Taking the Cast Off
Unmasking Structural Racism in America's Medical Education System by Lindsay Joseph
Written by Lindsay Joseph
Somewhere hidden in the hallowed halls of medical education, there exists a problem that demands our attention. So called unintentional divisions created throughout history in our society plant the seeds of partly intentional animosity. Once an idea takes off, it tends to linger in people's minds, growing stronger with time, and passing on from one generation to another. The enduring misconception that black doctors are somehow less capable still exists, leading individuals to think twice at the sight of black physicians. In this article, I’ll be unmasking the misrepresentation and underrepresentation of black doctors in America.
The turning point
In a distant time, medical school used to be like a “free for all”. There was no real structure or curriculum of education. Additionally, people didn’t quite believe in medicine or understood it, sometimes they even came up with their own theories. In the early 1900s, with the evident notice that medicine was in need of a major educational reconstruction, the Council on Medical Education (CME), formed under the American Medical Association (AMA), was called to evaluate if medical schools across the country were meeting the evolving standards. They proceeded evaluations in forms of school tours, and in those tours, it was crystal clear that Black institutions were significantly behind their White counterparts. These schools were very minimally funded by some missionaries and religious organizations with very little money. They were old, had outdated laboratories and equipment. They offered less relevant clinical experiences and students were taught by older generations with no knowledge of new practices. On top of that, Black medical colleges were among those with the highest failure rates on board exams. All of these factors made Black medical schools fall at the bottom of CME’s ranking list, leading to the closure of 3 of the 10 existing medical schools for African-American students. However, this major overhaul of medical education did not stop there. The AMA solicited an independent study to supplement its initial investigation. The Carnegie Foundation for the Advancement of Teaching took on this responsibility and chose Abraham Flexner to conduct it. 1
The Flexner report is not just any document. It drastically changed medical education forever. It was the start of higher admissions standards and of additional scientific research into clinical education. It is basically the blueprint of what medical school looks like today. This transformative report sheds an eye on the past issues in America’s health care system in a very valid way, but when you reach chapter 14 and encounter his idea of “THE MEDICAL EDUCATION OF THE NEGRO”, it most definitely makes you raise an eyebrow. In this chapter, Flexner goes on about how “The negro must be educated not only for his sake, but for ours.” Basically, he believed that black doctors needed to keep black people from getting white people sick, they needed to care for their people to control contagion. It did not matter the quantity of the medical schools for black folks, but the quality, not for completely moral reasons but because they needed good black doctors to provide care for their own kind, keeping diseases away from the millions of white people they lived in close contact with. To Flexner, the black physician was supposed to do sanitarian work, preventing the spread of “Hookworm” and “Tuberculosis” (these diseases were associated with African-Americans at the time) that the black community could communicate with the white community. This resulted in the closing of 5 more black medical institutions that were judged incapable of fulfilling this duty. Meharry Medical College (Nashville) and Howard University (Washington) were the only two left standing.
“Their duty calls them away from large cities to the village and the plantation, upon which light has hardly as yet begun to break. Of the seven medical schools for negroes in the United States, five are at this moment in no position to make any contribution of value to the solution of the problem” - MEDICAL EDUCATION IN THE UNITED STATES AND CANADA
BY ABRAHAM FLEXNER 2
This idea of “limiting” black doctors in this way, knowing surgery was, and remains, more lucrative is a problem, even if it’s indirect. I don’t believe the intention of the report was division, but it is still the result. Over a century after this report, black students still feel like they are part of a separate box. In fact, there is a clear lack of diversity in American medical schools today and people tend to second guess black physicians and their abilities.
Underrepresentation
In 1968, 2% of medical students were Black, even if most medical schools were not officially segregated. 3 Seeing this, the AMA planned to tackle the issue of underrepresentation of the African-American physician in 1970. Their goal being to increase the representation of minority students in medical schools and in the medical profession, to a proportion more representative of their place in the U.S. population. Their goal would be reached by: providing struggling students with financial assistance, and recruiting minority students to medical education. Parallely, many medical colleges put in place mentorship programs to recruit underprivileged Black students. Still, in 2018, 5% of all medical students identified as Black, even if the community was 13% of the US population. 4 African American students made up 10% in 2022-23, which is a major step towards AMA’s goal. 5
Misrepresentation
When you see a black doctor, you shouldn’t be asking yourself where they went to school or how long they’ve been practicing that profession. You don't have to second guess somebody’s ability because of the colour of their skin. Unfortunately, this idea has passed on and remains something lingering in the back of people's minds, because history never really disappears. It sticks. It also stings. Black doctors feel like they have to prove excellence and success in their profession, to compensate with the premade idea that they are “less than”... Making this idea fade starts with teaching others about the startling roots of it all. It starts with consciousness.
-
When I reach my dream, after years of studying and thriving to be the best, I really hope I am not looked down upon for the way I look. I hope that if my children decide medicine is their future, they don’t have to fight any more battles. I hope we can save lives without getting dirty looks, without having people questioning what we are capable of everytime we take a cast off. I hope instead they look at us and know how hard we had to fight to get here.
Additional references:
Powell, D., Dunlap, J., Yaba, S. & White, W. (2016). Racial Inequality in Medicine: How Did We Get Here? Globe: A Journal of Language, Culture, and Communication, Read article.
AMA Journal of Ethics. (2019). How Should We Respond to Racist Legacies in Medical Education? Read article.
St. Fleur, Nicholas. (2022). Medecine lost the trust of many Black Americans — how can we mend that? [episode 02]. Colour Code. STAT. Available at: https://open.spotify.com/episode/3HoKXQsykxh9dFb6Spoi5p
Comments