Increasing Representation of Black Men in Medicine

00:00:00:03 - 00:00:19:28
Tom Haederle
America is already running short on physicians and every health labor forecast projects it will only get worse in the next decade or so. Even more alarming, at a time when they are needed most. The percentage of black male physicians in the field has been basically unchanged for the past 80 years and isn't showing signs of growth even now.

00:00:20:15 - 00:01:10:19
Tom Haederle
What could be done to attract, recruit and train more talented young black men to the practice of medicine? And what implications would that have on the goal of health equity? Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In this podcast, Ogechi Emechebe, a senior communication specialist at AHA’s Institute for Diversity in Health Equity, and Dr. Leon Caldwell, senior director of health Equity Strategies, discuss ways to increase the number of black male physicians in the field and how that would lead to more equitable health outcomes for people of color.

00:01:11:04 - 00:01:27:14
Tom Haederle
They are joined by Dr. Owen Garrick, chief medical officer at CVS Health Clinical Trial Services, and Dr. Pierre Vigilance, senior partner at Korn Ferry, to explore how hospitals can create a pathway for black men into the health sector and provide a new vision for achieving health equity.

00:01:28:19 - 00:01:48:24
Ogechi Emechebe
Welcome, Dr. Garrick and Dr. Vigilance, thank you very much for taking the time today to speak with us for this very important conversation. So as you know, now it's February and it's also Black History Month. And today we wanted to discuss an interesting yet discouraging trend in America. And it's about the very small and stagnant number of black male physicians.

00:01:49:04 - 00:02:12:14
Ogechi Emechebe
According to the association of American Medical Colleges. Black men make up less than 3% of physicians nationwide. And a 2021 study by UCLA found that the percentage of black male doctors remained unchanged since 1940, which is around 2.6%. Meanwhile, the share of black female physicians and the doctors that are people of color have seen increases.

00:02:13:00 - 00:02:42:00
Leon Caldwell
So this is what we would call rather, if not disturbing trends. One problematic for our area of health equity. And as we talk about this topic and I thank you both again for your time and your work and your commitment to health in our country, one thing that's really of importance that we can lay out in the beginning of this conversation is data tells a story.

00:02:42:11 - 00:03:08:01
Leon Caldwell
And what I'd like to hear from it gets you first, Dr. Garrick, and then you, Dr. Vigilance, is when you hear this data and consider yourself within that 3% of physicians - what conjures up for you? Like what's the emotional space you're in when you hear those those numbers that represent your presence in the field? Dr. Garrick?

00:03:09:06 - 00:03:34:27
Owen Garrick
Sure. So so a few thoughts. One on the positive end, right? It seems like there's been the sisters are getting their act together, right? So it is much more an increase in presence and participation and numbers in terms of black female physicians. So positive trend there. So the thing I think through is what success, what is driving success there?

00:03:35:17 - 00:04:20:29
Owen Garrick
How can we mirror some of those strategies, alter some of those strategies for black men? And you know that statistic that in essence, it's been flat since 1940. I imagine there's been a little bit of movement, right? So they're probably some times when it's exceeded 3% and maybe retreated. So, you know, as a statistician, I fancy myself as a statistician, at least if I want to think through what are the some of the inflection points in, you know, a 40, 50 year history that we can point to or at least to look into the data, to share that, to see where there might be some successes and figure out how we amplify some of those.

00:04:20:29 - 00:04:22:28
Owen Garrick

00:04:23:00 - 00:04:23:13
Leon Caldwell
Great. Dr. Vigilance?

00:04:24:02 - 00:04:48:03
Pierre Vigilance
So the thing that makes me think about is we've not made significant strides with respect to health and wellness in the same communities that we were referring to having challenges with respect to physician populations or physician composition. Although we are seeing this increase, I've seen this increase in the number of black women who are entering the field of medicine.

00:04:48:03 - 00:05:22:18
Pierre Vigilance
And I think that that's fantastic. That the black male situation mirrors to me or for me a lot of the other sort of social determinants of health oriented considerations that we are also not seeing improvements or haven't seen improvements in. And it sort of relates to challenges around these systemic areas of concern outside of medical education itself. Back to K through 12, education and or support systems within communities and or the communities themselves and how well developed they are.

00:05:22:25 - 00:05:56:16
Pierre Vigilance
These socioeconomic driving factors of wellness in its entirety that include education, aspiration, income, etc. and all of these things being a set up for where individuals go and where communities go. So if communities of color were rising, if you will, then I would have expected for not just women of color to be increasing in their numbers, but also men of color to be increasing in the numbers in some of these fields.

00:05:57:01 - 00:06:26:13
Pierre Vigilance
And I think that that's a function of where we are with respect to some of those social determinants and the fact that those things haven't improved significantly enough for more people to be lifted out of or lifting out of existing circumstances to different circumstance to put them on a trajectory into medical school or elsewhere in the health care field I think is related to that.

00:06:27:06 - 00:06:58:29
Leon Caldwell
That's a really interesting concept. So here we have two physicians who have been in this space for quite some time. And going back to Dr. Garrett's point around looking at success, oftentimes we look at what why things fail. But if we sit and look at success with two successful black male physicians in our midst right now. Tell me a little more about what's your success story like?

00:06:58:29 - 00:07:00:14
Leon Caldwell
How did you get to where you are?

00:07:00:26 - 00:07:22:13
Owen Garrick
Sure. So I appreciate I'm going to take you're saying we've been in this space for a long time. You're calling us old ... Pierre is older than me. So I would say a few things. Well, first, you know, my motivation for becoming a doctor. I always wanted to be a doctor since I was a kid. Like, if you when I was three or four, that I have a faint memory of someone asking me what I wanted to be.

00:07:22:15 - 00:07:44:21
Owen Garrick
And with this, you know, to be a doctor, they weren't any physicians and the family - I have a brother in law now who's a hands surgeon, but no physician and certainly some nurses. And for me, it was I like the science. I want to make my grandparents proud. So I pursued the typical path of being pre-med. And obviously, go to medical school.

00:07:44:28 - 00:08:13:17
Owen Garrick
And I think back. I think there are a few things. One, parents that were both favorably supportive and laser focused on education. Right. We don't always think about Tiger parents in the African-American community. Right. But there are tons of them. And I certainly had them where, you know, I remember my dad being at literally every single parent teacher conference when I was, you know, growing up.

00:08:13:25 - 00:08:47:21
Owen Garrick
And I was like exceedingly well. So but there was just that support not just within the household, but also from without where whether it be mentors, teachers, professors that I built relationships with in college that continued to support me throughout. You know, that amplified some of my internal motivation and then don't in a peer network. Right? So as I mentioned, Pierre and I have known each other since medical school.

00:08:48:20 - 00:09:13:21
Owen Garrick
If I have any questions around from public health to policy. Greg, anything in health care, I might reach out to him. Right. So we have we've built this natural network. So I guess the constant theme is tons of support that I have had that is really amplified. I think my internal motivation because it's not it's not linear, right?

00:09:13:21 - 00:09:34:10
Owen Garrick
Med school ain't easy, as they say. Right? So you need to think through and have a system or a set of systems where you've got you have folks that hold you up and frankly, maybe even expand some of your thinking. Right. And I mean, in research. Right. And and more the the the business management side of research.

00:09:34:10 - 00:09:44:07
Owen Garrick
And 30 years ago, I would not have thought anything about this field. But there are many others. Many folks do it my path that exposed me to different aspects of health care.

00:09:44:07 - 00:09:53:23
Leon Caldwell
That's helpful. So I heard parental support, support in general and supportive networks as well. And exposure. Dr. Vigilance?

00:09:53:23 - 00:10:19:26
Pierre Vigilance
So I think that that network notion does start at home and being able to connect the dots to family members. Immediate and then more, more distal is is a very important part of things. So I grew up in a household where so my parents were immigrants from the West Indies to the UK and then were immigrants again from the UK, bringing us here to America.

00:10:19:26 - 00:10:46:11
Pierre Vigilance
When when I was in my late teens, that drive, seeing that understanding what that meant, understanding the sacrifices that they made and seeing the the way that they pushed themselves and the way that they pushed us was sort of a major piece of the initial part of how things got going. I don't have that same recollection of "wanting to be a doctor" in quotation marks.

00:10:46:11 - 00:11:08:17
Pierre Vigilance
When I was very young, my parents were both providers of some sort. My father was an optometrist, my mother was a social worker. And so that was an interesting set of conversations around access to care, care and that side of things from my father's side of things. And then the social spending, the social network part of things from my mother's side and social services.

00:11:08:24 - 00:11:32:23
Pierre Vigilance
So I've got a very interesting and different look at what health and wellness meant in a different country, different time, but still with people who were in that work with a particular set of focus, but like our own involvement and engagement, that sort of acts with our schools when things were good or when things weren't so good.

00:11:33:12 - 00:12:02:13
Ogechi Emechebe
Thank you so much for those answers, Dr. Vigilance and Dr. Garrick. So both of you mentioned that you know, it's really important to have a very strong support system. Something that we often hear from black men in medical school is that they see that they don't often feel support or they feel alone in their journey. So when men are in this on the school journey and they're talking about feeling isolated, feeling like no one understands them, how can we address this issue and what advice do you have for them?

00:12:02:22 - 00:12:04:05
Ogechi Emechebe
Dr. Vigilance, would you like to start?

00:12:04:29 - 00:12:31:24
Pierre Vigilance
Sure. So reflected on this before, and it was just quietly humbling to to recall that I was really blessed to have people at the schools that I went to for medical school and public health schools ... at Johns Hopkins in Baltimore. And there were a good number of there were a fair number of us in the I think we made up about 10% of our of our class.

00:12:31:24 - 00:13:00:22
Pierre Vigilance
So 12 or 13 of us in the class. But then there were a number of faculty members from the admissions office all the way through to cardiovascular surgery department. Dr. Levi Watkins, residents at the time, Dr. Malcolm Brock and others, internal medicine residents who were stars, I mean, they were well, well, well respected among their peers. And we'd hear about them from rotations and stuff like that.

00:13:00:22 - 00:13:42:10
Pierre Vigilance
And all these folks were ahead of us and they were available to us. They made themselves available to us. They engaged themselves with us, safe to say, years later, I'm able to pick up the phone and speak to any of them. A couple of them have unfortunately passed on. But certainly having those individuals there was hugely important. And I think that that's important for institutions now to make sure that there are those individuals who are not only present but also available to students for the type of support that we're talking about. Everybody who is of a particular skin color doesn't necessarily have the same lived experience.

00:13:42:20 - 00:14:21:29
Pierre Vigilance
And I think that from a culture perspective, from an institutional perspective, say, well, if we just have X number of students of color or students of African descent in the class, then they will naturally bond with each other and become one unit that will support each other may or may not be true, and the same can be said of faculty, etc. So having people who are able themselves to communicate regardless of even nuanced differences in background, but understanding some of the struggles based on race, ethnicity, etc. is very important, but something that institutions need to be mindful of.

00:14:21:29 - 00:14:34:18
Pierre Vigilance
The fact that simply having the numbers of a particular group doesn't necessarily mean that everybody in that group identifies the same way and means the same things.

00:14:35:17 - 00:14:55:11
Leon Caldwell
There's a part to this conversation, too, is like once you're out of medical school, right? Like once you're practicing, what I've always wanted to have conveyed is what difference does it make? Like why are having black male doctors even important to hospitals and health care systems?

00:14:55:29 - 00:15:20:06
Owen Garrick
And I'm having to take a credit that, you know, I want to come back to the original question and say, I think it's probably clear, but I want to make it obvious that these feelings, when we think about black male students or physicians and these feelings of isolation, I want to first acknowledge that your feelings are valid. Right?

00:15:20:06 - 00:16:01:09
Owen Garrick
So oftentimes we are, as black men, not allowed to feel angry, frustrated, scared. Right. And your feelings are valid. They are your own. They are acknowledged. So I think that is very, very important. And as Pierre mentioned, you know, there is this natural network you can build of African-American or like, you know, similarly cultured individuals. The other thing I think is important is accessing, especially if you're going to be in most of these professional settings, right.

00:16:01:09 - 00:16:37:04
Owen Garrick
They're going to be fewer numbers of people of color. So it will be, I think, important and critical to build relationships and be proactive about building relationships and looking for support with those that don't necessarily look like you. So I think it's critical that we look outside of sort of our cultural comfort to build these networks. And as to get to your your follow up question, you know, a few of us a few a couple of years ago published some research that looked at the importance.

00:16:37:17 - 00:17:07:25
Owen Garrick
And as Pierre mentioned, we want the real the real issue is health outcomes at the end of the day. So the importance of cultural congruence with that strong correlation and impact on health outcomes. Part of it is when you have people of color, physicians of color interacting with people of color, there is increased comfort, right? So there is an increase of exchange of information between provider and patient that leads to better insight.

00:17:08:05 - 00:17:39:16
Owen Garrick
It leads to I believe, though, that if we study this over the long term, earlier diagnoses and also more referrals to care options that you don't often see. Right. So better the increased ability to access the health care system facilitated by someone that looks like you, that has a frankly a born, inherited vested interest in your health and your health outcomes.

00:17:40:13 - 00:18:14:11
Leon Caldwell
So if you lean into the perspective that the presence of black male doctors will create, or at least afford the ability for a deeper knowledge, deeper relationships, kind of a joining, if you will, around health and particularly health outcomes. Would you conjecture that more black doctors would essentially decrease or if not eliminate, the disparities we see in black males health outcomes?

00:18:15:04 - 00:18:35:24
Pierre Vigilance
So as you both know, I have a...we're all raising children as we're raising kids at the moment. So and my little boy, I look at him and I think about what he's going to be dealing with going forward. Right. And we talk about why it's been a great boon that more African-American women are in medical school.

00:18:35:29 - 00:19:03:22
Pierre Vigilance
That's not to take away from the fact that they have climbed to those positions, working through a lot of sludge and mess, the kind of sludge and mess that impacts their ability to carry a child that has normal birth weight, for example. You know, an educated African-American woman ... actually, an uneducated white woman, is more likely to be able to carry a normal birth weight baby than an educated African-American woman.

00:19:03:22 - 00:19:29:22
Pierre Vigilance
And that's strange sounding statistic, but it's it's verifiable. And I think that we've got so far to go beyond just increasing the numbers of people, of "N." N equals a particular thing. It's almost like a particular approach to almost maybe even workplace or human resources. We say we've got X number of people doing that job now, so we're good.

00:19:30:13 - 00:19:57:14
Pierre Vigilance
The right people doing the work. And I think that that's important regardless of race, right? And if you're going to have people do certain work in certain communities, regardless of their race, regardless of the races of the community they're working in, if there isn't that desire to understand and to connect and to have dialog and to have the stories be told truthfully and there be this development of trust, then these outcomes don't change.

00:19:58:11 - 00:20:29:02
Owen Garrick
I would add. It's also getting individuals in leadership positions where they can control and directories sources. You know, if you think about the field that I'm in, ask more relevant research questions because a lot of this is nuanced. I think at the surface think, well, if if black women are having more success, why aren't just black men and women generally?

00:20:29:10 - 00:20:59:13
Owen Garrick
Right? So there's a nuance there you need to begin to think through. And if you have this, to to Dr. Vigilance point, this better connection, trusted relationship, you have the ability to hone in on what those distinctions are. If you control resources, you can leverage that analysis to direct resources in a more appropriate way. And we all invariably live in a resource constrained world, right?

00:20:59:13 - 00:21:21:29
Owen Garrick
So often times you need to have leaders decide where to put resources, which many times means not putting resources in other places. But I think that in addition to this connection that undergirds the leadership and the the control and the ability to direct resources would also be important.

00:21:22:18 - 00:21:45:08
Leon Caldwell
So, Dr. Garrett, here's a question I have for you. What do you see as the the role of hospice and health systems to advance equity for more black male physicians to take either leadership roles, practice roles, whatever roles they may take within health care in the United States?

00:21:45:28 - 00:22:13:03
Owen Garrick
I think there are a couple of opportunities here, right? So clearly, the ability to from a health system or hospital perspective to be part of that pipeline, that funnel. Right. So you are hiring, employing engaging black male physicians. You have it as a plan of yours not just to get them in, but to support them while they're there to advance their careers.

00:22:13:03 - 00:22:51:06
Owen Garrick
So they are you know, they grow into leadership positions and those positions could be clinical leadership, could be research leadership, but also the administrative or fiscal leadership of an institution. So that is broadly the opportunity. And as you think through one, this acknowledgment that there are smaller numbers having a commitment just like you would think about your nursing staff, right, your public administration staff, you build relationships with those institutions that educate and train that workforce.

00:22:51:24 - 00:23:18:23
Owen Garrick
The other part of this is thinking about what do you envision as the workforce of the future? So it's not just about bringing in individuals to fill a current role, but as you think about operating differently, you know, Dr. Vigilance mentioned these integrated care teams, but there are also these different settings, right? So it's not just hospitals are not just these inpatient entities, but are acquiring and building community presences.

00:23:19:05 - 00:23:27:13
Owen Garrick
So thinking through how black male physicians could and should have a role in the health care system of the future.

00:23:27:13 - 00:23:40:21
Ogechi Emechebe
I want to leave you both with one final question, and that is, what is your vision for health equity, given your experience and your knowledge and everything that you've dealt with so far up in your career, what would you hope? Where would you hope we are, you know, 50 years from now?

00:23:41:02 - 00:23:52:27
Owen Garrick
Yeah, I'll say that we put ourselves out of business, right? The entire apparatus of figuring out health equity, we figured it out in and we put ourselves out of business.

00:23:53:09 - 00:24:25:04
Pierre Vigilance
Yeah, I think we talk about this picture that we that we paint with the history that we were referring to before. And unfortunately, we're working on screens proverbially, that have many pixels missing. We've got only a partial picture of what entire communities look like because we've we've dug into certain spaces on those screens and we've got to define granular points of clarity with respect to some elements of it, but not others.

00:24:25:10 - 00:24:52:22
Pierre Vigilance
And none of us would buy a television screen that only showed half a picture. We'd take that back to the store immediately. But for some reason, to Doctor Caldwell's point about data, we've had data in to some extent. We have not necessarily chosen to go out and improve the collection of other data. And so we've got this partial fuzzy picture, but it's been okay and we've been able to we've just worked with it.

00:24:53:09 - 00:25:14:17
Pierre Vigilance
And I think that in 50 years time, hopefully much sooner than that, we will say, no, that screen is not sufficient for any of us and any part of an organization to be functioning to say that we're actually trying to improve outcomes and that we need to clarify this with adding to the data that's put into this picture so that it can be the high definition picture.

00:25:14:17 - 00:25:23:19
Pierre Vigilance
We need to be able to see exactly what's going on. And until you can see what's going on, you can't really address it.

00:25:24:03 - 00:25:59:29
Ogechi Emechebe
Well, thank you so much, Dr. Vigilance and Dr. Garrick for your time today and sharing with us this wealth of knowledge that essentially gives us and our members a call to action to tackle these issues. Thanks for listening. For more information from the Institute for Diversity in Health Equity, please visit our website at ifdhe.aha.org