If there was any doubt left that the Obama era didn’t usher in a postracial society, it was erased in the last few weeks by the spectacle that was the Donald Sterling affair. It probably doesn’t surprise anyone at this point that we have not yet reached the promised land of equality and racial blindness of which Dr. Martin Luther King Jr. spoke 50 years ago. And we have regular reminders of just how far we fall short in this country in many arenas and disciplines—particularly in higher education and at medical schools.
While the overall number of black and Latino physicians is steadily rising, the numbers in leadership remain anemic. Blacks represent only 5.7 percent of deans at American medical schools as of 2013.
As a physician of African-American and Latina ethnicity, I have seen a tepid, though somewhat steady, increase in the number of African-American medical students, but no corollary in the numbers of black medical-school faculty members.
There’s a higher attrition rate for minority faculty, partly due to insufficient mentoring in the profession and little room for such faculty’s advancement to leadership.
Even though medical schools are moving increasingly toward medical simulation as an educational technique, due to concerns for patient safety, the profession still clings to the old apprenticeship paradigm of “see one, teach one, do one.” The traditional method of teaching is one where trainees learn by following the leader, but the dearth of black leaders in medical schools makes this practice less beneficial to black medical students.
Although having mentors of different backgrounds and races is not an anathema, having mentors who look like you, who have walked your path, and on whom you can pattern yourself professionally is undoubtedly significant.
The shortage of black leadership at high levels in medical institutions sends a negative message to both majority and minority students—potentially narrowcasting minority doctors as followers, not leaders.
And we need more black medical-school leadership because of the undeniable effect on patients. Fewer black doctors in positions of authority sends a dangerous message to patients, perpetuating the belief that physicians of color are inferior to white physicians. By contrast, institutional equity—and better outcomes—occur when institutional leadership is diverse. Prejudice is thwarted when different voices commit to exorcising both hibernating and active racism.
We also need more black physicians to meet the health care needs of African Americans, who have more often than not felt marginalized. That more than 8 million Americans signed up for the Affordable Care Act underscores the fact that Americans desire access to health care. However, while the insurance battle appears to have ended and a truce is in effect, the larger war of true access rages on. Black physicians often serve in communities where insurance might now be present, but boots—or, perhaps, scrubs—on the ground are still absent.
A 2004 Commonwealth Fund study (pdf) recommended revision of health policy to encourage workforce diversity and called for programmatic funding to support the recruitment of minority medical students and faculty, with the goal that patient-provider concordance, as it relates to race and ethnicity, improves patient-physician communication, enhances health information gathering and improves overall patient-health outcome. This study provides potent support for diversifying medical-school leadership.
To be sure, health access does not equal health equity. The admission of highly qualified black students to medical schools is dwarfed by the lack of parallel professional growth and advancement opportunities and, as such, does not augur well for a truly equitable national health system.
The law has changed health policy in the area of access, but it has failed to consider the depth and breadth of that access. And the lack of emphasis in the ACA aimed at addressing workforce diversity and disparities in medical-school training and leadership could tarnish one of health care reform’s greatest legacies.
As Attorney General Eric Holder recently remarked, it is often not the highly publicized and outrageous cases—like the Sterling episode—that keep us from closing the racial divide in terms of education, wealth and health outcomes. Frequently, rather, it’s the more subtle and insidious disparities of our time that keep us from the fair, equal and just future we were promised.
Because of the importance of health care in our lives and in our communities, medicine and the medical profession must do more to provide effective care for an increasingly diverse America. That means, among many other reforms, a more diverse profession.
June M. McKoy, M.D., is an associate professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine and a licensed Illinois attorney. She is a Public Voices Thought Leadership fellow at Northwestern through the OpEd Project.