How Should Lived Experience of Racism Count in Medical School Admissions?

There are fewer Black men in US medical schools today than in 1970. This and other kinds of ongoing inequity express the systemic racism Black Americans face in health care. Increasing Black physician representation in medicine is key to motivating health equity, so many colleges and universities have developed programs to recruit and retain students with minoritized identities. This article suggests how Black medical school applicants' lived experiences of racism can contribute prominently to building medicine's capacity to promote healing and health equity.

Diversity in Medical Schools

This Viewpoint reviews the many factors contributing to underrepresentation of Black physicians in US medical training pipelines and the health care workforce, and urges actions to dismantle structural barriers to Black medical school enrollment and achieve racial parity in the profession.

“Sisters of a Darker Race”: African American Graduates of the Woman’s Medical College of Pennsylvania, 1867–1925

During its first seventy-five years (1850-1925), the Woman's Medical College of Pennsylvania (WMCP) graduated eighteen Black women-more than any other predominantly white medical school. This article examines the lives and careers of these "sisters of a darker race" as they sought a foothold in medicine. Its exclusive focus on WMCP allows historical examination of the experiences of Black medical professionals in a "white space." This perspective helps illuminate the racism that Black women encountered from their white colleagues. WMCP itself maintained a racially exclusionary internship policy that barred Black women and contributed to a racial divide in the female medical world, making plain its educational objective to prepare African Americans for medical careers in Black medical spaces. Nonetheless, WMCP did prepare this pioneering group of Black women physicians with the education and skills to make significant contributions to medicine and Black communities in the United States and Africa.

Closing the Gap in Health Care: A Personal Odyssey.

This narrative provides insight into medical education for Black physicians in South Carolina in the 1960s, during the civil rights movement. It also discusses the many rewards and challenges of being a physician of color, describes what has been done to develop programs that benefit minority communities, and argues that more such programs are needed.

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

NewsCAP: Black newborns are more likely to survive if they're cared for by Black physicians.

NewsCAP: Black newborns are more likely to survive if they're cared for by Black physicians.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

Patients, Pride, and Prejudice: Exploring Black Ontarian Physicians' Experiences of Racism and Discrimination.

Black physicians' and trainees' experiences of racism are not well documented in Canada, reflecting a knowledge gap needing correction to combat racism in Canadian health care. The authors undertook a descriptive study of Black physicians and trainees in the Canadian province of Ontario. The goal of this study was to report upon racism experienced by participant Ontarian physicians to challenge the purported rarity of racism in Canadian health care. An anonymous online survey of physicians and trainees who self-identify as Black (African/Afro-Canadian/African American/Afro-Caribbean) was administered in March and April 2018 through the Black Physicians' Association of Ontario (BPAO) listserv. The survey was modeled on qualitative interview guides from American studies. Snowball sampling was employed whereby BPAO members forwarded the survey to eligible colleagues (non-BPAO members) to maximize responses. Survey data were analyzed and key themes described. Survey participants totalled 46, with a maximal response rate of 38%. Participants reported positive experiences of collegiality with Black colleagues and strong bonds with Black patients. Negative discrimination experiences included differential treatment and racism from peers, superiors, and patients. Participants reported race as a major factor in their selection of practice location, more so than selection of career. Participants also expressed a lack of mentorship, and there was a strong call for increased mentorship from mentors with similar ethno-racial backgrounds. This study challenges the notion that racism within Canadian health care is rare. Future systematic collection of information regarding Black physicians' and trainees' experiences of racism will be key in appreciating the prevalence and nature of these experiences.

Trauma of Racism Has Long-Term Impact on Health

Back to table of contents Previous article Next article ProfessionalFull AccessTrauma of Racism Has Long-Term Impact on HealthTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:13 Oct 2020https://doi.org/10.1176/appi.pn.2020.10b14AbstractBoth overt forms of racism and microaggressions contribute to a constant state of stress in Black people, say experts.iStock/FG TradeThe long history of racism in the United States and the day-to-day traumas of racial tension, discrimination, and microaggressions have a lasting impact on the physical and mental health of Black people, said mental health experts and physicians in an August webinar. The webinar was hosted by PsychU, a community and online resource library for mental health sponsored by Otsuka Pharmaceutical Development & Commercialization Inc.Napoleon Higgins, M.D., a child, adolescent, and adult psychiatrist in Houston, began the discussion with a historical perspective on racism and how the mistreatment of Black people for generations has destroyed their trust in the American health care system. He is the owner of the Bay Pointe Behavioral Health Services and the Southeast Houston Research Group, and CEO of Global Health Psychiatry LLC.“Because of the history of [racism in] America, we don’t trust America. We question everything we hear,” Higgins said. He added that this played out in a study that found that Black patients who saw a Black physician were nearly 20% more likely to follow the physician’s recommendations than if they had seen a non-Black doctor.“That’s a disparity right there … where Black people have issues being able to trust their doctors. Then from the doctor’s point of view, the Black patient is less likely to follow recommendations. The mistrust goes all around between both parties,” Higgins said. The mistrust contributes to higher rates of death by natural causes among Black people when they don’t get appropriate care, he said.Kimone James, M.D., discussed how microaggressions often go unrecognized as a form of racism. She is the medical director at two Fresenius Kidney Care sites and instructs internal medicine residents at Wellstar Health Systems in Marietta, Ga.“Some people may say, ‘I’m not a racist, I don’t do racist things,’ but as a Black woman, I know that in the workplace alone, microaggressions are prominent, even if it’s someone imitating the way they think Black women swivel their necks,” James said. “That’s the problem with racism. People often think that racism is the Ku Klux Klan, swinging a Confederate flag, or [using] slurs, but sometimes racism is a very simple thing like microaggression.”Higgins described how repeated exposure to racism in all its forms can take a toll on the body.“If you stress a person out enough, you’re going to see physical changes. It [involves] learning and memory, where you see instances of racism, and then you see it again, and it all stacks up,” Higgins said. “It increases cortisol, which increases your heart rate and increases your blood pressure because your body is always geared up.”James said that this stress response contributes to the impact of COVID-19 on the Black community.“When people ask me why more Black people are dying of coronavirus, I think, ‘Well, look at our poor bodies right now,’” she said. “We have increased stress from racial tension, increased lack of medical resources, and more untreated diseases, and you throw on top of it poor air quality [in Black neighborhoods] … and jobs where you’re exposed to toxins because you’re doing factory work. Are those bodies suitable [for defending against] any disease, not to mention coronavirus?”Betsy Bennett, Ph.D., addressed white people and what they can do to combat racism as individuals. She is a clinical health psychologist at Clarity Consulting, a consultant on cultural competency, and adjunct faculty at the Adams School of Dentistry at the University of North Carolina at Chapel Hill.“The number one thing you can do is be curious, be open-minded, and learn as much as you can. Try not to be embarrassed about what you don’t know because all that does is get in the way of you learning more,” Bennett said. ■“Impact & Trauma of Racism” is posted here. ISSUES NewArchived