ROCHESTER, Minn. — A new study has learned that the percentage of American doctors who are Black men has not changed since 1940, and that the percentage of doctors who are Black has only risen 4 percentage points since the beginning of the 20th century.
Dr. Dan Ly, an assistant professor of medicine and a Health Services Research specialist at the David Geffen School of Medicine at UCLA, consulted the U.S. Census longform survey from 1900 to 2000, as well as subsequent Census surveys from 2010 and 2018.
Upon estimating the total percent of U.S. population and U.S. physician population that were Black for each survey year — a count totaling nearly 150,000 physicians, approximately 3,300 of whom were Black men — he reported the findings.
In 1940, while 9.7% of the U.S. population was Black, just 2.7% of American doctors were Black men. By 2018, the percentage of the population that was Black had climbed to 12.8% and yet the percentage of American doctors who were Black men had dropped to 2.6%.
During this same period, the percentage of physicians who were Black women climbed by 2.7%.
Ly also reported that in 1900, 11.6% of the population was Black and yet just 1.3% of American doctors were Black. By 2018, nearly 120 years later, 12.8% of the population was Black, while the percentage of American doctors who were Black had climbed to just 5.4%.
"These findings did surprise me," said Ly in an email. "Especially that the proportion of physicians who are Black men has remained basically unchanged for 80 years. That’s just such a long time for there to be no real improvement."
Ly cites research published last summer in JAMA showing that most of the historically Black medical schools were closed early in the 20th century. Those closures were a product of The Flexner Report, a landmark 1910 document standardizing medical training, and a transformation that critics argue exacerbated and prolonged racist admission policies of the era.
"Had they stayed open," Ly says, "these schools could have trained about 30 thousand more physicians."
Black men face barriers to medicine
The study, published in The Journal of General and Internal Medicine, also found that Black men who are physicians face pay disparities that have changed little since 1960, dropping from $68,000 to $50,000 annually.
He speculated the effect could be related to Black male physicians working for Medicaid patients more frequently, and their lack of representation in higher paying specialties, but did not have data specifically on race and specialization training.
"I think that (barriers to specialization) is a large contributor," said Dr. Kenneth Poole, a general internal medicine practitioner, medical director of Patient Experience for Mayo Clinic's campus in Arizona, and an admissions committee member for Mayo Clinic School of Medicine. "I don't think its the only contributor."
"I will say that as a Black male medical student I've experienced personally, and also seen peers be actively discouraged from higher paid specialties," Poole said. "Even if it's done subconsciously, but I've seen it done actively by institutions... it's almost like the goal posts are moved, if you will, as it pertains to the requirements or perceived requirements for matching in the higher-paid specialties. So those specialties have largely eluded a lot of us."
Poole believes even within specialties, barriers have kept Black male physicians' pay lower.
"The contracts physicians have, the way they are provided resources and opportunities to grow their practices, practicing in academic settings which tend to be lower-paid versus more elite private practice settings, all those things play a role as well. So even if you made the proportion of Black male physicians more equitable amongst higher-paid specialties, I would venture to say there would likely still be a pay gap."
Poole calls the findings "good in the sense that it's being talked about... but not surprising at all. Being a Black male physician, those numbers — I experience those numbers in terms of just my experience throughout medical school residency, training and working."
Both Ly and Poole believe a primary reason to bring more Black men into medicine comes down to health care disparities known to be linked to the diversity of the physician workforce.
Research shows "Black patients are more likely to undergo preventive care by Black physicians," says Ly, "and that therefore increasing the number of Black physicians could reduce Black-white gaps in life expectancy. So both improved quality of care and equity favor increasing the number of Black physicians."
"It's hard to find single drivers," Poole said, "but one thing that has been shown is increasing the proportion of Black providers, particularly Black male providers, can move the needle in some health outcomes, and also improve the experience of care. "
"I would just say that what we are doing now obviously isn’t working," Ly says. "Given how long it takes to train a physician, which starts during and arguably before college, we need to do something different, and soon, if we care about the racial diversity of the physician workforce."