Black men are increasingly underrepresented in medical schools and in the medical profession. As Louis Sullivan, M.D.,2 noted in his keynote speech, although Black3 Americans constitute 13 percent of the U.S. population, they make up less than 7 percent of medical students and less than 3 percent of practicing physicians.4 Moreover, according to the Association of American Medical Colleges 2014 report Altering the Course: Black Males in Medicine, although the proportion of Black students in medical schools has increased in the past several decades, the gains are entirely attributable to advances among Black women. By contrast, in the same period, the number of Black men in medical schools decreased. For example, only 515 Black or African American men matriculated to medical school in 2014 compared with 542 in 1978. Furthermore, whereas the numbers of male and female medical students are approximately equal for most racial and
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Joint Workshop was prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
2 Sullivan is chairman and chief executive officer of The Sullivan Alliance to Transform the Health Professions and president emeritus of the Morehouse School of Medicine.
3 The planning committee prefers the use of the term Black. However, throughout the proceedings, the terminology used reflects the language used by individual participants or in original sources.
ethnic groups, there are substantially more Black female medical students than Black men. Of note, this contrasts with gains in representation among other racial and ethnic minorities in medicine.5 Despite these advances, many minority groups remain underrepresented in medicine and science. This problem is particularly acute among Black men.
Victor Dzau, M.D., president of the National Academy of Medicine (NAM), remarked that a diverse workforce is a key attribute of quality health care.6 As he and Sullivan both remarked, research suggests that a diverse workforce may help to advance cultural competency and increase access to high-quality health care, especially for underserved populations. Conversely, lack of diversity in the health workforce threatens health care quality and access and contributes to health disparities. In this way, the growing absence of Black men in medicine is especially troubling, because their absence in medicine may have adverse consequences for health care access, quality, and outcomes among Black Americans and Americans overall.
A concerted initiative to explore ideas, especially new ideas, to effectively address the issues surrounding the lack of Black men in medicine began with the W. Montague Cobb/NMA Health Institute (Cobb Institute), its founding chair of the board, Cato T. Laurencin, M.D., Ph.D.,7 and the Connecticut Legislative Black and Puerto Rican Caucus of the Connecticut General Assembly. At the same time, Laurencin and Marsha Murray, M.S.,8 published “An American Crisis: The Lack of Black Men in Medicine” in the Journal of Racial and Ethnic Health Disparities, a publication of the Cobb Institute. The article, which the NAM reprinted as a discussion paper, called for, among many things, a national dialogue on the subject of Black men in medicine.9
To better understand the factors that contribute to the low participation of Black men in the medical profession, facilitate discussion of current strategies used to increase their participation in medical education, and explore new strategies along the educational and professional pipeline that may have potential to increase participation in medicine,
5 For the full report, see https://members.aamc.org/eweb/upload/Black_Males_in_Medicine_Report_WEB.pdf (accessed March 15, 2018).
6 See also Institute of Medicine. 2003. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press. https://www.nap.edu/catalog/10260 (accessed March 20, 2018).
7 Laurencin is university professor, Van Dusen Distinguished Professor of Orthopaedic Surgery, and director, The Raymond and Beverly Sackler Center at the University of Connecticut.
8 Murray is state treatment coordinator/research assistant at UConn Health.
9 For the paper, see https://link.springer.com/article/10.1007%2Fs40615-017-0380-y (accessed April 4, 2018) and https://nam.edu/an-american-crisis-the-lack-of-black-men-in-medicine (accessed April 4, 2018).
the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (the National Academies) and the Cobb Institute jointly convened a 2-day workshop on November 20 and 21, 2017, in Washington, DC.
An ad hoc committee (see Box 1-1 for the planning committee’s Statement of Task) planned and designed the workshop to meet the following objectives:
- Briefly review the past and current history of Black men in medicine and science and the challenges encountered in the transition points to becoming successful physicians and scientists.
- Explore innovative strategies to support entry and successful passage through educational and career transition points leading to an increase in Black men in science and medicine.
- Consider the role of government, educational systems, philanthropy, industry, and others in effecting change along educational transition points.
- Explore ways in which innovative strategies can be shared with others, spread, and scaled up.
To achieve these objectives, the planning committee organized panels addressing challenges and barriers for Black men’s entry into the medical profession, current strategies to address these challenges, and how medical schools, philanthropies, and government can address the absence of Black men in medicine.
In his introductory comments at the workshop, J. Michael McGinnis, M.D., M.P.P.,10 noted that the absence of Black men in medicine is a problem not only for health and medicine, but a challenge for the future leadership of society at large. NAM President Dzau was unable to attend the meeting in person, but sent a recorded video providing some context about diversity in medical education. In his recorded remarks, he noted that African Americans, Latinos, and Native Americans are underrepresented in the health professions relative to their proportion of the U.S. population. Drawing on Missing Persons: Minorities in the Health Professions,11 the 2004 Sullivan Commission on Diversity in the Healthcare Workforce report, which keynote speaker Sullivan chaired, Dzau added that enrollments of racial and ethnic minorities in medical, dental, and nursing schools are projected to decline. Dzau commented that he hoped that the workshop would serve as a “call to action to all of us to work together to reverse these trends.” He stated that the shortage of Black men in medicine is of particular concern given the poorer health outcomes they experience relative to other racial, ethnic, and gender groups in the United States. He elaborated that this shortage “threatens the quality of our health system, hampers progress improving health for all, and challenges equity and justice.”
Laurencin pointed out that the dearth of Black men in medicine is not a new issue, but a growing issue. He highlighted the article he coauthored with Murray on this issue, which they describe as “an American crisis that threatens efforts to effectively address health disparities, and to address excellence in clinical care.”12 He closed his remarks by echoing Dzau’s hope that the meeting would be a “call to arms for people to get together nationally to move forward.” He elaborated that the workshop is intended to bring out ideas. Additionally, he commented that the proceedings of the workshop could be used as a tool to discuss the ideas raised at the meeting and to raise awareness about the growing absence of Black men in medicine as a problem for all Americans.
This Proceedings of a Joint Workshop describes presentations, synthesizes discussions that occurred at the workshop, and highlights par-
10 McGinnis is Leonard D. Schaeffer Executive Officer and Senior Scholar at the NAM.
11 For more information, see http://www.aacnnursing.org/Portals/42/Diversity/SullivanReport.pdf (accessed February 20, 2018).
12 For more information, see https://nam.edu/an-american-crisis-the-lack-of-Black-men-in-medicine (accessed February 20, 2018).
ticipants’ ideas for opportunities that may have potential to address the absence of Black men in medicine. Chapter 2 summarizes two keynote presentations that examine the history and current state of Black men in medicine, the problem of their growing absence, and why it matters for health and health care. Chapter 3 summarizes presentations on the challenges and barriers Black men face along the life trajectory that may contribute to their absence in the health professions, while the presentations in Chapter 4 focus on challenges and barriers along the educational trajectory. Chapter 5 examines current strategies to support the entry of Black men in medicine. Chapter 6 summarizes reflections on the barriers for Black men to pursue medical careers and the current strategies to address them from the first day of the meeting. Chapter 7 begins with opening remarks from the second day of the meeting and discusses how medical schools can increase diversity in their student body and how they can hold themselves accountable for doing so. The presentations in Chapter 8 examine financial barriers to medical education, including how non-educational financial cost can hinder educational achievements. Chapter 9 summarizes presentations on the role of philanthropies, and Chapter 10 discusses the role of government. Chapter 11 presents final reflections on the workshop sessions and summarizes a general discussion in which participants brainstormed potential strategies to address the dearth of Black men in medicine.
In accordance with the policies of the National Academies workshop participants did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues discussed by the speakers and workshop participants. In addition, the planning committee’s role was limited to planning the workshop. Cato T. Laurencin was the designated rapporteur and prepared a factual summary of what occurred at the workshop.
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