The disproportionate impact of COVID-19 on Black people, coupled with the harrowing effects of police brutality, has once again laid bare institutional racism in America. This, along with growing support for the Black Lives Matter movement, necessitates that we work to eliminate racism in every space. In medicine, structural and social determinants of health in the Black community and gross injustices in health policy have produced inequities that are woven into the fabric of our society.
As members of the medical community — students, clinicians and educators — we must challenge this reality to fully honor the Hippocratic oath and begin to deliver on the promise of liberty and justice for all. To begin the multiplex work of confronting racism against Black people in our health care system, we must shore up the Black physician workforce, meaningfully address social determinants of health, close empathy gaps toward Black patients and recover the Black community’s trust in medical institutions.
How to reform
Bolstering medical and research fields with Black leaders is a pivotal first step in improving Black health disparities. Systemic adversities that accompany being Black in America (toxified water, the biologization of race, a lack of health coverage, insufficient health literacy, and lower-income and wealth) contribute to worse health outcomes.
External forces have an equal and internal reaction: Black patients treated by Black doctors are more likely to receive subsequent treatment, highlighting the role of race in access to optimal care. If we can activate an expansive network of Black health care leaders and pay health disparities the attention they require, Black patients will likely show greater trust in their care and better outcomes, too. This is best accomplished with investment in rigorous academic research that focuses on Black health. Well-endowed research institutes that seek to address social determinants and health disparities would result in tangible outcomes at every level of health care delivery. Improving care for Black individuals elevates the practice of medicine and will allow us to build more equitable policies for everyone.
Black people make up 13% of the U.S. population but only 4% of doctors.
This measure is even worse for Black men, the only demographic whose representation in medicine has dropped since 1978.
As our national shortage of doctors worsens, especially in minority communities, it is crucial that medical schools and residencies prioritize training underrepresented students through targeted programs so that the physician workforce better represents the people it serves. Research funding for medical schools should be contingent upon specific investments in underrepresented medical students — including representative mentorship, funding for elective learning opportunities, focused recruitment and retention efforts and compensated representation in academic leadership and administration.
Further, Medicare should update the funding mechanism for graduate medical education based on the 2012 Institute of Medicine recommendations, which incentivize performance-oriented toward health equity, particularly in underserved areas.