Many assume that the lack of Black physicians is because Black “affirmative action” medical students simply aren’t smart or strong enough to get through residency training to practice independently. Yet my conversations with dozens of young Black physicians dismissed from residency programs tell a different story.
The pattern revealed in these conversations are eerily similar, like a horror movie being replayed on a loop. In the opening scene is a Black medical student, who was heavily recruited and welcomed into the residency program with a showy demonstration of the program’s commitment to diversity. Within weeks, there is a perceived slight from them. Perhaps they questioned the appropriateness of a senior White male attending physician’s care plan or elicited tears from a White female nurse. The slight results in a blinding spotlight on the young doctor, culminating in an ironclad case for dismissal for being “unprofessional,” often for offenses ignored when they come from White counterparts.
I have yet to hear about a resident being removed for poor patient care or incompetence.
However, many dismiss these lived experiences as anecdotes, rather than the norm. “Where is the data supporting these claims?” they ask.
For the past four years, Dr. William McDade, the Chief Diversity and Inclusion Officer of the Accreditation Council for Graduate Medical Education (ACGME), has presented internal data from 2015-2016 to numerous academic medical audiences showing that Black resident physicians make up about 5% of all resident physicians but 20% of dismissals—four times their representation. Similarly, a study published in JAMA Surgery this year found that Black residents had the highest attrition from surgical specialties at 6.2%, and White residents had the lowest attrition of 1.8% over 18 years.
Pulitzer Prize-winning STAT News journalist Usha McFarling’s “‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents” reports on more than a dozen Black residents and former residents giving similar accounts. Black resident physicians participating in studies from Liebschutz, Osseo-Asare, and the Journal of the National Medical Association reported differing expectations, harsher punishments, and a daily barrage of microaggressions and bias.
This is why Black physicians have made up only 4% of the physician workforce for decades.
The lack of Black doctors has a tangible impact. In 7 states, including Maryland, at least 20 percent of all Medicare beneficiaries, who the Centers for Medicare and Medicaid Services (CMS) serves, are Black, and a larger share of Black (37%) and Hispanic (36%) Medicare beneficiaries than white beneficiaries (24%) report fair or poor health status.
Chronic disease and mortality are significantly higher among young adult Black Americans than among the U.S. population. According to the U.S. Census Bureau, Black Americans’ life expectancy in 2020 was 3.6 years shorter than non-Latino White Americans. Black American infants have a death rate of 10.8 deaths per 1,000 live births – almost twice the national average.
One way to address these persistent health inequities? Have more Black doctors. Black infant mortality is cut by half when they have Black doctors. The gap between Black and White men in cardiovascular mortality drops by 19% when Black men see a Black doctor. In counties with even one Black doctor, whether or not Black patients see those doctors, Black populations saw lower mortality from all causes and had lower disparities in mortality rates between Black and White residents. Having enough Black doctors saves lives.
According to the Association of American Medical Colleges, the United States is projected to face a shortage of up to 124,000 physicians over the next decade. At a time when demand continues to outpace supply, there is no national database to corroborate the inequitable reasons for disproportionate dismissals of vitally-needed Black doctors because no one is collecting the data. Because they don’t have to.
The Centers for Medicare and Medicaid Services (CMS) can change this.
Since its inception in 1965, CMS has been the primary investor in medical residency training (or graduate medical education, GME), providing tens of billions of dollars each year—$16.2 billion of public tax dollars in 2021 alone—to produce the types of physicians our increasingly diverse nation requires. As we face a national healthcare workforce implosion, CMS must mandate that residency programs report attrition data with explanations to stop the excess loss of Black resident physicians. It is long past time for the nation to see a return on our investment.
Vanessa Grubbs, MD, MPH
Vanessa Grubbs, MD, MPH is the Founder and President of Black Doc Village. She is the author of “HUNDREDS OF INTERLACED FINGERS: A Kidney Doctor’s Search for the Perfect Match”. She is a Board-certified internist and nephrologist. Dr. Grubbs freelances for the California Health Care Foundation blog, practices primary care at West Oakland Health, and does patient education through her blog at www.thenephrologist.com.
