Electronic Fall 2021 - Issue 48

Black Men in White Coats

By: Jasleen Singh

At the end of August, APA hosted a screening of documentary “Black Men in White Coats” by Dale Okorodudu. This film starts off by identifying a crisis – black men are dying and not enough black men are becoming doctors. This was met with several statistics, that “100 less black men applied to med school in 2014 than in 1978” and that black men make up “2% of all physicians in America”. Dr. Dale Okorodudu discusses the Black Men in White Coats movement and the perpetuation of healthcare disparities, which is further supported through the presentation of several case examples and media presentations. Exacerbated by the COVID-19 pandemic, social impediments of health transcend genetic predisposition and disproportionately affect the African American population. Such commentary is tied to the “loss of opportunity” for patients secondary to the lost opportunity for students. It is noted that the patient perception of having a black doctor allowing for race to not be a factor in medical care contributes to increased compliance and decreased healthcare costs. It is proposed that the first step in progress is the responsibility of medical school admissions in actively addressing this disparity. Per Dr. Valerie Montgomery Rice of Morehouse School of Medicine, several medical schools do not have any black men in their classes, and this lack of diversity results in different conclusions on how to best care for patients. While medical school admissions may be a first step to target, obstacles arise in every stage of the process – before and after medical school and residency. The documentary then transitioned to the importance of role models and the notion of “you can’t be what you can’t see”. Given the lack of representation of black men in medicine, especially those who are relatable, from urban communities, it is not often regarded as a possible career path.

Following the screening, on Saturday, August 28th, 2021, Area 4 of APA hosted a discussion on this documentary, with about 30 people in attendance. The session began with an introduction from Dr. Vivian Pender, president of APA, and was followed by Dr. Dionne Hart, who hosted the rest of the discussion. Dr. Hart discussed the Black Men in White Coats movement, the goals of the documentary. and noted that in 2020 and 2021, APA renewed its commitment to addressing mental health disparities. Subsequently, discussion from panelists Dr. Rahn Baily, Dr. Frank Clark, and Dr. William McDade ensued. They acknowledged barriers in medicine for black men in particular, because while the numbers are low overall, the disparity predominantly affects black men. The first barrier identified, also discussed in the documentary, was the Flexner Report of 1910, a landmark report of medical education where 5 of 7 HBCU (Historically black colleges and universities) medical schools were closed down. This was followed by closing of hospitals in some areas, which further decreased access to care and led to migration of black doctors to other areas or to other professions. It was noted that this was just one in a long pattern of activities that led to a downward push.

Not only were social determinants of health discussed, but social determinants of education were also addressed, with wealth gap and difference in resources, politics, and racism all making it very difficult for African Americans to attain higher education. Health disparities were further highlighted by the disproportionate deaths of African Americans at the beginning of the COVID pandemic. Furthermore, it was mentioned that JAMA had a podcast earlier this year where structural racism was denied, and in response to upheaval, 14 positions for equity were announced in June 2021 by AMA. The importance of continuing this momentum was also highlighted with concerns that if this momentum stops, we may slip to the “status quo” and dominant culture of society as it has been previously. The goal is to make sustainable changes, increase awareness of the barriers and hurdles that prevent many people and groups from having equal opportunity. Yet, it was noted that people are being more proactive and this need for allies was emphasized.

The discussion then transitioned to “minority tax”, a concept where minorities are often called to with higher expectations, including being representatives of diversity. It was noted that especially in the academic setting, work in diversity and equity inclusion is often not credited or rewarded in the same sense that other types of scholarship are, especially when looking at promotions or tenure cases. Thus, while the minority tax burdens individuals with extra work, it doesn’t reward them in the same fashion. Strategies for making sure that there is acknowledgement of such work was also discussed, with concerns that people may become upset about “reverse discrimination”, when the goal is equality and acknowledging work in multiple forms. Therefore, work in diversity must be normalized, as with work in other disciplines. It was noted that diversification of the physician workforce is a key strategy to help attain this.

ACGME initiatives were then addressed, with acknowledgement of a regulation to increase diversity of faculty, senior academic leadership, GME staff, residents, fellows, and medical students. One year ago, ACGME changed its mission statement to address that this will afftect both accreditation and education, with the creation of 30 modules on diversity and equity inclusion to help foster diversity. The “equity matters collection” toolkit will likely be available next year, to address reverse ideation, acknowledging what programs do that prevent people from being successful graduates. The stark fact is that 30-40 African American men graduate from psychiatry every year, fewer than 1 per state. Consequently, more diverse populations being encouraged to consider medicine at the high school and college level are also essential.

After an hour of discussion from panelists, closing remarks were made by each panelist and breakout sessions ensued with group discussion for wrap-up. It was mentioned that to more effectively promote diversity equity inclusion, a fiscal component from the government will also be key, as this will allow deans to see this as something that is culturally and financially essential to their medical schools. At the very end, Dr. Frank Clark provided closing remarks and mentioned a quote he saw by Cornel West, “You can't lead the people if you don't love the people. You can't save the people if you don't serve the people.” He highlighted the need to practice humility and humanity and emphasized placing high regard for life, and concluded with a statement from the opening of the documentary, that too many black people are dying too early in life.