The Case for Black Doctors

In virtually every field of medicine, black patients as a group fare the worst. This was one of my first and most painful lessons as a medical student nearly 20 years ago.

The statistics that made my stomach cramp back then are largely the same today: The infant mortality rate in the black population is twice that of whites. Black men are seven times more likely than white men to receive a diagnosis of H.I.V. and more than twice as likely to die of prostate cancer. Black women have nearly double the obesity rate of white women and are 40 percent more likely to die from breast cancer. Black people experience much higher rates of hypertension, diabetes and stroke. The list goes on and on.

The usual explanations for these health disparities–poverty, poor access to medical care and unhealthy lifestyle choices, to name a few–are certainly valid, but the longer I’ve practiced medicine, the more I’ve come to appreciate a factor that is less obvious: the dearth of black doctors. Only around 5 percent of practicing physicians are black, compared with more than 13 percent of Americans overall.

As a general rule, black patients are more likely to feel comfortable with black doctors. Studies have shown that they are more likely to seek them out for treatment, and to report higher satisfaction with their care. In addition, more black doctors practice in high-poverty communities of color, where physicians are relatively scarce.

As a psychiatrist, I’ve seen this up close. I’ve frequently been the only black doctor (or one of very few) in clinics with large black populations. Quite often, patients ask to see a black doctor, but the sheer volume of people seeking help prevents me from accommodating most of their requests.

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Perhaps the most compelling evidence that black patients are more likely to trust black doctors comes from the mental health field, where a patient’s relationship with his or her provider is especially important. Black people have often fared poorly in their interactions with the mental health care system. For example, they are nearly half as likely as whites to receive treatment for diagnosed mental health disorders of comparable severity. When black patients do receive treatment, it is far more likely to occur in an emergency room or psychiatric hospital than it is for whites, and less likely to be in the calmer office-based setting, where longer-term treatment can take place.

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{snip} In the 2011-12 school year, the most recent for which figures are available, there were 5,580 black students enrolled in medical school, making up about 7 percent of the medical student population, which is roughly half of the proportion of the black population in America.

Nonetheless, when viewed through the lens of history, this recent figure reflects progress: In the 1968-69 school year, 783 black students were enrolled in American medical schools, just 2.2 percent of the overall total. Race-based affirmative action programs, which began to be implemented around this time, undoubtedly played a major role in expanding the number of black students in medical school. By the late 1970s, the number of black students had increased nearly fivefold, with the proportion peaking at 8 percent in the mid-1990s.

Since that time, however, opposition toward affirmative action has grown stronger. Many states have banned race-based admission efforts at public universities, and last year, the Supreme Court ruled that this was permissible. Purely race-based affirmative action is not yet dead, but it appears to be approaching its twilight years.

Even those who are uncomfortable with affirmative action or oppose it outright should consider the potential impact of this trend when it comes to medical school. A recent study in The Journal of Higher Education found that affirmative action bans in six states led to a 17 percent reduction in the enrollment of underrepresented students of color in medical school. Policies resulting in fewer black doctors could lead to even worse health outcomes for a population that is already the least healthy.

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