Black physicians are critical to Black health

By Brian E. Muhammad and Nisa Islam Muhammad | Last updated: Oct 8, 2019 - 1:59:16 PM

How do we overcome challenges and increase numbers of Black doctors?

A recent report in the Journal of the American Medical Association suggests while numbers of physicians from minority racial/ethnic groups have increased over time, the physician work force still does not represent the demographics of the United States.

Experts of the medical profession say it is a particular concern for Black people who say having a physician who looks like them matters. Furthermore, the disparity in the numbers of Black doctors is a problem that has plagued Black people since the early 20th Century.

“It’s a problem that goes back to Reconstruction,” said Dr. Jewel Crawford, assistant professor at Morehouse College Department of Community Health and Preventive Medicine. “This deficit in our health and healthcare providers has been present since we left Africa and came over here,” she added.

Dr. Crawford said there are more Black doctors now, but percentage wise, the number is still close to what it was a century ago. Figures from Data USA said Black physicians and surgeons comprise only six percent of the profession compared to their White counterparts at 69.8 percent and Asians representing 21.1 percent of the profession.

Studies show Black people get better care sooner and with greater outcomes when they have a Black doctor. Dr. Marcella Alsan from Stanford University’s School of Medicine led a study in 2018 that tracked the affect a Black doctor had on the medical decisions and outcomes among Black men.

She recruited over 1,300 Black men in Oakland, Calif. Her clinic provided preventive services and was staffed with 14 male doctors. The men were asked about their need for services (such as cardiovascular screening) before meeting their assigned physician and then asked again after speaking with their physician. Men who met with Black doctors asked to receive more preventive services than men who met with non-Black doctors.

The researchers found patients were 29 percent more likely to talk with Black male doctors about other health problems they were experiencing, and Black physicians were 35 percent more likely to write notes about Black patients than non-Black physicians.

The problem is Blacks make up 13 percent of the U.S. population, but less than seven percent of U.S. doctors and less than seven percent of U.S. medical students. The numbers of Blacks applying to medical school and being admitted are increasing but those numbers are still low.

According to Shemmasian Consulting, during the 2018-2019 application year 4,430 Blacks applied to medical school, 1,596 were accepted for an acceptance rate of only 36 percent, 1,540 actually went to medical school for a matriculation rate of 35 percent.

There have been efforts to diversify the physician workforce over the last decade. In 2009 the Liaison Committee on Medical Education—an accreditation body—instituted formal accreditation guidelines requiring medical schools develop programs and partnerships designed to make admissions to medical education more accessible to applicants of diverse back-grounds.

‘The problem is Blacks make up 13 percent of the U.S. population, but less than seven percent of U.S. doctors and less than seven percent of U.S. medical students. The numbers of Blacks applying to medical school and being admitted are increasing but those numbers are still low.’

Authors of the Journal of the American Medical Association report released Sept. 4, titled “Trends in Racial/Ethnic Representation Among U.S. Medical Students,” said there is a need for more robust policies and programs to create a physician work force that is representative of the U.S. population.

A 2018 study found Black male patients were more likely to talk with Black male doctors about their health problems.

Dr. Crawford told The Final Call there are a myriad of problems that impacts the situation. Even though Blacks historically struggled for social justice and equal opportunities and paved the way to get into medical schools, the system of public education is a problem, she explained.

“We’re not benefiting from them because our pipeline—that’s supposed to feed the children into medical school is … beyond leaky; it’s deteriorated,” said Dr. Crawford.

In addition, Black communities are among the most underserved for health care. Although no one will deny that a person with skill and training can serve these populations, observers note there are cultural issues that factor in both care givers and patients.

“Historically, Black physicians have provided medical care to Black patients at a higher rate than physicians of other racial backgrounds,” said Dr. Annelle Primm, MD, MPH and chair of the All Healers Mental Health Alliance.

“Similarity in racial and cultural back-ground can be a plus in communication in the healthcare encounter in which trust and respect are very important,” added Dr. Primm.

Dr. Primm is a psychiatrist and explained that some of the disparities in healthcare in the Black community are linked to the disproportionately low percentage of Black physicians and other health professionals compared to other racial groups.

There are consequences to cultural incompetence, according to one study published in the January 2016 Journal of Pain and Symptom Management. It compared differences in physicians’ verbal and nonverbal communication with Black and White patients at the end of life. It said Black patients nearing the ends of their lives received less empathy from White physicians than from Black physicians, despite receiving the same factual information.

Consequently, Black people are more likely than Whites to die in intensive care units with life sustaining treatments. The study linked the disparity in part to care providers’ verbal and nonverbal communication with the patient.

Another study issued in 2016 by PANAS—the official journal of the National Academy of Sciences— pointed out how racial bias and false beliefs by White doctors about biological differences between Blacks and Whites determine how pain is managed. A key outcome of that study was that “Black Americans are systematically undertreated for pain” relative to White Americans.

A troubling example cited in the study was half of the medical students at the University of Virginia erroneously believed that Black patients’ blood coagulates faster than White patients and that Black people have more tolerance for pain.

“These findings suggest that individuals with at least some medical training, hold and may use false beliefs about biological differences between Blacks and Whites to inform medical judgments,” said the study.

Kimberly Wilson started Huedco.com to help Black patients avoid her dilemma of finding the right doctor to treat her fibroids. The White doctors she went to recommended she get a hysterectomy, said Ms. Wilson. She finally got a referral to a Black doctor who understood the nuances Black women face with fibroids.

“Huedco is a platform that diversifies the patient/doctor connection by connecting patients (of color) with health and medical professionals (of color) that specifically understand their cultural, physical and mental needs. This will give prospective patients easy access to care from people that look like them i.e. ‘hued’ healthcare providers,” said Ms. Wilson.

Issues of trust is also a sordid history of medical experimentation on Blacks like the infamous Tuskegee Experiment. It was in a 1932 to 1972 study conducted by the U.S. Public Health Service on the effects of untreated syphilis secretly given to poor Black men who were denied treatment for the disease.

In an August 2018 interview with U.S. News and World Report, Dr. Damon Tweedy, author of a 2015 memoir, “Black Man in a White Coat,” said there is a tendency to think of doctors and health care as somehow separate from other institutions, and in some ways that’s really not the case. Racial discrimination exists in other institutions, there’s no reason to think that it wouldn’t be present in health care, said Dr. Tweedy.

Then there are challenges of high tuition costs and availability of educational loans for four years of college and four additional years of medical school. Medical education is expensive with students carrying hundreds of thousands of dollars in debt. This is a barrier for many Black students whose families cannot afford to pay out of pocket. It takes up to 10 years to produce a doctor under the current system.

“There are so many challenges to becoming a doctor,” Dr. Mayyadda Muhammad told The Final Call. “Many young Blacks may not think they can do it, that it’s not attainable for them. They don’t understand the process, or they think it’s too hard. Medical school costs a lot of money and then there’s the MCAT test to get into medical school. It can be difficult to pass. Many can’t get past that test,” she said.

“There are programs to help students pass that test because people of color have had difficulty passing it. I was at a family medicine conference recently and one of the seminars was on the need for more Black doctors. The presenters spoke about their concerns regarding the MCAT. It knocks out so many applicants and there’s nothing they can do about it. It’s a major barrier. Unfortunately, in America most patients are Black, and most doctors are not.”

Dr. Muhammad passed the MCAT by studying medicine in Cuba where she received a scholarship for a free medical school education provided by the then president of Cuba, Fidel Castro.

In 1998 hurricanes Mitch and George killed thousands and left horrific damage in Central America and the Caribbean. Cuba responded with a comprehensive, cooperative project that sent brigades of doctors, nurses and other health workers to the most affected areas. After that Fidel Castro, created the Latin American Medical School (ELAM) to train young doctors to serve in those countries. The program recruited mostly students from poor families, low-income and remote locations representing more than 100 ethnic groups. This diversity is the strength of the cultural unity of this project.

The program has expanded and now has students from 117 countries from all around the world. It has graduated more than 25,000 physicians in 84 countries.

For American students coming from poor and low-income families, Mr. Castro promised a free medical school education in exchange for returning home and serving in poor communities.

“I learned medicine and I learned it well in Cuba. Their program is more hands on. After your first two years you can do so much more hands on in Cuba if you put forth the effort by the time you graduate medical school you are doing what residents are doing. I know third year students that were delivering cesareans,” said Dr. Muhammad.

For Erin Powell going to medical school in Anguilla was just the right decision for her. She’s a student at the Saint James School of Medicine on this small Caribbean Island which only enrolls U.S. citizens or permanent residents and Canadian citizens and tuition is affordable at $6,350 per semester, according to the program.

“I was already a nurse and saw myself doing a lot of what the doctor was doing without the title or the salary, so I decided to go back to school. The program is competitive and intense. I spend 18 months here and then come back to the states for my residency. Getting into medical school in the states is hard. I know so many who try and fail,” Ms. Powell told The Final Call.

In general demand for physicians continues to grow faster than supply according to the Association of American Medical Colleges. The group tracks trends of the profession and said though physician supply is projected to increase modestly between 2017 and 2032, demand will grow more steeply.

Their website projected by 2032 a shortfall between 21,100 and 55,200 of primary care physicians; 24,800 and 65,800 nonprimary care physicians and 14,300 to 23,400 surgical specialists.

“The gap hasn’t closed much due to a combination of factors including limited educational opportunities and academic development, especially in the STEM (Science, Technology, Engineering and Mathematic) fields (and) lack of mentoring of young people to encourage them to pursue healthcare careers,” reasoned Dr. Primm.

Dr. Crawford suggests Black people must learn self-development and educate themselves on better health. “More and more people are doing more to take care of themselves and that I’m happy to see,” said Dr. Crawford.

“I go into the health food stores and see more Black people now and a lot of it in our community we have to credit the Most Honorable Elijah Muhammad,” said Dr. Crawford referring to the Nation of Islam patriarch who taught his followers the importance of eating a proper diet in his books, “How To Eat To Live.”

The answer to getting more Black doctors is mentorship said, Dr. Muhammad. “Young people need to see more examples of Black doctors to see that they can do it. It’s difficult to be what you can’t see,” she said.

But until those numbers start to increase Black people still face challenges of finding a Black doctor.

The Final Call