What the Viral Response to the Medical School Student Photo Missed about Race, Equity, Healthcare and the Black Doctor Crisis in America
by Anitra D. Brown
A photograph that made the rounds on social media as 2019 waned produced positive pandemonium (if there is such as thing) of viral proportions.
It was the picture of 15 Black Tulane University Medical School students standing in front of an old slave’s quarter on the Whitney Plantation.
It was inspirational.
It was telling, too.
First, The Inspirational Part
The photo is moving because, as every article, post and comment written in reference to it suggests, those 15 young and gifted Black students have indeed surpassed the wildest dreams of the enslaved men and women whose existence was marked by that worn wooden shack and by the sugarcane and rice fields at large Southern plantations, where ancestors endured treatment that should be unknown to the human mind, body and spirit.
The picture went viral and spawned local and national stories, including coverage by CNN, The Washington Post, NBC News, ABC News, USA Today, National Public Radio (NPR), People Magazine, BlackEnterprise.com, Essence.com, thegrio.com, and the FOX affiliate in Washington D.C. among many others.
One such report, an on-line story published by BlackEnterprise.com, quoted second-year medical student Russell Joseph Ledet sharing why it was important for him and his classmates to choose that setting.
According to reports, Ledet said: “I wanted this photo to just show: ‘We’re here’. This place is meant to destroy us. This place is meant to devalue us. But we’re here. We wanted to make sure that we remain tied to our history and remain humble, you know, and understand whose shoulders we’re climbing on — and pay homage.”
And it is moving to see young, Black medical students, proud of who they are and what they are accomplishing, yet mindful of the shoulders on which they stand and cognizant of the 400 years of systemic racism and bigotry that threatened their very existence and the existence of young people like them throughout generations.
Yes, they are here. And that fact is a testament to the spirit of a people undaunted, undeterred and unrelenting in the face of unimaginable trauma and suffering. Those medical school students—and the many others that came before them—should be proud.
Black Americans, especially, have always had these stories of Black perseverance and Black excellence in the face of the most formidable circumstances.
The Meharry Medical Department of Central Tennessee College admitted its first 11 medical students admitted in 1876—just 11 short years after slavery’s end. And in 1915, the department received its own separate charter to operate independently as Meharry Medical College, becoming the first medical school in the South to offer four-year medical training.
And Dr. James Monroe Jamison, Meharry’s first graduate, was the first African-American physician to be formally trained in the South.
Dr. James McCune Smith was born into slavery in 1813. Emancipated as a teen, he was a good student who earned several degrees. In 1837, he became the first African American to earn a medical degree after graduating from University of Glasgow in Scotland, He interned in Paris and eventually returned to New York where he practiced internal medicine for about 20 years. He was never allowed admission into the American Medical Association.
Dr. Charles Drew pioneered methods of storing blood plasma for transfusion and organized the first large-scale blood bank in the U.S. during WWII. After, the war, he took a position with the American Red Cross to work on blood storage program. He soon resigned after officials decided to segregate the blood of African-Americans.
Dr. Louis Charles Roudanez, the free Black man who founded the historic New Orleans Tribune as a voice for Black people both free and enslaved, was only 12 years old when three physicians in 1834 founded The Medical College of Louisiana (the institution that would ultimately become Tulane University Medical School). But in 1844, at the age of 21, young Charles had to go to Paris to earn his medical degree and then to Dartmouth to earn a second before returning to practice medicine at home in New Orleans.
Closer to home, this paper’s executive publisher, Dr. Dwight McKenna, a 1966 graduate of Meharry Medical College, was elected coroner in Orleans Parish in 2017–the first African-American elected coroner anywhere in the United States.
Even in the field of medicine, as with others, we have known hardship…and we have always known triumph. And with all that has been accomplished, the stinging truth is that there still aren’t enough Black doctors is the U.S.
The Telling Parts
So after the initial reaction to its historical and emotive relevance of the viral photograph, the first revealing aspect was that there were not more students pictured.
Eleven years after slavery, 11 Black students began medical school training at Meharry. Here we are nearly 155 years since the end of slavery. Why were there not many more students among those med school classmates in the widely circulated photo. Instead, there were only 15, which tells much about the effects of institutional racism on education and healthcare in America.
On its website, Tulane University Medical School provides a snapshot of its most recent class—students admitted in the Fall of 2019. That class profile shares a lot about the group—overall GPA, the age range and average age of the class, a breakdown of male and female students. It even informs that there are 33 states represented in the most recent class at the second oldest medical school in the Deep South—a region of the country that generally includes Georgia (where 30.5 percent of the state’s population is Black population), Alabama (26.2 percent), South Carolina (27 percent), Mississippi (37.3 percent), and Louisiana (32 percent).
Now, what the Tulane Medical School class profile does not say is how many of the 190 first-year medical students are Black.
It is probably too much to expect that a medical school that boasts of being the second oldest in the Deep South would actually have enrollment demographics that reflect the racial makeup of the Deep South (roughly 30 percent Black) or even the nation ( a meager 13 percent Black).
Those numbers would be nice, but we are certain that is not the case.
In May 2109, U.S. News & World Report released a survey detailing the top 10 (non-HBCU) medical schools with the highest enrollment of Black students. All 10 of the medical schools, which included Duke University, the Medical University of South Carolina and Ohio State University, had a student enrollment that was at least 10 percent Black. Tulane was not on the list.
Our best guess is that Tulane Medical School’s Black student enrollment mirrors national medical school enrollment numbers, which tell that about 7 percent of all students enrolled in med schools across the nation are Black. So at best, maybe 13 or so of Tulane Medical School’s 190 new students are Black—maybe.
With its selective admissions process, only 190 out of nearly 13,000 applicants were accepted in 2019. And at best, we are certain that only about 7 percent–if that many–of those students were Black. Now, we are not picking on Tulane, because it is not unique in this regard. And that is the problem with the viral photo and the real story it tells.
A look at the racial breakdown of medical school graduates in the United States points to a stark reality.
For the 2018-2019 academic year, of the nearly 20,000 medical school graduates in the United States 10,879 or 54.6 percent were White. Only 6.2 percent or 1,238 were Black, according to the Association of American Medical Colleges, which also reports that in 2019-2020, the number of Black students enrolled in medical schools across the nations was only 7.3 percent or 6,783 of the total 92,758 students.
Moreover, in 2018, less than four percent of practicing physicians in the United States were Black.
And even more telling is the gender breakdown of the 15 students in the viral picture. Thirteen of them were young Black women, but only two were young Black men. Unfortunately, those numbers are reflective of what has been trending for decades—a dip in the number of Black men attending and graduating from medical school and becoming doctors.
In 1986, while over half of Black medical school graduates were men, data reported by the AAMC showed that there was a drop from 57 percent in 1986 to 35 percent in 2015.
So as nice as that photograph is, there is a problem when African-Americans are 13.2 percent of the population, but represent: less than 4 percent of the doctors practicing across this nation; barely 6 percent of last year’s medical school graduates; and only a bit more than 7 percent of current medical school students across the nation.
That is the very definition of a disparate or unequal conditions. For Black male doctors and med students, those statistics are more bleak.
One cannot look at that photo without seeing disparity and equity.
As happy as we are for those 15 med school students, reveling in their existence without acknowledging the deep disparities that still exist—inequities that have resulted in a shortage of Black doctors in America—could have the dangerous side effect of suggesting that the problem has been solved.
It has not.
In fact, it should be disheartening to know that fewer Black men entered medical school in 2014 than in 1978, according an article published by the AAMC on the decline of Black men in medicine.
The Disparities that Play a Part
In a 2018 report by NBC News, Dr. Louis Sullivan, president emeritus and founding dean of the Morehouse School of Medicine and the secretary of health under President George H.W. Bush, discussed the role he believes history and racism play in the current shortage of African-American physicians, especially Black male doctors.
In that report, Sullivan said, “Blacks, and especially Black males, have always been underrepresented in medicine. This stems from slavery and legally enforced segregation.”
He also added that the cost of medical school was a deterrent for Black students from low-income families.
In the same article, Dr. Marc Nivet, Executive Vice President at UT Southwestern Medical Center, pointed to historic and systemic racial disparities in higher education as a contributing factor to the low number of black students pursuing medicine.
“The majority of Black doctors come from only three or four historically Black colleges and universities — Spelman, Howard, Xavier and Morehouse,” Nivet said in the NBC report. “Those institutions need more resources, both federal and philanthropic, based on their great and historic track record of sending African-Americans to medical school.”
Meanwhile, issues contributing to the fledging number of Blacks entering medical school and Black doctors are the persistent systemic disparities in public elementary and secondary education. A system that should be preparing all young people, and especially young Black youth for higher education and opportunity to decrease poverty and close the racial wealth gap, is actually failing Black students.
Consider these disturbing education inequities that exist according to a report by the UNCF:
• African American students are less likely than White students to have access to college-ready courses. In 2011-2012, only 57 percent of Black students had access to a full range of math and science courses necessary for college readiness, compared to 81 percent of Asian American students and 71 percent of White students.
• African American students are less likely to be college-ready. In fact, 61 percent of ACT-tested Black students in the 2015 high school graduating class met none of the four ACT college readiness benchmarks, nearly twice the 31 percent rate for all students.
• Black students spend less time in the classroom due to the disparate manner in which discipline is meted out, which further hinders their access to a quality education. Black students are nearly two times as likely to be suspended without educational services as White students. Black students are also 3.8 times as likely to receive one or more out-of-school suspensions as White students. In addition, Black children represent 19 percent of the nation’s pre-school population, yet 47 percent of those receiving more than one out-of-school suspension. In comparison, White students represent 41 percent of pre-school enrollment but only 28 percent of those receiving more than one out-of-school suspension. Even more troubling, Black students are 2.3 times as likely to receive a referral to law enforcement or be subject to a school-related arrest as White students.
• Students of color are often concentrated in schools with fewer resources. Schools with 90 percent or more students of color spend $733 less per student per year than schools with 90 percent or more White students.
• Less qualified teachers and novice teachers are often assigned to schools that serve the most disenfranchised populations, a fact that has become increasingly more commonplace with the so-called education reform movement driven by corporate interests.
In short, the pipeline to medical school for Black students will never be fully cleared until we address the racial inequities and disparities in resources and funding in our nation’s public education.
Meanwhile, the impact of a report written nearly 110 years ago that resulted in the closure of at least five Black medical schools by the early 1920s, cannot be discounted.
In 1910, the Carnegie Foundation commissioned Abraham Flexner, an American educator and medical researcher, to evaluate the medical schools in the U.S. and Canada. When Flexner wrote his report that year, there were seven Black medical schools in the United States. And most of the other nearly 80 medical schools that existed at the time didn’t admit Black students. In his report, Flexner called five of the seven Black medical schools “ineffectual” and wrote that they “were in no position to make any contribution of value.”
Flexner’s racially biased report called for the closure of New Orleans’ Flint-Goodridge Medical School, along with Black medical schools in Raleigh, NC, Knoxville, Tenn., Memphis, Tenn., and Louisville, Ken. It also meant that Blacks interested in the study of medicine had fewer opportunities and less access.
The two Black medical schools left standing after Flexner released his report were Meharry Medical College in Nashville, Tenn., and Howard University Medical School in Washington, D.C. In 1949, 75 percent of all Black medical school students in the nation attended one of those two schools.
As a result of Flexner’s report and the disproportionate closure of medical schools dedicated to training Black people, the number of Black physicians in America steadily decreased for the next 60 years, while the number of White physicians increased—contributing to the lack of culturally competent healthcare providers in America that is, in part, responsible for existing disparities in healthcare delivery and outcomes today.
And Why It Matters
Health disparities are gaps in the quality of health and healthcare across racial, ethnic, and socio-economic groups. There are a number of factors that contribute to these disparities—access, use, affordability, quality of care, or any one or a combination of individual, provider, health system, societal, and environmental influences.
And as a report by the Kaiser Family Foundation notes, health care disparities not only affect the groups facing disparities, but also detract from quality of care and health for the broader population. It is a social justice issue and an economic one, as health disparities are costly.
A recent analysis estimated that disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year as well as economic losses due to premature deaths.
And the disparities that exist for Black communities are real. When compared to non-Hispanic Whites, Black Americans are:
• 44 percent more likely to die from stroke.
• 40 percent more likely to die form breast cancer
• 52 percent more likely die from cervical cancer
• 72 percent ore likely to be diabetic
• 3 times more likely to die from pregnancy related complications.
• 2 times more likely to die from prostrate cancer.
African-American children also face disparities. They are:
• Being 2.5 times more likely to die as infants
• Being 2 times more likely to suffer from asthma
These are just a few statistics. And while the above disparities focus on outcomes, others are more related to access and quality of care.
Despite gains in insurance coverage for people of color under the Affordable Care Act, significant disparities persist. And these disparities leave people of color at greater risk of difficulty accessing care and financial instability from health care costs.
Moreover, African-Americans are more apprehensive toward and less trusting of the health care system—a reality that has been molded by history and personal experiences in the way they have been treated by medical professionals.
Research shows that health outcomes for Black patients are better when Black doctors treat them.
A recent clinical trial among 1,300 Black men in Oakland showed that 29 percent more were likely to talk with Black doctors about health problems and seek more invasive screenings.
The study also concluded that increasing the amount of Black physicians could lead to a 19 percent reduction in the Black-White male cardiovascular mortality gap and an 8 percent decline in the Black-White male life expectancy gap.
In other words, when Black patients see Black physicians, who are more likely to have shared experiences or at least possess an intrinsic understanding of the mental, physical, emotional and cultural realities of what it means to be Black in America, they are more comfortable, they feel more respected and are more engaged in their own healthcare. And the result, is better care.
In other words, America needs more Black doctors.
We need those 15 young men and women in the viral photo. And 15 more them.
We need the 1,238 that graduated from medical schools across the nation last year. And 1,238 more to join them.
We need the ones that comprise the 4 percent of all doctors that are practicing in America now. And we need more to join them.
That is why we like Tulane med school student Russell Joseph Ledet’s idea (as reported in an NBC article) to get 100,000 copies of the viral photo framed and hung in classrooms across the country so that young Black children in all sorts of schools and in all sorts of circumstances can be inspired.
Because what we really need is for the medical community and educational leaders at all levels to come together on a collective plan that creates a clear and reachable path for Black youth—from elementary school to medical school—increasing the ranks of Black doctors in America to such a degree that one day a picture of dozens of Black medical students standing in front of an old slave quarters (or anywhere else for that matter) will be so commonplace, so familiar that it won’t even go viral.