When Gabriel Felix applied to medical school in 2012, he was rejected from all 15 of his chosen universities. He started to think he wasn’t cut out for the profession.
Then the 20-year-old from upstate New York attended his first Annual Medical Education Conference (AMEC), an event dedicated to supporting medical students from underrepresented communities.
That’s where Felix met a black physician for the first time.
The medical professionals there not only looked like him but also had similar stories, too — stories of parents who were supportive but unfamiliar with the medical school application process, of struggling to pay thousands of dollars for test prep, of dealing with rejection.
“It made me realize this is not a reason to give up,” Felix said.
Armed with advice from admissions counselors, professors, and other students at the conference, he applied a second time.
In 2015, he was accepted to Howard University College of Medicine. He’ll graduate in May.
This week AMEC is in Philadelphia, bringing more than 2,200 pre-med and medical students to the city for four days. Felix, who is now president of the Student National Medical Association, which hosts the conference, hopes it will give other students like him the support they need to become physicians.
That could be crucial in addressing the shortage of black male doctors in America. It’s a deficiency that has plagued the medical field for decades — not only representing inequality but also, research shows, harming patient care.
According to the Association of American Medical Colleges (AAMC), less than 6 percent of medical school graduates nationally identify as black, even though black people make up 13 percent of the U.S. population. In the Philadelphia region, no medical school has more than 10 percent black students — about half the proportion of black people in the region.
There were more black medical students in the 1970s, said Jerry McCauley, chief of nephrology at Thomas Jefferson University Hospital and vice chair of health equity, diversity, and inclusion for the Department of Medicine.
“A lot of segregation of health care and medical schools was beginning to roll back then,” he said. “But we’ve made no progress since.”
An AAMC report found that the number of black men admitted to medical schools in the U.S. peaked in 1978 at 542 students. In 2014, 515 black men were admitted. (The number of black women medical students is small, too, but increasing.)
The AAMC report cited several reasons for the low numbers: an absence of black male doctors as role models, black males being subjected to stereotypes and suspended from school more than other students, black students disproportionately attending poorly funded urban schools that don’t deliver a good foundation in the sciences.
There’s also an issue of mistrust in the medical system, McCauley said.
Black Americans have experienced a long history of medical abuse, from the time enslaved people were purchased for medical experiments to the more recent Tuskegee syphilis experiment in which black males were misled about the study’s purpose and not offered effective treatment.
That history not only keeps black students from pursuing medical education, it also alters the relationship black patients have with doctors today, McCauley said.
Black patients often come to him for a second opinion on whether they need to undergo dialysis. “When I look at their labs, there’s no question they should start dialysis soon,” McCauley said. “But they have concerns about whether it’s warranted. ‘I know doctors experiment on us,’ they say.”
How a doctor’s race can affect patient care
In 2002, the Institute of Medicine published the Unequal Treatment report, using a large body of research to demonstrate that minority communities in the U.S. receive lower-quality medical care than white people, contributing to poorer health outcomes.
Seventeen years later, statistics show not much has changed. Black men have the lowest life expectancy of any demographic, living on average five years less than white men. They also have higher rates of chronic disease, hypertension, and stroke.
While there are many factors that affect health disparities, the 2002 report found that even when taking into account income, neighborhood, other medical conditions, and health insurance type, health outcomes among black people were still worse than among white people.
Recent research has focused on how experiencing racism can harm physical and mental health, as well as how providers — sometimes implicitly — treat black patients differently. Studies show doctors give black patients less pain medication than white patients, stand farther away from them, make less eye contact, and sometimes feel fear and discomfort around them.
From a public-health perspective, the conclusion is clear, said Jeffrey Sterling, CEO of the health-care consulting firm Sterling Initiatives and former chair of the SNMA board. “The absence of black faces as physicians, dentists, nurses, and more directly leads to poorer health-care outcomes.”
Conversely, research has shown that having more black doctors can improve patient care.
A 2018 study done in Oakland, Calif., found that black patients seen by black doctors were more likely to agree to such preventive measures as screenings for diabetes and cholesterol. Having a black doctor was even more effective in getting patients to get a flu shot than offering them $10.
The difference was driven by better communication and more trust, the study found.
Of particular note, patients who had the most mistrust of the medical system were the ones who were most likely to change their minds after talking to a black doctor and have more services done.
Preventive services can address such issues as hypertension and high cholesterol that affect black people disproportionately. The study authors estimated that a workforce with more black doctors could prevent enough cardiovascular deaths to close the life expectancy gap between white and black men by 8 percent.
Building up black doctors
Knowing that more black doctors could mean better outcomes for black patients adds urgency to diversifying the medical field, experts say. But those initiatives have to start early to be successful.
As early as preschool, said AMEC’s keynote speakers: Maxime Madhere, Pierre Johnson, and Joseph Semien Jr., co-authors of Pulse of Perseverance, which chronicles the friends’ journeys to becoming physicians.
“Many minority kids don’t even know about the resources that exist, let alone having access to them,” said Madhere, a cardiothoracic anesthesiologist in Louisiana. That includes everything from the free education website Khan Academy to more costly test prep books.
That was the case for Johnson, who recalled the first time he took the MCAT, “the scores looked like I’d closed my eyes and picked numbers randomly.”
For the next year, Johnson studied 16 hours a day, determined to master the concepts of biology, anatomy, and chemistry. But when he took the test a second time, he scored only three points higher.
“It wasn’t a knowledge deficiency,” Johnson said. “It was a test-taking deficiency.”
Numerous studies have shown that because of the way standardized tests are developed and scored, minority and low-income students score lower even when they have similar knowledge.
The key, as Johnson learned the third time he took the MCAT, is in doing as many sample test questions as possible. Until the inequalities of the standardized testing system are addressed, that’s what black students need to know, Johnson said.
But the need for additional support for students of color extends beyond exams.
When Sterling was an undergraduate, a college adviser told him he could never get into medical school. Wanting to ensure that other students of color weren’t given that same misinformation, he founded a program called MAPS: Minority Association of Prehealth Students. Over the last 30 years, the program has grown to 242 chapters across the country in which medical students of color mentor premed undergraduates and help them navigate the application process.
AMEC aims to build on such initiatives with conference sessions such as “First Among Firsts: Breaking Down Barriers,” “Emergency Evolution and Education of the Black Doctor,” and “How to Respond to Racist Patients.”
On Wednesday, SNMA members spoke to nearly 150 high school students from Philadelphia and Camden about pursuing careers in health care. Throughout the year, SNMA chapters run health programming in elementary and high schools, bringing in guest speakers and teaching kids such skills as how to measure blood pressure.
McCauley said early interventions are key. When he’s wearing his white coat and walking around hospital buildings in Center City, McCauley often finds black kids staring at him in surprise.
“They haven’t seen anything like me before,” he said. “We have to give them a sense that it is possible for them to become a physician.”