The Shortage of Black Physicians is a Legacy of Racism and Class-Based Discrimination

Photograph by Nathaniel St. Clair

“Nobody wants to be an emergency at Harlem Hospital but if the Negro surgeon is visiting, pride cuts down the pain.”  Author Toni Morrison was alluding to the scarcity of Black physicians in 1926 (Jazz, 1992). Kareem Abdul-Jabbar took similar note almost 100 years later.

The basketball legend pointed out that, “Black babies survive more often under the care of Black doctors than white …  Black people have a reasonable trust issue with the medical profession dating back to the Tuskegee Experiment.” He explained that U.S. government physicians, studying the natural progression of syphilis, administered inert material to Black men rather than actually treat them.

He regards U.S. healthcare as a “more insidious and damaging threat to the health, lives, and economic well-being of Black Americans” than police brutality. He indicates that, “Black men have the lowest life expectancy of any demographic group, living an average of 4.5 years less than white men.”

The number of Black physicians is far less than the proportion of Blacks in the U.S. population.  In 2018,  56.2 % of physicians were white,17.1% Asian, 5.8% Hispanic, and 5.0% Black.  White people that year made up 76% of the population; black people, 13%.

Black people’s health suffers. “Racial and ethnic minority physicians are more likely to practice primary care and serve in underserved communities,” says one investigator. Studies show that Black men trust Black doctors more than they do white doctors; communication is more open. According to one overview, preventative care provided by Black physicians resulted in “a 19% reduction in the black-white male gap in cardiovascular mortality and an 8% decline in the black-white male life expectancy gap.”

Black women die at higher rates than white women from various types of cancer and from complications of pregnancy and childbirth. One factor may be their lack of trust in their physicians, especially white physicians. Another may be that not enough Black doctors are studying medicine.

Of all medical students in the early 1960s, only 2% were Blacks; 75% of them attended all-Black Howard and Meharry medical colleges. Then began the era of affirmative action. Theoretically, affirmative action would allow population groups subjected to discrimination to gain equal access to education and employment. Black youths wanting to be doctors would benefit.

Applied to the process of deciding who should enter medical schools, affirmative action had results.  By 1969 Blacks were 2.7%  of all first-year medical students. The rates varied subsequently from 6.3% in 1974 to 5.7% in 1980, 8.0% in 1996, 7.2% in 2001, and 7.1% in 2018.

Medical schools were accepting Black applicants almost as readily as they did whites. Data from the American Association of Medical Colleges (AAMC) show 43.8% of the Black applicants being admitted in 1973, 37.6% in 1977, 50.3% in 1989, and 42.6% in 2001. Acceptance rates for whites were 35.8% in 1974, 67% in 1985, 38.5% in 1995, and 51.7% in 2001. The 2019 rates for Blacks and whites were 38% and 45%, respectively.

More Blacks were studying medicine, but not enough to meet affirmative action’s primary goal, which was to match the proportion of Black doctors to the share of Blacks in the general population. Regulation of the admissions process was supposed to have accomplished that.

Entering students, both Black and white, had benefited from favorable family circumstances. They very likely had received encouragement for academic achievement. Their families had provided them with both educational and financial support as they prepared themselves for medical school.

Financial capabilities, of course, are crucial to meet the well-documented high costs of medical education in the United States. Scholarships are in short supply.

Most Black young people don’t grow up in families able to offer the educational and financial resources required for all kinds of advanced education. Any long-term aspirations may be short-circuited at an early stage. Money is short, and even short-term planning is difficult.

Census Bureau data for 10 years from 2010 on show a yearly average of 36.5% Black children living in poverty, compared with 12.4% of all white children. Public schools that Black children attend are often segregated (still), crowded, and inadequate. Their parents may work at low-pay jobs, if they can find work. Homelessness is common. Parents – sometimes “essential workers” – work irregular hours and are often away from their children. Lives are precarious.

These children and their families would have had to move mountains for young people in their circumstances to gain a medical education. They represent a different Black population from the population group that does send Black students to medical schools.

Data provided the present writer by the AAMC in 2002 is revealing. Parents of all U. S. first-year medical students between 1990 and 2000 provided the AAMC with information. They numbered 11,515 mothers and 11,203 fathers of Black students and 110,587 mothers and 110,315 fathers of white students.

The median yearly income for Black families was $49,000; for all Black families, $29,114. Half the fathers of the Black medical students had completed college; 25% of both fathers and mothers had obtained master’s degree. Half the mothers had attended college. Only 13% of all Black men and 13.6% of all Black women had completed college.

A divide stands between those Black students who have been able to study medicine and the unprepared group of young people who never made the attempt. The two groups are divided by social class. Being a doctor is not in the cards for the great majority of Black working-class children. That’s true also, it must be added, for white young people of working-class origin.

Public health experts Magnus and Mick argued convincingly in 2001 that affirmative action was not equipped to target social and economic discrimination. And so, the vast majority of working-class Black young people are still unable to attend medical school. However, to imagine that affirmative action might have been programed to allow them to attend would be wishful thinking. What’s required, it seems here, is overhaul of an unjust, discriminatory society.

Meanwhile, more Black women are studying medicine than Black men.  In 2018, 60.8% of entering Black medical students were female. Male and female white students were divided more or less equally. What accounts for the disparity? Is it a problem?

At issue is another imbalance, also with adverse consequences.  Kareem Abdul-Jabbarmentions both Black people’s diminished trust in white physicians and a shorter- life span for Black men than for white men. To the extent that Black men bestow more trust in the male doctors caring for them than they do in female doctors, then surely, it’s a problem.

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