Why the U.S. Needs More Black Physicians
Medicine’s race gap alienates patients and providers alike.
The woman sat up and stared as James Carter ’82 entered her hospital room. Her mouth opened, but no words came out. Finally, he asked what she was looking at. “I had no idea there were Black doctors on this campus,” she replied. Carter, a cardiologist specializing in wound care at University of Colorado Hospital, has been practicing medicine for more than three decades—but this encounter didn’t take place early in his career. It happened last year.
As the United States faces a racial reckoning, glaring inequities among medical professionals persist, with Black physicians remaining particularly scarce. In 2003, when a landmark Institute of Medicine report called for an increase in minority healthcare workers to address longstanding health disparities, Black people represented 13 percent of U.S. residents and 3.3 percent of physicians. Nearly 20 years later, Black Americans still make up 13 percent of the population—and only 5 percent of physicians. Haverford alumni working in medicine can attest that although the factors perpetuating the physician workforce gap are complex, they intersect to produce one clear-cut consequence: poorer health outcomes for Black individuals.
That patient of Carter’s? She was Black. She’d visited the emergency room twice with stroke symptoms; both times, she was discharged without a stroke diagnosis, even though she had indeed suffered a stroke.
“That would not have happened if she’d had a Black doctor,” Carter says. “There are many institutional biases that have to be dismantled. We need change.”
SAVING BLACK LIVES
It’s well documented that Black Americans suffer from higher rates of chronic conditions—diabetes, asthma, hypertension, obesity—than white Americans and are less likely to receive preventive care. Among all racial groups in the United States, Black men have the shortest life expectancies, Black women have the highest maternal mortality rates, and Black babies have the highest infant mortality rates.
The issues causing these disparities—poverty, food insecurity, violence, systemic racism, chronic stress—are compounded by the lack of diversity among physicians. Studies have shown that Black patients have better health outcomes and routinely agree to more—and more invasive— health tests and interventions when they’re seen by Black physicians.
The white-dominated field of medicine has a history of exploiting Black Americans, from the infamous “Tuskegee Study”—a 40-year government experiment that left hundreds of Black men with syphilis untreated so scientists could study the disease—to the case of Henrietta Lacks, whose cancerous cells were taken without her consent and became a mainstay of biological research. Donna Whyte-Stewart ’98, a longtime pediatric hematologist at Johns Hopkins University who now works for the U.S. Food and Drug Administration, says Black patients therefore hesitate to accept white physicians’ advice.
“I was right there at Hopkins, where we had Henrietta Lacks,” Whyte-Stewart says. “Black people still hold onto this idea that if you walk too close to the hospital, they’ll snatch you inside, and no one will ever see you again. The past is still fresh in people’s minds, and you have to cut through that in order to get them to do something for their disease, whether it’s taking a new medication or being in a clinical trial. Coming from a Black physician, this is easier for them to bear.”
Black physicians are more likely to practice in underserved communities than their white counterparts, the benefits of which are twofold for Black patients: easier access to care and a sense of comfort and familiarity, as Brandon Johnson ’04, a New York-based ophthalmologist, explains.
“Patient rapport is incredibly important. I work in Harlem and in the Bronx and am very familiar with the African American community there. There is definitely a demographic of those patients who would have a barrier to establishing a rapport with a white doctor,” Johnson says. “Black patients see me come in and they light up.”
Beyond cultural competence, Black physicians can bring distinct diagnostic skills to the exam room. Last year, emergency physician Kimberly Collins ’89 was working with a white colleague who had diagnosed a Black patient with dermatitis—but Collins identified the rash as a condition called pityriasis rosea.
“The other provider said, ‘Oh, I thought those lesions were supposed to be salmon colored,’” Collins rememtbers. “Well, on Black skin, of course, they are not going to be salmon colored. But most dermatology books show rashes of white people, so that is what providers learn.”
Equitable healthcare requires progress in the laboratory as well as in the clinic, and Black physician-researchers tend to study topics related to the health of Black communities. Ted Love ’81, CEO of Global Blood Therapeutics in San Francisco, oversaw his company’s development of a first of-its-kind oral therapy for sickle cell disease, which predominantly affects Black individuals.
“People with sickle cell disease have the most tremendous pain a human can experience, but they get little attention,” Love says. “I do think treatments would be pursued more aggressively if sickle cell disease affected more white people. Take cystic fibrosis [which primarily affects white people]—we’ve got many very innovative therapies for that. Government and pharmaceutical investment in sickle cell research lags far behind cystic fibrosis, even though sickle cell disease is three times as prevalent.”
Love says disparities in research funding and productivity fail Black patients just as acutely as clinical mistreatment. “It is common for these patients to dress up before going to the emergency room to avoid being accused of faking pain to get narcotics,” he says. “That itself is astounding, but so is the fact that, until recently, good medicines have not been developed, and the reasons why.”
Diversifying the physician workforce makes sense in a diversifying country, but is a goal more easily set than achieved. Medical school adds an enormous amount to the already-burdensome cost of an undergraduate degree, and Black students are more likely to struggle financially. Black students also face a dearth of mentors who share similar life experiences; fewer than 3 percent of U.S. medical school faculty members are Black.
These discouraging forces work against aspiring Black physicians. In 2018, medical schools admitted 21,000 students, but only 1,500 of them were Black—and only one-third of those were Black men, a demographic whose medical school matriculation rate has remained virtually unchanged since the 1970s.
Johnson, who interviewed at several Ivy League institutions, remembers the process as “daunting.”
“I barely saw any people of color interviewing along with me, and I only remember one or two people of color interviewing me,” he says.
Once enrolled, Black medical students aren’t always embraced. Recent studies found that 38 percent of minority medical students reported exclusionary treatment by both peers and professors and that faculty members evaluated minority medical students more harshly than white students.
A white professor was once so impressed with one of Donna Whyte-Stewart’s laboratory reports that he questioned whether she had actually written it herself. “I also remember walking in the hallway and a professor asking, ‘You’re still here?’—as if I should have failed out by then,” she says.
Family medicine physician Traci Trice ’01, who was “overjoyed” to have one Black professor during the classroom-based portion of medical school, still thinks about the lack of support she received after an upsetting experience on a clinical rotation.
“A patient’s husband informed my white attending he didn’t want any minorities in the room, so the attending simply told me, ‘Don’t go in there,’” she recalls. “There was no further conversation—no one at that hospital acknowledged how that might make me feel. That could still happen to any student today, and I hope our institutions would do better in taking a stand against discrimination.”
And long after their training has ended, Black physicians continue to experience a shortage of mentors as well as racism at work, often through inappropriate comments and structural biases that impede career advancement. “When I step into a patient’s room, I am often seen as everything but the doctor. Even when talking to other staff members, I’m always assumed to be the nurse or the social worker,” Whyte-Stewart says.
Cardiologist Michelle Albert ’90, a professor of medicine and director of the Center for the Study of Adversity and Cardiovascular Disease at the University of California, San Francisco, who is also president of the Association of Black Cardiologists, notes that, “A career in academic medicine as a woman of color, especially as a Black woman, is somewhat harrowing. I have had to reach out for mentors—I’ve always had to look internally at the institutions I am in as well as externally in more of a national context, because that is how you survive the system.”
James Carter now works in academic medicine but spent most of his career in private practice—a practice he departed immediately following a racist encounter in 2013.
“A group of white physicians was reviewing some of my work because they didn’t understand it,” he explains. At the end of their meeting, the group concluded that he had done a great job but said that “my quiet demeanor and my passion to always do the right thing for my patients was intimidating and maybe their [small Arizona] town wasn’t ready for my expertise. I walked out and never went back to that hospital. I just left and started over.”
FIXING A LEAKY PIPELINE
Though structural inequalities that keep Black students from pursuing careers in medicine endure, the hurdles blocking their paths can be lowered. Traci Trice says those hurdles crop up as early as elementary school; many Black communities have unreliable or no internet service, preventing children from accessing valuable STEM (science, technology, engineering, and mathematics) resources that often are not offered in their school curricula. Increasing that access is imperative.
“If a child does not have a strong educational foundation, that student is starting out way behind,” says Trice, who serves as assistant dean for Diversity and Student Diversity Programs at Thomas Jefferson University’s Sidney Kimmel Medical College. “Look at our public schools here in Philadelphia, where the majority of students are Black and Brown. They are so under-resourced and unable to meet children’s educational needs, these students are not equipped to succeed.”
Pediatrician Francine Jacobs ’94, the only Black physician in her Albuquerque, N.M., practice, says children need to be empowered to see a professional future for themselves.
“Early on, the problem is purely visual. If Black kids don’t see Black doctors, they don’t think of it as a job they can do. We need more Black doctors so kids have exposure to them and think, ‘I can do this, too,’ ” she says.
Raised in Jamaica until she was 8, Jacobs believes growing up in a country with a majority Black population helped instill the confidence she needed to dream big. “In the Caribbean, all you see are Black people, everywhere, doing everything—so I felt I could be whatever I wanted, which might have been different if I were born in the U.S. After we moved to Queens [New York], I didn’t hear a lot of Black kids talking about being a doctor,” she says. “I actually picked my high school because it had a pre-med program, which was amazing—but kids need encouragement much earlier than high school.”
Formal minority pipeline programs are rare at the grade-school level but have proved successful in undergraduate institutions, particularly at historically Black colleges and universities. At Sidney Kimmel Medical College, Trice founded and directs the Summer Training and Enrichment Program for Underrepresented Persons in Medicine, which prepares minority undergraduate students for medical school application and matriculation. Twenty percent of participants have enrolled in medical school since the program’s inception in 2015.
“One thing we work on is how to finance their education, but money is always still an issue. The average debt upon med school graduation is close to $200,000, and that’s med school alone, not including undergrad or MCAT fees or the price of traveling for interviews. Cost is not the only deterrent for underrepresented students, but it’s a big one,” Trice says.
Across higher education, about 70 percent of Black students who drop out cite debt as the reason. Expanding financial aid for Black students during undergraduate school and beyond would go a long way, as would reducing exam fees or establishing programs through which colleges and medical schools would contribute to them. Some physicians are calling for schools to de-emphasize or even eliminate standardized testing altogether.
“When we think of a good physician, we don’t think about MCAT scores,” Carter says. “So why do we emphasize them? Because that is a good way to benefit one particular part of society. Any test someone could pay money to study for in order to prove they are better than another person, we need to get rid of. We have to redefine what makes a physician qualified: empathy, purpose, resiliency, communication.”
Michelle Albert, who is in her first year as UC San Francisco School of Medicine’s associate dean of admissions, agrees that good grades do not promise good bedside manner.
“There is no one element that is most important—we look at many different experiences and attributes,” she says. “Creating a workforce that will lead health equity efforts requires a holistic approach to admissions.
“In my own medical school class, there was only one other Black student. That is part of why I’m involved in admissions now. I want—I need—to be part of the process of improving the numbers of those who are underrepresented in medicine.”
For medical school students and faculty of all backgrounds, mentoring is essential for retention and advancement; some institutions incentivize faculty for their mentorship efforts. Psychiatrist Derek Tate ’92 cites mentorship as the make-or-break factor for surviving medical school.
“Without consistent mentoring, Black students often don’t have any existing template to work from. A lot of us didn’t have a relative or anyone else close to us to tell us what we needed to do at every turn in the road,” Tate says. “You may have well-meaning family behind you, but they can’t understand what medical school is really like, how intense the workload can be, and how to adequately support you. One would hope that other Black people ahead of you would be there to do that and help you by keeping it real. To survive medical school, you don’t need cheerleaders—you need a fairy godmother or godfather.”
Kimberly Collins found one of those “fairy godmothers” right at Haverford: the late Slavica Matacic, a professor of biology at the College for 35 years.
“She took it on to support students of color who wanted to go to medical school,” Collins says. “We need more people like her in colleges. She was a real advocate, someone who encouraged us and answered our questions and helped us with applications. This was a really big deal, and I think more Black people would consider medicine if they had someone like her.”
THE COMMON GOOD
To ensure culturally competent care, a physician workforce should mirror the population it serves. But that’s not the case in the United States—and the lack of diversity among physicians can mean the difference between life and death for Black patients.
As Tate notes, that’s not to say Black patients should receive care only from Black physicians: “Cultural connections matter, but if you are a skilled, empathic clinician, you can connect with anyone. It takes a willingness to really ally with the patient and show that you are in it with them and want to understand their personal and emotional experience.”
Still, Trice says, reducing bias in healthcare requires fostering a more diverse medical community—and providing more educational, financial, and mentorship resources for Black students can help make that happen.
“Medical students and physicians both benefit from diverse colleagues who can share their experiences and also introduce them to new ones. Diversity increases physicians’ level of empathy toward each other and toward patients from backgrounds different from their own,” she says. “We need more Black physicians because the health of the population depends on it.”
"THE LATEST MIRROR OF INEQUALITY "
For evidence that greater access to Black physicians would benefit Black communities, one need look no further than the COVID-19 pandemic.
The coronavirus is infecting Black Americans at a rate three times that of white Americans—and killing them twice as often. Multiple studies have shown that clinician bias influences the care Black patients receive; one found that those with COVID symptoms were six times less likely to receive testing and treatment in comparison to white patients.
Gregory Patrick ’72, the only pulmonologist practicing in Sewickley, Pa., was approaching retirement when the pandemic struck—but he couldn’t walk away. In addition to taking shifts in his hospital’s intensive care unit, he embarked on an educational campaign geared toward Black communities through the local affiliate of the National Medical Association, which represents African-American physicians and their patents.
“There is so much bad information out there about COVID—minority communities need someone they trust to answer their questions and help them stay safe,” says Patrick, who has hosted webinars, Zoom meetings, and Facebook chats for Black audiences.
“Members of the Black community are more likely to have jobs that can’t be done from home,” he says. “They are more likely to have multigenerational households and smaller spaces that make it impossible to socially distance. They have to take public transportation because they can’t afford a car. Their health insurance has so many deductibles, they have to be careful how often they go to the doctor.
“There is this idea among white people, even among white doctors, that Black and Brown people are dying more with COVID because it’s our fault. But really, this is just the latest mirror of inequality.”
BEARING THE BURDEN
Maternal health is widely regarded as an indicator of a population’s overall health. In the United States, Black women are three to four times more likely to die from pregnancy-related causes than white women.
Their babies’ lives are at greater risk, too—but that risk drops when Black physicians oversee their care. A study published in September 2020 reported that Black newborns are three times more likely than white newborns to die in the hospital when their doctors are white. When Black infants were looked after by Black doctors, however, their mortality rate was cut in half.
New York obstetrician/gynecologist Nwamaka Ugokwe ’00 acknowledges that racial bias likely contributes to this trend.
“Systemic racism plays a big part in health disparities,” Ugokwe says. “I work in one of the most underserved areas in Brooklyn—almost all of my patients are Black or Brown. Our neighborhood sees a lack of prenatal care and a lot of preterm births and teen pregnancies. If our hospital were not there, people in this area would have a huge issue getting healthcare at all.”
Ugokwe says the “relatability factor” of having a Black physician—especially a Black OB-GYN—can improve the health of an entire community of women.
“A woman who goes to an OB-GYN she can see herself in will then recommend that OB-GYN to her mother, her sister, her aunt,” she says. “The connection really helps us overcome barriers and meet the needs of women who have been overlooked.”