Over ten years ago, the Department of Health and Human Services pledged to achieve “health equity, eliminate disparities, and improve the health of all groups” as a goal for its Healthy People 2020 agenda. As you can imagine, this hasn’t happened.
The recent resurgence of the Black Lives Matter movement and growing awareness of racial inequality in America has made it clear that racism and bias extend even to medicine. Doctors are supposed to be objective scientists that heal people, but humans are imperfect, and this can affect patients’ experiences with clinical care. It has been proven time and again that ethnic and racial minorities are less likely to receive preventative health services and often receive lower-quality care. Black Americans experience some of the worst health outcomes of any racial group, including the highest maternal/infant mortality rates, and implicit bias can even affect how seriously doctors take the physical pain of POC patients. Thankfully, there’s a lot of research and ample resources giving suggestions for how to both analyze and address this issue. Check it out– it’ll make you a more effective and caring doctor.
But for this article, we wanted to analyze racial disparities from the other side. Instead of analyzing patient experiences with racial bias, we can ask: How does racial bias and prejudice affect doctors and aspiring medical professionals? And how can this have downstream consequences on the quality of medical care for minorities? This post focuses on considering these questions through the lens of premeds and medical students.
Representation is Important in Medicine
The CDC itself has said on more than one occasion that clinician diversity is crucial to administering equal care to all patients. Diverse public health and healthcare workforces can increase access to and quality of care for many vulnerable populations. Liliana Garces, who is an education researcher at the University of Texas at Austin, claims that racial diversity “leads to not just more doctors, but also better-prepared doctors who go into communities of color.”
Lack of representation also causes a cyclic effect, or negative feedback loop, where fewer doctors of color mean that there will be fewer premeds of color— one BIPOC UCLA female pointed out that most of her peers (who were predominantly white) grew up around people and doctors that looked like them. Being black, she felt disconnected from the faculty of her school, and she felt like more of a statistic than a person. To find a role model that looked like her, she had to seek out an organization for black women physicians. This was one of the first truly supportive professional environments she found. She also cited that many freshman advisors at the school actually recommended “easier” classes to BIPOC students.
It All Starts in Med School
Garces also posits that a possible strategy for increasing diversity within medical schools is to decrease the importance of standardized tests during the admissions process. An analysis of examinees’ average MCAT scores shows that, similar to other standardized tests like the SAT/ACT, Black and Latino test-takers scored lower than their white peers. The analysis also identified parents’ education and income as significant factors that contribute to this difference. Standardized tests like the MCAT allow those that benefit from structural racism to perform better simply because their upbringing was privileged— and that, of course, is no indication that less fortunate students are somehow less capable or less worthy of being doctors.
One example of a school trying to combat this is The Ross University School of Medicine in Portsmouth, Dominica. The school fosters an affirmative action program– it explicitly accepts students from underrepresented minorities with lower standardized test scores and GPAs than white applicants, and then places the students in a program that provides educational support and mentorship during the first semesters of medical school. These affirmative action programs can be taken a step further and start before medical school at the high school or undergraduate level— giving financial support to undergraduate students of color can provide early exposure to research and increase representation in STEM graduate school programs.
This is a direct way of addressing the issue, but there is also some indication that affirmative action programs can bias people against those that benefit from it, by claiming that minority students who are given a greater chance of admission because of such rules are less qualified. After the landmark 1978 case of Regents of University of California vs. Bakke was decided (which ruled that medical schools were allowed to consider race and ethnicity in admissions), a Caucasian student who was rejected sued the medical school for discrimination because his entrance scores were significantly higher than those of a number of accepted applicants. Yet the data consistently show that while black students are, on average, preferentially admitted to medical schools over academically similar white peers, they aren’t “taking spots” from “better” white candidates. A one to three-point increase on the MCAT does more to improve a white applicant’s odds of getting into medical school than eliminating affirmative action would.
Another barrier to achieving representation is simply money. Freeman Hrabowski, who is the president of the University of Maryland at Baltimore County, runs a program to financially and academically support students of color. But he notes, “Without funding, there is no serious commitment.” He hopes that government agencies can take notice of this issue. Of course, this requires voting for elected officials that prioritize STEM and diversity.
Hrabowski also hopes that these programs can specifically help advance Black men in medicine. In 1986, 57% of Black medical school graduates were men, but by 2015, that number had dropped to just 35% even though the total number of Black graduates had increased. Data from the Association of American Medical Colleges also shows that 41% of Black male applicants were accepted into medical school in 2015, which was the lowest rate of acceptance across all genders and ethnicities. The data shows that this phenomenon is specific to Black students and specifically men— Asian, Latinx, and White applicants tend to get into medical school at roughly the same, higher rate.
How To Be an Ally for Minority Premeds
You’ve probably heard this on social media already, but the best way to be an ally is to educate yourself— listen to activists, academics, doctors, researchers, organizers, and leaders of all racial backgrounds. Follow them on Twitter to hear updates. Think critically about how you get your news and how diverse your information sources are. Are you consigning yourself to an echo chamber because it’s easier than being proactive about expanding your horizons?
Know that in order to achieve true equality of healthcare, there needs to be representation and inclusion among doctors and medical professionals, and we’ve only started the battle to correct for years of injustice that has prevented qualified BIPOCs from achieving their dreams.
As a student, carefully observe BIPOC faculty members and their experiences in their field. According to Stat News, Black faculty members have often cited a lack of mentorship, barriers to promotion, and hostile work environments as factors in their attrition from academic medical centers. But don’t rely on these people to explain racial inequality for you— the same faculty are likely tired of leading diversity initiatives to explain what they face every day. If you attend a university that has an adjacent medical school, foster conversations between medical students and undergraduate premeds regarding the school’s culture and how it can be improved. Students at the Yale School of Medicine, for example, have said the school is a “visual demonstration of the school’s values… whiteness, elitism, maleness, and power.” Yet small modifications to increase representation can change the game— Brigham and Women’s Hospital in Boston, which is a teaching hospital within the Harvard Medical School system, removed paintings of its predominantly white male former department chairs from its main auditorium and dispersed them to other areas of the hospitals. This was reported to help improve a sense of belonging among the hospital’s workforce.
In addition, call out or report problematic behavior when you see or hear about it. The aforementioned UCLA student also shared that a white woman commented on her skin color and hair during a medical school interview. While intended to be a compliment, this obviously singled out and fetishized her race. How can we avoid future occurrences like this? Unconscious bias and racial diversity training for interviews could mitigate this, as well as vigilance in reporting when things go wrong. Alexis (the UCLA student) actually shared her experience on a podcast called The Premed Years, which you can check out here.
Remember that remaining “apolitical” is not an option in this climate— while it’s easy to think that medicine is objective and removed from messy politics, that’s also not true. Healthcare is inherently political.
And finally, continue the conversation even after it’s inconvenient or trendy.