Who is responsible for increasing the number of Black men (and women) in medicine?

As a public school teacher for over 20 years I know that seeds of greatness can be planted early. Words are powerful and can be the seeds. Believing in a kid can be transformational. Events like the BMWC conference where young and old are invited (becoming visible) can plant the seed. Then the actions in our schools and in communities must support the seed. YES, mentors in college and med school. Before they get out of middle school each young person of color should have a mentor from the community. Our communities (schools, public libraries, houses of faith, community centers) can work together to continue to promote greatness.

I believe it is up to every single person to help promote and support all races to enter the medical field. I believe that medical professionals should all advocate for diversity and equality and be members of outreach programs as part of the licensure requirements.

I'm with doctor Daniel on this. I believe us being black in the African American community we have to not only encourage youth to be doctors but we have to assist and put our youth in the right positions to succeed. We have to motivate, teach, bring awareness into the community about the importance of medicine and the importance of having representation. We can't wait and depend on the system to change or others outside the community to help us. We have to help each other first and I believe it starts in the home and what our parents teach us and what we teach our children and youth.

I love the provocative nature of this question. Of course the system of higher education is filled with gatekeepers, and it is the gatekeepers following the instructions of the owners of the castle for the safety of those who inhabit its grounds that have some responsibility. But the entirety of US medical education is filled with gates and standardized exams that justify the use of other gates and exams. After all, standardized test scores tend to be a good predictor of other standardized tests... the MCAT is valid because it predicts Step 1. The MMI predicts OSCE/Step 2. Every measurement in admissions has to have a measure of predictive validity, and that's a challenge to try to completely purge standardized exams or measurable professional activities from all of education. We know the limitations, but we need the predictive validity.

Over the past decade, many involved in increasing diversity have been stymied by a number of different issues from the lack of educationally qualified black students to a lack of funding to retain students within our programs. I support the contention that mentoring is absolutely essential because seeing someone achieve is crucial to believing one can make it, even knowing the odds to get there. The problem though is many of our gatekeeping screening processes fail to credit strong mentoring, which is a key component of success for anyone pursuing a professional career, not just medicine or health care professions. We ask for letters of recommendation from professors and managers, but we don't read for mentoring within the letters themselves. In some cases, we limit our consideration of experiences to fall only after high school has been completed. It hurts to think that the virality of that great moment with the 10-year old would never be entered as evidence should he apply to medical school in 10 years... at least not with the way we establish criteria for materials for an application. We do have mentor networks, but these are hardly funded or competing with other programs. So while we say it is important to pump the pipeline at the early stages as early as 3rd grade, mentioning involvement at so young an age throughout college may not get all the proper credit that it should in some schools' admissions committees.

Implicit bias is only one part of any solution. What do we do with the biases we have and activity mitigate them when it comes to the applications we read, the patients we talk to, the peers we promote? Having the biases does not mean we truly reflect on the consequences of the biases we have in our collective decision-making. A decade of implicit bias has not made a difference in seeing more underrepresented (especially Black/African-American men) applicants become successful. But the problem then lies with the conundrum: to prevent negative triggers regarding black male stereotypes, we emasculate and de-identify any mention of race or gender in our activities for the sake of reducing stereotype threat and negative implicit bias... I don't know if that is what is intended.

You do need people in the rooms where decisions are made (the rooms where it happens), and you need to make sure the spaces are safe enough that people can voice questions or objections. But it is always tough when prestige and high metrics are associated with successful accreditation visits (US News ratings notwithstanding, this happens even in programs that do not have their reputation rely on US News). Black men are not appearing in certain health care occupations... they aren't anywhere in a high proportion as professionals with decision-making authority it appears.

Postbac programs are great options but are also expensive. Having students have to spend additional years in school paying graduate-level tuition is an enormous challenge since they also will need to think about how much more debt to take on once in medical school. The one program I know that actually offers a stipend for underrepresented individuals dedicated to pursue a career in medicine only has enough funding for about a dozen people every year, and unfortunately not all 15 get into the school to which there is an intended linkage. Many other programs I know about disappeared, much like the 5 HBCU medical schools after the Flexner report (noting the AAMC Flexner award is no longer named for Flexner because of his racist views). The issue of debt is significant for all medical students and is thought to guide people to choose their specialties (which we won't even want to go how that system is set up), and minority physicians tend to get into specialties that are not the high-paying spots.

In the end, one cannot be held responsible without a commitment to measuring data properly and making bold, long-term financial commitments to make changes necessary. Better education of the circumstances that are barriers to those who have the ability to decide is necessary but should also cover the entirety of academia with appropriate rewards and accountability therein. Presidents, chancellors, and deans of schools should be subject to a cut in pay or a demotion for not meeting expected diversity and retention goals, and accreditation penalties should be harsher. But a profession is about peers monitoring others, and I just cannot see anyone in a peer-reviewed process do anything to punish their own knowing they may have their own complicity to wrestle with.

Write a comment

Plain text

  • No HTML tags allowed.
  • Lines and paragraphs break automatically.
  • Web page addresses and email addresses turn into links automatically.