Racism in medicine: Have times really changed that much?

I remember one very distinct time in my medical training when I encountered racism.

I was working in the ER as an attending physician when I walked into a room to speak with a young female White patient with severe abdominal pain. After reviewing her scans, I knew this was a surgical case, and immediately consulted with the general surgery team.

My co-worker, who was on call for general surgery, walked into the room wearing scrubs. Before I could introduce him to my patient, she immediately asked him, “Are you here to transport me to the operating room?”

“No, miss,” he responded. "I am the general surgeon on your case. It’s a pleasure to meet you."

He was a young Black surgeon who was only a couple of years out of residency like myself.

Not the first time

I spoke to him about this encounter after he successfully operated on her ruptured appendix.

“This is not the first or last time someone assumed I am not a doctor because I am Black,” he told me. “I have seen patients who refuse my care because I am Black. I've treated patients with Nazi and Confederate flag tattoos.”

“You have to focus on the job, and maybe it will change their opinion, maybe not,” he said. “But in the end, you can't let that change how you treat them.”

Are we making a change? A look at the statistics

In the early 1800s, James McCune Smith was forbidden to attend medical school in the US because of the color of his skin. However, he did not give up on his dream and attended medical school in Scotland.

After graduating with a degree, he came back to the US and became the country’s first professionally trained African American physician.

Although times have changed since the early 1800s, African Americans and other minority physicians still face unique barriers in their pursuit of medical education and career opportunities.^[]

According to the 2019 Diversity in Medicine report published by the Association of American Medical Colleges, 5.8% of active physicians in 2018 identified themselves as Hispanic, and 5% identified as Black or African American.^[]

However, these proportions are an underrepresentation of the national makeup of the US, since, in 2019, Hispanics/Latinx and African Americans made up an estimated 18.3% and 13.4% of the population, respectively, according to the report.

The race gap and understanding the ‘why’

Lack of access is not just an ongoing problem for Black patients, who continue to face economic and social barriers to healthcare.^[] The gaps are evident in the medical profession itself.

And these gaps can have a real impact on the care patients receive. There are many specific root causes, such as inequities in education, household income, the judicial system, community resources, and many other factors.

Why is diversity in medicine important?

For minority patients, having a physician with the same skin color as them, who may look like them, or may have similar experiences, could give them a sense of common ground and comfort. This common ground can lower the treatment barriers based on racial bias, and allow minority patients to be treated with the same level of care as other patients.

Diversity can also improve medical students’ learning outcomes, cultural sensitivity, and interpersonal skills.

JAMA published an article showing that minority physicians were more likely to care for a vulnerable patient population.^[]

For example, African American, Hispanic, and Asian doctors were more likely to have patients on Medicaid—a program for those with limited income and resources—and patients of Hispanic physicians were more likely to be uninsured.

The study's authors concluded that “increasing the racial and ethnic diversity of the physician workforce may be key to meeting national goals to eliminate health disparities.”

Minorities entering the medical profession may want to keep these three phrases in mind:

• Find role models

• Prepare for injustice

• Advocate for yourself