Why Aren’t There More Black Doctors in the U.S.?

Michel Martin: Thanks Christiane. Dr. Uché Blackstock, thank you so much for joining us.

Dr. Uché Blackstock: Thank you for having me.

Martin: So, Dr. Blackstock, you are actually one of three Dr. Blackstocks. And you and your sister, your twin sister, were the first legacies from both Harvard undergrad and Harvard Medical School, where your mom went. tell us a little bit about your mom, why did she wanna be a doctor?

Blackstock: We refer to her as the original Dr. Blackstock. And she was, you know, she grew up in very different circumstances than my sister and me. She grew up, you know, here in Central Brooklyn and in New York, in poverty. Her, the family was on public assistance to a single mom. She had five other siblings, and they moved often, changed schools often. Life was really quite difficult for her. But my mom had very strong work ethic. She had a strong curiosity for science. And when she was in – she became the first person in her family to graduate from college. And in college, she actually had a chemistry professor, Black man, who saw her spark, who saw her potential and said, You know, I think you should apply to medical school. And she ended up applying to all her medical schools and got into every single one and matriculated at Harvard Med School where she obviously felt like a fish out of water. But she found her people there. And after she graduated, she ended up coming back to, not only New York City, but she ended up practicing in the same neighborhood that she grew up in, you know, caring for her friends and her neighbors. And so for my sister and me, just sort of, you know, seeing that, knowing her story, it made a huge impact on us in terms of what we wanted to do, you know, with our own career. And obviously being a physician, there was no doubt that we were going to do the same.

Martin: The piece that you wrote for the Washington Post, and also your book “Legacy,” which is a kind of a marvelous story of family as well as about, the history of Black Americans in medicine. But what did she like about being a physician, and why was she so good at it?

Blackstock: You know, she thought about sort of every aspect of what her patients’ lives were. You know, I always say, you know, thinking about the social and political context in which her patients lives. So not only did she realize that she was in the room with her patient, but she also recognized that more holistically, she was in the room with their family, their friends, where they worked. She had a very holistic understanding of what makes people healthy. Now, we talk about health equity, right? And that’s a more of a newer expression, but I feel like my mother was providing equitable care to her patients, you know, in the eighties and nineties when we didn’t have those terms. 

Martin: Your book arrives at an interesting moment, you know, where people are just starting to acknowledge something that has been true all along, which is that African Americans, you know, Black people in the United States have poorer outcomes, poorer health outcomes The maternal mortality rate is many times that of white people, white people who get pregnant. people who are similarly situated in terms of income, similarly situated in terms of education, you know, all those, you know, classic indicators, the health comes, outcomes are still poorer. The short question for you, Dr. Blackstock, is why is that?

Blackstock: So there’s several different reasons for that, all related to interpersonal and systemic racism. But one thing that is really important to recognize is that we have seen this in the data, we’ve heard it anecdotally, that when we go to seek care from health professionals, Black people, we are often, our concerns are dismissed, ignored or minimized. And we have seen that lead to very, very horrific consequences.

You know, misdiagnoses, delayed diagnoses, harm, and even death. So there’s that interaction with health professionals, but then there’s also what happens, you know, a weathering process. There is a public health researcher named Arline Geronimus, who coined that term weathering. And this weathering process is what happens when you deal with a chronic stress of living with everyday racism, regardless of your socioeconomic status. And that causes wear and tear on our bodies that prematurely ages us and makes us susceptible to, you know, developing chronic diseases or, you know, dying, dying early. You know, Black people in this country, we have the lowest life expectancy. And so there are, you know, these are the reasons for that we really have to name racism when we’re thinking about what are the interventions and solutions.

Martin: What made you think of this? Like, what made you kind of connect all these dots?

Blackstock: One thing that you know, I write about in my book is that, for me, it was a journey. Because many of these – you know, I talk a lot about the history of racism in medicine in the book. I talk about how the father of gynecology, J. Marion Sims, experimented on enslaved Black women and made these really useful discoveries, but did so in a horrific way by not even, you know, being able to obtain consent because these people were enslaved, but also performing painful surgeries. So I talk about all that because I never learned that in medical school. I didn’t learn that in my residency. There were so many things that I learned as a practicing physician. And I grieved not having learned that when I was in medical school, and really making sure that our future generations are educated about that so that we understand why we are here today. You know, a lot of, a lot of these myths about black people being biologically different are deeply rooted in slavery, in Jim Crow. And so we know that that impacts how health professionals care for people, because those myths get perpetuated, unfortunately, even in our medical education.

Martin: Reading from your book, “The number of black physicians in this country remains stubbornly low with only 5.4% of all US physicians identifying as black. 2.6% is black men, and 2.8% as black women. Although black people make up 13% of the population. There’s actually a smaller percentage of black male physicians now than there was in 1940 when black men made up 2.7% of black physicians.” you know, I’m sure that some people listen to this think, well, that’s just too bad, you know, the black folks just don’t have the, quite the right preparation, or they don’t have access to the right education, or, you know, or just not, can’t just cut the mustard. And what you would say in your, in your essay and in your book, is that that’s not true. It was like a deliberate effort to kind of cut off access to medical education. Could you just talk us through that story?

Blackstock: So I talk about The Flexner Report, this report that was published in 1910. The American Medical Association, which is the oldest and largest organization of physicians, and Carnegie Mellon Foundation, commissioned the report and an education specialist named Abraham Flexner, he went around to assess all 155 US and Canadian medical schools to hold them against higher standards of the Western European medical schools that, or in the US, Johns Hopkins, which was the gold standard. 

Of course, we know that black – historically, black medical schools did not have the resources or wealth that predominantly white medical schools had. And so that report actually led to the closure of five out of seven of the historically black colleges in 1910, leaving behind only Howard and Meharry. 

There was a study that came out in 2020 that estimated if those five medical schools had remained open, they would have trained between 25 and 35,000 physicians. And we know they would probably mostly, mostly have been black physicians, because to this day, Howard and Meharry, which are historically black colleges and universities, they still put out the largest number of black medical students. But when I heard that number, or when I read that number, I thought about – I cried, I cried. It was very emotional because I thought about the tremendous loss to our communities. They could have cared for hundreds of thousands of patients. They could have mentored black students and trainees. They probably would’ve been more likely to have done research around black health. And so this decision, or this report that was made in 1910 and had this devastating consequences, we’re still seeing the ripple effect of that today in 2024, which makes –

Martin: Well talk a little bit more about Abraham Flexner, because this person, Abraham Flexner, was avowedly racist, I mean, avowedly racist. This is what he said about black students. “He wrote that Black students should be trained in ‘hygiene rather than surgery,’” quoting here, “and were best employed as ‘sanitarians’ who could help protect White people from common diseases such as tuberculosis. ‘Not only does the Negro himself suffer from hookworm and tuberculosis; he communicates them to his white neighbors,’ 

Blackstock: Oh, absolutely. He felt that the only reason that we should even be in medical schools is to prevent our white peers from getting sick. He didn’t feel like we needed to be there. He felt that black medical schools would never be able to train competent black physicians. So he held racist beliefs, which is something that, you know, it’s really important to understand about the legacy of racism in medicine. There have been many, many physicians that have been revered for, you know, this so-called wonderful work they’ve done like J. Marion Sims. But these are people who either, you know, held, you know, were enslavers or held very racist beliefs. And so you have to believe that that may have influenced these policies that they developed.

I think that speaks to the fact that we need medical schools to, you know, currently teach this history to our students, because otherwise they really are going to think – and we have data that shows this – they really are gonna think that their black patients are very different, or their black, you know, peers in medical school are literally different, don’t deserve to be there or their black patients are just inherently unhealthy when actually it’s a result of practices and policies in the past and in current time.

Martin: So why would it be that black patients would get different care from black physicians or superior care, or have superior outcomes if they’re treated by black doctors? Like, why might that be?

Blackstock: You know, physicians are just like, you know, average citizens. They are the one, they, you know, they live life like everybody else. And so they absorb cultural messaging, you know, through media, through books from their family, just like anybody else. And so to think that they would not be impacted by anti-black messaging that is always around us would be almost silly. Like, of course, of course they probably hold these, you know, we call them unconscious biases. I know, I think explicitly most health professionals would say, no, I wanna make sure I’m giving all my patients the best care possible. But we already have the data that shows that’s not the case. 

I don’t think that there should necessarily always be black physicians caring for black patients, because obviously the numbers don’t work out that way.

We need all physicians, regardless of their racial background to be able to adequately and competently care for black patients. But I think part of that really is starting to assess what your internal biases are. You know, we know that, for example, in terms of how pain is treated in black patients, like, there is data that shows that black patients’ pain is often like under, undertreated. That the perception of how in pain black people are is much less than for white patients. We need health professionals to hold themselves accountable as well as healthcare institutions and hospitals.

Martin: It does make you wonder whether some of these poor outcomes arise, not just from access, but from avoidance. Is that you’ve had negative experiences with healthcare providers, you think they’re gonna look down on you, dismiss you or treat you poorly. You don’t go, It just sort of makes you wonder, you know? Yeah.

Blackstock: No, exactly Yeah, and we talk about this idea of unmet needs, unmet medical needs in black communities. And those unmet needs are often a result of black patients not feeling comfortable enough to seek care. And so when they don’t seek care whatever disease process is happening actually gets worse. And I wrote about a patient in my book who, you know, he, I was in urgent care with him and elderly black man, he was, he had covid pneumonia. I diagnosed him with it. And I said, sir, you need to go to the emergency department. He said, no, I’m going home because I know they’re not gonna treat me well in the emergency department. And I, to this day, I wonder about him. I wonder how many other patients were like him that decided to go home because they didn’t wanna go to the emergency department because they didn’t think they would receive respectful and dignified care.

Martin: So what’s the way forward here, Dr. Blackstock? What’s the way forward here, in your opinion? 

Blackstock: So, I have a lot of ideas about the way forward, but I do think, you know, there are things that people can do on an individual interpersonal level and then more on a policy level.

 I think – you know, obviously, and there are things I mentioned that, you know, medical schools making sure the curriculum tells the history and is, you know, an anti-racist curriculum that we create diverse, inclusive learning environments for our black students and other students of color. Because that’s the other issue. Once they get there, they’re often feeling isolated and have to deal with microaggressions.

But I also think that it’s the obligation of academic medical institutions, hospitals, and even, you know, local state government to really invest in the pipeline of black physicians starting from preschool, starting from kindergarten, in terms of mentoring, sponsoring, even financial assistance. I talk about this in the Washington Post piece about being really intentional about addressing the lack of generational wealth in black communities to ensure that we have access to these opportunities. 

I also would love for policymakers to read this book and understand that health is in all policies. So I do think that when we look at the United States, and as you mentioned, we have some of the worst health outcomes for everyone, not just black people, everybody. Life expectancy overall is going down, and we spend the most on healthcare. And so there are some basic things like making sure that everyone has health insurance. We know that in states that have expanded Medicaid, people are healthier, people do better. When we look at housing, education, employment, there are ways that we can really make people healthier by investing in policies in those areas as well.

Martin: Your book arrives at a time when you have some individuals and groups who are very aggressively pushing back against the kind of history, hidden history that you’ve uncovered, and remedies that you recommend. Given that you’ve got this very hostile political environment, even to knowing these things, I’m just curious of how you feel that that could be overcome and what would overcome that? 

Blackstock: Well, you know, I know, we’re in very difficult times. Like even the recent SCOTUS decision on race conscious admissions, I fear that’s probably gonna have a similar ripple effect as the Flexner report. I think that we have to be really smart, innovative medical schools specifically have to think about what are the workarounds in terms of addressing the SCOTUS decision that there – some medical schools are saying, we’re just gonna look at class or socio-economic status. And I say in the Washington Post piece, that that’s not enough, because that doesn’t address the roots of racism. So I do think that we have to, you know, organize, I think we have to work with our policymakers and legal folks to come up with really smart ways to counteract this. But I know it’s going to be, definitely be a challenge. I try to stay positive, but I’m concerned.

Martin: Before I let you go, I have to ask, you know, your mom, such a pioneer. You lost her when you were only 19 years old. She accomplished so much in her short time here on Earth. She was only 47, But if she were here today, you know, what do you think, what do you think she would tell us to do? What do you think her message would be today?

Blackstock: Oh, wow. Well, one, I think she’d be very proud of me <laugh>, which is why I always, you know, obviously want from her. But you know, I think that she had this vision of, you know, what’s the work that we need to do on behalf of our communities? I think that she would be alongside me being a health equity advocate. I feel like this is an opportunity for me to give my mother a large – she always had a voice, but a platform. Because some of these ideas, you know, you know, the local health fairs that she was having the diabetes screening, you know, all of that is what we now call health equity. And so I think she’d really should be a pioneer in health equity and just be working to advance a lot of these efforts that we’ve talked about today.

Martin: Dr. Uché Blackstock, thank you so much for talking with us today.

Blackstock: Thank you, Michel.