May 1 , 2019
Whose Healing Hands? For African Americans in New York City Medical Schools, No Progress in 40 Years
By Barbara Caress
Last year, 78 African Americans graduated from a medical school in New York City. The 47 women and 31 men were seven percent of the 1,225 people awarded MD degrees from those seven schools. In 1975, the same seven schools conferred degrees on 75 African American students.
The 1975 number was a result of nearly a decade of affirmative action. It has barely moved in the intervening 43 years. During that time, African American medical school graduation numbers in New York City have fluctuated within a very narrow range, from a high of 86 in 2001 to a 2017 low of 52.
After the 1968 assassination of Dr. Martin Luther King, Jr., the prestigious Association of American Medical Colleges (AAMC) urged its members to rapidly ramp up admissions of under-represented minorities, including African Americans, Latinos, and Native Americans. The AAMC’s leadership projected that by 1975 the number of new students from these communities would be equal to their population percentage. That meant 12 percent for African Americans. The closest they’ve come since was 1998, when 7.6 percent of graduates were African American.
By the late 1970s, public pressure for greater inclusion of African Americans in higher education, including professional schools, had waned. While the 1978 U.S. Supreme Court decision in Regents of the University of California v. Bakke declared affirmative action legal, more importantly it invalidated racial quotas in college admissions. The not-so-subtle message to admissions committees was “do your best, but don’t worry too much.” Six state legislatures have subsequently banned affirmative action in admissions to their states’ medical schools. The result was a 17 percent drop in medical school enrollment by people of color in those states, according to 2015 study published in the Journal of Higher Education. Nationally, the pool of African American college graduates has doubled since 1975. But the proportion of African Americans enrolled in U.S. medical schools has declined. Since the turn of the century, it has hovered around six percent; in 2017 it was 5.7 percent.
Progress at New York City medical schools stopped in 1974. Moreover, local schools have failed to even contribute proportionately to the nation’s slim minority physician pool. City medical schools educate about one in 10 U.S. students, but only one in 15 of the nation’s African American students. My tabulations of data reported by the AAMC show that between 2001 and 2018, African American/Black students (AAMC's categorization) comprised slightly under 10 percent of graduates from the public State University of New York Downstate Medical Center College, which narrowly outperformed private schools Columbia and Cornell in this category. The other private medical schools, Einstein, Mt. Sinai, New York University, and New York Medical College, all did far worse. (Two-thirds of matriculants at the six private schools come from out-of-state. Most who come from elsewhere go elsewhere when they graduate.)
2001-2018 Medical School Graduates
One-quarter of New Yorkers are Black. Fewer than four percent of our doctors are. This absence of African American doctors contributes to the on-going health emergency of nonwhite New Yorkers. In 2015, the City Department of Health reported that babies born in the predominately African American Brownsville neighborhood in Brooklyn could expect to live 74.4 years. Ten years more life expectancy was registered just 10 miles away by mostly white babies lucky enough to be born in Manhattan’s Battery Park City. That same year, Dr. Damon Tweedy, a psychiatrist at Duke University Medical Center, wrote in a New York Times op-ed that “The longer I’ve practiced medicine, the more I’ve come to appreciate” how much such disparities are due to “the dearth of black doctors.”
Increasing the number of African American physicians could save lives, according to a systematic study reported in 2018. Researchers from Stanford University and the University of California at Berkeley found that Black men randomly assigned to see Black MDs were much more likely to agree to preventive measures, including blood pressure measurement, diabetes screening, and cholesterol screening. “Our back of the envelope calculations suggest the increased demand induced by black doctors could reap substantial health benefits. Specifically, we calculate that increased screening 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.”
The academic medical community’s main response to the civil rights demands of an earlier generation was to increase the number of African American medical students, but not their representation. Between 1969 and 1976, a substantial growth in government funding fueled a 50 percent increase in medical school seats. This was designed in large part to help the profession meet the greater demand for services created by the then-newly enacted Medicare and Medicaid programs. Another benefit of this increase was that minority student enrollment was expected to increase, too. It did, but growing at a much greater pace was the number of White students. So in a sense, the principal beneficiaries of affirmative action in medical education were the very same people who had been there all along. Once the rapid medical school expansion stopped, so did growth in the number of Black medical students.
More than 40 years ago, I wrote a report entitled “The Myth of Reverse Discrimination.” Charlayne Hunter-Gault of The New York Times reported a story drawing on it. It was published on the front page on April 28, 1977. She wrote, “Despite seven years of efforts aimed at increasing minority-group enrollment in the seven medical schools in New York City to at least the national average, the schools have, with one exception, fallen even further behind.” Unfortunately, what was front page news then has since become the same old story.