Among the devastating consequences of our nation's history of racial injustice is the pervasive inequity in health along racial and ethnic lines. If the most important measure of society is the well‐being of its populace, then dismantling the direct linkage between one's health and race should be our most urgent priority.
Black communities have higher rates of chronic disease and premature death. COVID‐19 has worsened the problem. We must do better.
The complicated reasons for this inequity involve socio‐economic variables, criminal justice, behavioral lifestyle conditioning, access to healthy food, as well as a distrust of the healthcare system or institutions in general.
One strategy to help close the gap is often overlooked: creating a healthcare system that reflects the diversity of society.
Just 5% of U.S. physicians are Black, compared to an overall population almost triple that percentage.
Why it matters
A pool of healthcare professionals reflecting the diversity of the community helps solve two underlying variables in the healthcare gap.
First is trust. Effective health management is often related to a personal relationship with one's doctor. When based on trust, open communication and common understanding, great things happen.
A 2018 National Bureau of Economic Research study showed when Black patients and physicians were paired together they had better health outcomes. Small commonalities make big differences in whether Black patients seek medical treatment, accept diagnoses or stay on treatment regimens. When patients see physicians who look like them, conversations are more candid, more questions are asked and more straight‐forward answers are given.
Second is access. Underserved communities face difficulties attracting physicians to neighborhood clinics. Black physicians are more likely to seek employment in underserved communities and to be better equipped with the cultural competencies to be optimally effective.
Creating a future for healthcare that is more reflective of society will take an aggressive approach across the entire pipeline. An individual's decision to pursue a medical career is made earlier, usually as a youth with a penchant toward science and a passion for helping people. We need to do more to get inside the K‐12 educational infrastructure to reach more Black students and paint a vivid picture of the path, the requirements and the rewards of a career in medicine.
Medical school: from recruitment to graduation
The steepest step on the journey to becoming a physician is medical school.
We must address the financial barriers that young Blacks face considering the expensive process of becoming a physician. The price tag for medical school, roughly a quarter-million dollars, is steep. In 2019, median wealth for white households was 7.8 times higher than for Black households. It's no surprise that medical education debt varies by race. We need to develop strategies to make medical school financially accessible, including more public support for students who need it.
We also must reexamine medical school admission practices. A study of admissions in university health programs found that policies emphasizing a "holistic review process" achieved greater diversity while seeing no change to student success. Furthermore, any examination of the admissions process must consider providing support to level the playing field in the preparation for the MCAT.
Medical education must also become more geographically expansive. Young people from disadvantaged communities are less likely to be able to move long distances to attend medical school.
Some healthcare systems have partnered with medical schools to provide the clinical support necessary for satellite campuses. Case in point is a collaboration between Methodist Le Bonheur Healthcare and Meharry Medical College, the nation's largest historically Black medical school. Morehouse School of Medicine and CommonSpirit Health recently announced a similar partnership.
A climbable mountain
All stakeholders along the physician development pipeline should set a goal to double the number of Blacks entering medical schools by 2030. This seems like a steep mountain to climb, but consider this: If every U.S. medical school committed to increasing Black enrollment by just three students per year, we would achieve this goal. We can do this.
Such an achievement would have profoundly positive consequences on the way we practice medicine and deliver care in this country. Such an achievement would make significant strides in closing the health equity gap by providing more patients with a physician that understands their experiences.
It's time to stop admiring this problem and drive meaningful and real change. The health and well-being of the Black community is at stake.