WebMD Magazine Special Series: Social Justice
The rise of the Black Lives Matter social justice movement throughout 2020 caused quite an uproar in America and beyond. Protests and demonstrations about police misconduct led to even deeper discussions about the institutional racism and the lack of diversity in various industries, while the global pandemic magnified deep inequities within various levels of this country’s health care system. It was a clear reminder that certain lives are not equitable to others. In the midst of it all, an issue, which has been ever-present within the Black community, was brought to the forefront: Where are all the Black doctors?
Creating Programs in Medicine for Black Students
Since schools in the Black community are still playing catch-up to the STEM (science, technology, engineering, and math) education emphasis that gained steam a decade ago, they are not properly able to support students going into the field of medicine. Black or African American applicants constituted only 8.4% of the U.S. medical school applicant pool compared with 46.8% of white applicants, according to the report “Diversity In Medicine: Fact and Figures 2019” from the Association of American Medical Colleges (AAMC) and the American Medical Association’s (AMA). To see a substantial change, David Acosta, MD, the AAMC’s chief diversity and inclusion officer, says the pathway to becoming a doctor starts by creating a pipeline of programs that specifically encourage and prepare underserved Black students to see medicine as a tangible and viable career option.
“We found that when you look at the growth of the applicant pool of African Americans going to medical school, it only grew by about 1.2% over the last 30 years,” Acosta says of a study conducted by the AAMC and the National Medical Association. “When you look at the initial numbers and where they are today, you’ll see that we haven’t really budged very much.”
Looking past the data, Acosta admits there is one mighty force at hand that has prevented African American students from applying to medical school and making the nearly decadelong commitment to their education.
“It really comes down to structural racism—a racism that has been embedded into our educational system, but also society in general. We’re at a wonderful space and time in which we’re finally beginning to add more voices to call out those subtle manifestations of structural racism and how they have excluded many students and that self-preservation model to protect the dominate majority group,” Acosta says.
“It really comes down to structural racism—a racism that has been embedded into our educational system, but also society in general.”
–David Acosta, MD
Every year, about 21,000 students are admitted into 154 medical schools in the United States. Black men only make up about 254 of that entering class. Acosta says these numbers are downright “atrocious” and the reason is a racist construct that feeds its way into a dysfunctional educational system that starts at kindergarten and can manifest itself all the way into residency and beyond. Most Black medical students today, especially those under 30 years old, have had to support themselves mentally, financially, and emotionally, creating their own path with minimal mentors.
“Public perceptions, stereotypes, and biased images that society has about Black males, the low expectations of them, the lack of support from family and friends to pursue medicine because it’s kind of unreachable, and the lack of role models or mentors that have achieved that,” are some of the roadblocks that exist for Black medical students, Acosta says. “It’s like if you don’t see it, then it can’t happen.”
Dr. Russell Ledet speaks at a Black Lives Matter protest at Tulane University on June 7, 2020.
Photos courtesy of Tulane University
While Ledet’s story is exceptional, everyone isn’t afforded this same path. Many Black students have limited knowledge about what it takes to become a physician—the tests, the time, the money—and not every college or university is equipped with faculty to properly advise them on how to get started. The Association of Black Women Physicians is just one group coming to the rescue. The organization was established in 1982 on the ideals of service, with mentorships, scholarships, and patient education.
They are definitely doing something right. The number of Black medical students studying to be doctors are increasingly Black women. According to a report from the AAMC, the number of Black women who enrolled in U.S. medical schools for the 2018-2019 academic year was 936 compared with 604 Black males who enrolled. In this same school year, however, 5,338 white women and 5,442 white males enrolled. There is clearly more work to be done.
President Sylvia Gates Carlisle, MD, MBA, ended her tenure in December 2020, but is proud of what the Association of Black Women Physicians is doing to increase the number of Black doctors in the country.
“We have a sister-to-sister mentorship program where every other month, we have premed, medical students, and residents get together with practicing physicians around coaching activities like prepping for interviews. Some of it is just creating a safe place where people can say their truth,” Gates Carlisle says. “And, we have a scholarship program and we’re very proud that we’ve been able to raise three-quarters of a million dollars over our history. By definition, Black women physicians, there’s not a whole lot of us and so we’re very proud that we’ve helped some of our past scholarship recipients become practicing physicians.”
The Financial Barriers
The cost of applying to medical school can be an expensive and heavy burden to anyone who is also leaving undergraduate school under a mountain of debt. According to the AAMC’s 2019 “Medical Student Education: Debt, Costs, and Loan Repayment Fact Card,” the average educational debt for those who are already carrying debt into medical school is nearly $202,000. It can take a physician anywhere between 3 and 17 years to pay off those loans with interest.
Besides the cost of school itself, students also need to consider the charges associated with the application process. This includes the application fee, which is approximately $170 per school and the registration fee for the Medical College Admission Test, which is $320. Factor in additional travel and accommodation expenses if you actually want to visit the school before deciding to attend. Students must remember to multiply this by whatever number of schools to which they choose to apply.
And while there are financial assistance programs that can recommend scholarships, grants, and low-interest loans, medical school students are encouraged to start paying off schooling while they are still in school. In some cases, schools may even defer admittance until an applicant's credit history can be cleared or repaired. These additional financial barriers can deter some Black students from entering medicine altogether. Money determines a lot and it’s one of the reasons Ledet uses his platform to assist those who aren’t as fortunate as he is.
"More Black doctors will mean more Black lives saved, and fewer health problems that limit economic opportunity.”
In December 2019, Ledet was inspired to help others cope with similar challenges to attending medical school after inviting the other 14 Black students at Tulane University School of Medicine to visit the slave quarters at the Whitney Plantation in Edgard, LA. It’s the only museum in the state to focus primarily on the lives of enslaved people. While there, the group decided to take a series of photos that went viral and brought more attention to the underrepresentation of African Americans as medical professionals. It was the birth of The 15 White Coats (the15whitecoats.org), a nonprofit with a mission of inspiring future leaders in the medical field by establishing an ongoing scholarship and mentorship program.
“I came up with the idea to go and wear our white coats and illustrate to the world how far our people have come in spite of systems that were put in place to make sure that we never don a white coat,” says Ledet, president and manager of The 15 White Coats. “I knew in that moment that this was going to be a big deal. Now, we use the money we get from the photo to help other Black people get into medical school. People are going to learn from it, they are going to learn from looking at this photo. You get to see these Black bodies in front of a system that was put in place to make sure that those Black bodies never existed. It’s a hard thing for people to take, but there is a resilience there and that is why our moniker is ‘Resilience Is In Our DNA®’.”
Grassroots organizations like the Association of Black Women Physicians and The 15 White Coats are doing their part and making significant inroads, but one might argue that systemic racism can only be surmounted by an equally formidable opponent. In September 2020, former New York City mayor and presidential candidate Michael Bloomberg through his Bloomberg Philanthropies announced a $100 million donation over the next 4 years for students attending four historically Black medical schools: Morehouse School of Medicine in Atlanta, Charles R. Drew University of Medicine and Science in Los Angeles, Howard University College of Medicine in Washington, DC, and Meharry Medical College in Nashville.
“More Black doctors will mean more Black lives saved, and fewer health problems that limit economic opportunity,” Bloomberg said in a statement. It’s just the first step of many he hopes will go toward leveling the playing field. Now, students at these institutions will receive enough money to ensure minimal loans and allow them to focus on their studies instead of their bank account. This immense gift doesn’t fix the problems of microaggressions that Black doctors say still exist within most medical schools, residency programs, and patient care. Nonetheless, this funding and what it allows is a peek into what is hoped to be a better future.
“Kids on both sides of the coin need to have a better understanding that it is possible for you to be Black and don a white coat,” Ledet says. “The white kids need to think, ‘Oh yeah, my Black friends can be a doctor just like I can be a doctor.’ And the Black kids need to think, ‘I can be a doctor just like my friend over there.’”
More in This Series
Mental illness has long been cloaked in shame in the Black community. Experts talk about the misconceptions that have prevented this group of people from getting the help they need.