Minority dental school graduates: do they serve minority communities? (original) (raw)
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How Does Racial Segregation Taint Medical Pedagogy?
AMA Journal of Ethics
Persistence of racial segregation makes equitable health care impossible for African Americans, as does the supra-geographic segregation perpetuated by enduring racial medical mythologies that remain unchallenged in health professions education. This article canvasses how these mythologies exacerbate myopia in health professions practice and education, maintain barriers, and perpetuate racial health inequity. Codifying Racial Segregation In 1870, the American Medical Association (AMA) twice excluded 1 the racially integrated delegation from Washington, DC, to the AMA's national meetings while admitting a White one. 2 Between 1846 and 1910, the AMA developed a state-based organizational structure that excluded most African American physicians even as the association shaped medical education. 2 Schools commonly rejected Black medical aspirants like James McCune Smith, who moved to Glasgow, Scotland, where he earned his medical degree in 1837, 3 and Daniel Laing, Isaac Snowden, and Martin Delaney, who were admitted to Harvard Medical School in 1850 but were expelled when White students protested. 4 African American physicians responded by founding their own societies 2,4,5 and medical schools because the relatively few Black patients admitted to White hospitals were typically pressed into service as "teaching material" and research subjects. 6 When the AMA decided to elevate medical education by creating the Council on Medical Education in 1904, it did not essay to treat the 9 million underserved African Americans in the South. 2 Instead, the AMA Council commissioned the Carnegie Foundation for the Advancement of Teaching to evaluate American medical education and produce the 1910 Flexner Report, which recommended closing all but 2 of 7 African American medical schools-Howard and Meharry. 7 Moreover, the report castigated African American physicians-already denigrated as purveyors of drugs, alcohol, and abortion 8,9-as "limited," declaring: "A well-taught negro sanitarian will be immensely useful; an essentially untrained negro wearing an M.D. degree is dangerous." 7 Five of the 7 schools closed, and the number of African American physicians plummeted, ensuring that Black patients' needs remained unmet. A lingering consequence today is that only 5% of US physicians are Black. 10 And though African American men, who have
Poor Representation of Blacks, Latinos, and Native Americans in Medicine
Family medicine, 2015
In this article, the authors discuss how various systems in medicine are limiting representation of blacks, Latinos, and Native Americans. Flat and decreasing percentages of Underrepresented Minorities in Medicine (URMM), especially in the black and Native American populations, is concerning for family medicine since members from URMM groups care for minority and underserved populations in greater numbers. Underrepresentation is not only noted in the medical community but also in our medical schools when it comes to numbers of URMM faculty. The changing definition of…
Efforts of colleges and universities to increase the enrollment of minority students also have increasingly become the focus of sharp criticism (Bowen, 1998). While empirical evidence of the impact of diversity in colleges and universities has become a core part of the debate about college admission policies, little attention has been given to rigorously assessing the scientific evidence about the likely impact of increasing the numbers of underrepresented minority physicians, especially as an intervention to improve health care for minority populations and, ultimately, to reduce health disparities in the United States. The goals of this paper are to present a brief overview of racial and ethnic disparities in health and the potential causes of these differences, primarily related to health care, and then to review the conceptual underlying bases and the evidence about the likely pathways by which increasing the diversity of physicians might decrease disparities. We focus on three hypothesized pathways. The first pathway is through the practice choices of minority physicians, which may lead to increased access to care in underserved communities. The second pathway is through improvements in quality of health care due to better physician-patient communication and greater cultural competency. The third hypothesized pathway is through improvements in the quality of medical education that may accrue to medical students as a result of increasing diversity in medical education. BACKGROUND Disparities in Health Status Across Racial and Ethnic Groups in the United States Differences in health status across racial and ethnic groups in the United States have been described for a wide array of diseases, conditions, and outcomes (NCHS, 2000). Despite overall improvements in life expectancy in the past century, African Americans still experience a lower average life expectancy at birth and higher average age-adjusted all-cause death rates than Whites. African Americans also experience higher death rates for many conditions, including coronary disease, stroke, and cancer, and infant morality rates are higher among both African-American and American Indian/Alaska Native populations than among Whites and most Hispanic subpopulations. Mexican Americans experience a higher rate of uncontrolled hypertension than white Americans. Asian and Pacific Islander Americans, African Americans, and Hispanic Americans all have an elevated incidence of tuberculosis compared with the white population. African Americans, Hispanics, and Native Americans have surpassed Whites in the incidence of HIV infection, and die at higher rates than Whites from diabetes mellitus, homicide, and unintentional injuries (NCHS, 2000). With respect to health-related quality of life, higher percentages on African Americans and Hispanics report that they are in fair or poor health as compared to Whites (NCHS, 1994).
White Coats, Black Specialists? Racial Divides in the Medical Profession
This study assesses whether racialized patterns of medical specialization persist among a recent cohort of U.S. medical students. Data from the Association of American Medical College's 2004 Graduation Questionnaire (GQ), an annual survey of all graduating U.S. medical students, are employed to explore how factors internal and external to medical education influence specialization patterns among black and white medical school graduates. The data suggest that a degree of racial division in medical specialization endures, but that division does not neatly map onto specialty prestige and is deeply gendered. Black graduates are more likely to enter high-prestige surgical residency programs than their white colleagues, but this finding holds only for male medical school graduates. That the surgery effect emerges only with the inclusion of social factors inside and outside medicine suggests these have distinct impact across race. We conclude by suggesting directions for future studies of stratification in medicine.
African American Physicians and Organized Medicine, 1846-1968
JAMA, 2008
Like the nation as a whole, organized medicine in the United States carries a legacy of racial bias and segregation that should be understood and acknowledged. For more than 100 years, many state and local medical societies openly discriminated against black physicians, barring them from membership and from professional support and advancement. The American Medical Association was early and persistent in countenancing this racial segregation. Several key historical episodes demonstrate that many of the decisions and practices that established and maintained medical professional segregation were challenged by black and white physicians, both within and outside organized medicine. The effects of this history have been far reaching for the medical profession and, in particular, the legacy of segregation, bias, and exclusion continues to adversely affect African American physicians and the patients they serve.
In the minority: black physicians in residency and their experiences
Journal of the National Medical Association, 2006
Objective: To describe black residents' perceptions of the impact of race on medical training. Materials and methods: Open-ended interviews were conducted of black physicians in postgraduate year 22 who had graduated from U.S. medical schools and were enrolled in residency programs at one medical school. Using Grounded Theory tenets of qualitative research, data was culled for common themes through repeated readings; later, participants commented on themes from earlier interviews. Results: Of 19 participants 10 were male, distributed evenly among medical and surgical fields. Four major themes emerged from the narratives: discrimination, differing expectations, social isolation and consequences. Participants' sense of being a highly visible minority permeated each theme. Overt discrimination was rare. Participants perceived blacks to be punished more harshly for the same transgression and expected to perform at lower levels than white counterparts. Participants' suspicion of racism as a motivation for individual and institutional behaviors was tempered by self-doubt. Social isolation from participants' white colleagues contrasted with connections experienced with black physicians, support staff and patients, and participants strongly desired black mentors. Consequences of these experiences varied greatly. Conclusions: Black physicians face complex social and emotional challenges during postgraduate training. Creating supportive networks and raising awareness of these issues may improve training experiences for black physicians.
Barriers to Diversity: Why Do So Few African American Men Go into Medicine?
Annals of Behavioral Science and Medical Education, 2014
Despite efforts to increase diversity in the US physician workforce, African American men comprise only 2% of the student population, which is the lowest percentage of medical school matriculants of all major racial groups. These data confirm the disparity in educational attainment that begins early in school experiences with low rates of high school and college graduation and lack of entry into science-related fields or graduate studies such as medicine. Research suggests that this disparity has important negative consequences in the areas of educational and economic opportunities for these men, for patient care, for research into topics of importance to the African American community, and for the cultural competence of the medical community as a whole. Looking through the dual lenses of Bronfenbrenner's Ecological Model and Critical Race Theory, this paper elucidates the complex causes of this disparity and presents potential solutions.