The number of African-American physicians in academic medicine is dismal, and this leads to an abundance of problems. Academic hospitals (teaching hospitals associated with universities) generally do not have a proportionate representation of underrepresented minority faculty as compared to the surrounding population. According to a U.S. News & World Report article, the number of African-American faculty increased by 0.2 percent in ten years from the year 2000 to 2010; yet, the growth of this group in the general population was 30 percent. This fact has been duly noted and highlighted as a discrepancy that deserves attention. The Institute of Medicine writes:
[We have] defined the climate for diversity as “the perceptions, attitudes, and expectations that define the institution, particularly as seen from the perspectives of individuals of different racial or ethnic backgrounds.” Though there may be various drivers of poor recruitment, retention, and promotion of black faculty members, the role of institutional bias and the climate for black faculty at academic medical centers deserve scrutiny. By any measure, academic medicine’s persistent difficulty in developing black faculty members is a serious concern.
The lack of African-American faculty at academic hospitals is concerning for several reasons. According to the New England Journal of Medicine article, “Bias, Black Lives, and Academic Medicine,” many African-Americans may not trust physicians of other races as much as they would someone of their same race. This mistrust dates back hundreds of years and has been ingrained in the African-American culture. There is a long history of unethical experimentation on Black individuals including the Tuskegee Project and Mississippi Appendectomies (see Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington). Still, years later, although there are now institutional review boards designed to ensure such atrocities never happen again, this mistrust remains. When caring for patients, trust is of utmost importance. If patients do not heed their physician’s advice, this can lead to increased hospitalizations, morbidity, mortality, and ultimately health disparities.
Why is there a deficit of African-Americans in academic medicine? There are a number of contributors to this problem, not the least of which is that African-Americans make up a small percentage (6.1 percent in 2011) of medical school students in the U.S. and there has actually been a recent decline in the number of African-American males who are applying to medical school. Fewer black medical students means that there will be fewer black faculty. Subsequently the lack of racial diversity among academic faculty becomes discouraging to a multitude of medical students, residents, and fellows who perceive there are no available mentors for them (do note that this is a perception because many successful physicians have been mentored by individuals from a different race). This problem, therefore, becomes a cycle … a very vicious cycle!
Pertaining to mentoring, those who are successful in academic medicine have stood on the shoulders of giants; this is crucial and fundamental for the developing physician and scientist. Consider the fact that many clinicians in academic medicine are encouraged to conduct research. How can one be successful in research at the university level without excellent mentorship? This requires an extensive background in basic laboratory or translational work. In 2013, African-Americans only made up less than 5 percent of postdoctoral research fellows conducting scientific research. Considering diversity in research is abysmal, this can build a cultural barrier. This barrier may be preventing African-American students from pursuing research and building curriculum vitae for a career in academic medicine.
The lack of diversity in academic medicine is a significant issue that can compromise our patients’ health and the education of our training clinicians. There is a vicious cycle in which there are few black academic physicians, leading to seemingly fewer available mentors for black students, which in turn leads to even less of them pursuing careers in academic medicine. As a medical community at large, it is imperative that we understand the implications of this problem, not just on the black patient population, but on the nation as a whole. Its effects ripple through our economy and finances, public health/disease transmission, and educational infrastructure. Knowing this, it is more important now than ever that we promote diversity in academic medicine and to be more specific, that we encourage students, residents, and fellows to pursue such careers.
