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Picture this: Two dozen men gather in a classroom in rural south Georgia to get their hair shaped up and talk about life. The barbers are the main attraction, but the get-together is organized by medical students – specifically Black medical students – as a way to reach people who might not otherwise see a doctor. They check blood pressure amid the buzz of electric clippers. No surprise, nearly everyone in the room is hypertensive.
Evan Curry, a second-year student of osteopathic medicine in Moultrie, Georgia, and a member of Brothers in Medicine – the group that organized the “Barbershop Talk” and blood-pressure check – is a great embodiment of the new generation’s commitment to making an impact. “We talked about emotional health. We talked about fatherhood. We talked about getting Black men to come into the doctor’s office,” Curry said to a newspaper in the area.
This real-life scenario illustrates a broader challenge within America’s health care system: We need more Black doctors. Georgia is in the heart of the “Stroke Belt,” where stroke mortality rates are highest in the nation. Although, we might have expected similar results at one of our health care centers in Philadelphia, where we serve the medical needs of the local community through quality health services, which has comparable stroke mortality and significantly elevated hypertension rates among Black residents.
However, health disparities transcend geography and socioeconomic status. Earlier this year, Olympic gold medalist Tori Bowie tragically passed away at only 32 years old due to complications from pregnancy. Tori’s death is not an isolated occurrence, and it would be a disservice if we treated it as such. Black women have the highest maternal mortality rate of any demographic in the U.S. and are three times more likely to die from pregnancy complications compared to white women.
Across nearly every metric – from hypertension and stroke deaths to pregnancy complications and maternal mortality – Black patients have poorer outcomes compared to their white peers. Why?
There is no single answer, but the shortage of Black physicians is almost certainly a contributing factor. Only 5.7% of U.S. doctors are Black, while the overall Black population in the U.S. is at least 13.6%. Hispanic/Latino and Indigenous doctors are also chronically underrepresented. In fact, only 6.9% of physicians in this country are Hispanic despite making up 19.1% of the country, and even smaller than the Black doctor population is Indigenous doctors at 0.4% vs. 1.3% of the U.S. population.
Professional representation is important in its own right, but the lack of diversity in medicine also has drastic implications for patient care and population health. For example, 1 in 5 Black Americans say they have experienced discrimination in health care settings, and 70% believe that our health care system treats people differently based on race and ethnicity.
Health disparities are complex, involving multitudes of public policy and socio-environmental factors. There is no single (or simple) solution. But there are steps we can take in medical education to support positive outcomes.
First, we must fight discrimination and build understanding across groups throughout the health care industry. Clinicians must also be culturally competent in our practice and mindful of implicit biases – lest we inadvertently contribute to the problem. It’s unfair to suggest that Black doctors and other BIPOC providers must solve racism and racial disparities alone.
For higher education, we must encourage underrepresented students to begin exploring medical careers even before college and ensure medical school applicants from disadvantaged backgrounds have a fair shot in the admissions process. By engaging early and throughout the educational journey, we can help students gain experience and build strong application packages. And then, through truly holistic review of applicants, we can see beyond test scores and admit intelligent, empathetic students who embrace our mission. After all, mastering the MCAT can require time and resources that aren’t equally available to all students, and even the American Medical Association acknowledges that excellent test performance “doesn’t mean you’ll become a great, or even a good, doctor.”
Further, we need programs to support underrepresented students once they are enrolled in medical school or other advanced health education programs. Black students and those from marginalized backgrounds may be two to three times more likely to drop out of medical school on account of financial constraints and under-resourced backgrounds, and even as a result of bias or lack of diversity in the field. But this is preventable with smart interventions, supportive learning environments and diverse faculty to act as mentors.
Although the challenge is daunting and the stakes are high, there are reasons to be hopeful.
Medical students generally cite a desire to help as a top motivator in their decision to study medicine, and internal data shows more students citing our mission – caring for the whole person and making a commitment to diverse communities – as a primary factor in their school selection.
The health care system needs more of this – more empathy and also more diversity. We all stand to benefit.
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