When I gaze upon the (virtual) fresh faces of students starting medical school, I am struck by the few Black faces present. As president of the Student National Medical Association (SNMA), America’s largest student-governed organization dedicated to addressing the needs of underrepresented medical students and underserved communities, I am starkly aware of our lack of representation in many spaces in American society. The long-standing physician shortage experienced by the poor and by communities of color in the United States has only worsened with the COVID-19 pandemic.1 Notably, there are disproportionately few Black physicians in the United States.2 This not only negatively impacts patient care for people of color3 but also increases the burden of representation Black medical students face as we manage our educations and our additional responsibilities: fighting for racial justice within the medical community.
Giving Black Patients the Care Needed
When a Black patient is admitted to my service on the wards, I instinctively request that he or she be placed on my patient list. This instinct comes from years of seeing Black patients receive substandard care due to systemic beliefs or stereotypes that Black people are “non-compliant,” “drug seekers,” have a “higher pain tolerance,” or “put themselves in these situations” because of their “poor life choices.”
I had one Black male patient who was described as “non-compliant.” I sat and listened to him, and I heard frustration and hints of mistrust as he told his story. He had been placed on many medications to treat his primary health issues, with extra drugs added to treat side effects, without his receiving appropriate counseling about each medication. As my patient experienced side effects, he—like any reasonable human—would stop taking the medications and attempt to make a follow-up appointment with his physician, which would take from weeks to months to be scheduled. By the end of our conversation, I knew he was someone greatly misunderstood by the healthcare system, burdened by poor access to care, and poor quality of care. He had just won his battle with cancer and was tired. I reviewed each of his medications and why each one was necessary. Once we were done, he expressed feeling reassured and better able to make informed decisions regarding his health. Unfortunately, rather than his providers trying to understand his situation, his skin color led to a rushed judgment as “non-compliant.” I worked to correct these dangerous errors of the medical team, but I worry about the countless other Black patients whose perspectives get erased in our racially unjust healthcare system. Patient experiences like this one have unfortunately been regular occurrences during my medical training.
Doing the Work that Others Cannot and the Burdens of 2020
In addition to my medical studies, I attend multiple committee meetings on diversity and equity at my medical school. I am tasked with representing the “Black voice,” and I am not alone in paying the “minority tax.” Black students are highly underrepresented in medical school, yet Black students do the heavy lifting in anti-racism work for our institutions, whether by providing feedback and solutions to inappropriately racially stereotypical cases presented during problem based learning sessions, standing up for Black patients treated unfairly in the clinical setting, or creating curricula that encompass diverse communities.
This list is not exhaustive. Black medical students serve as leaders and carry the burden of championing justice, often without acknowledgement and support for our central role. Concerningly, students are often reproached for being over-extended and not studying enough. We are expected to perform academically at the same level as our peers, in addition to working for institutional change—a burden that isn’t equitably placed on our peers.
The year 2020 has presented even more burdens for Black medical students. We see our Black brothers and sisters dying disproportionately from COVID-19. Many of us have lost family members and friends. We see our Black brothers and sisters dying disproportionately at the hands of law enforcement and a racially biased justice system. We also face racism from our own classmates and teachers. A former medical student defaced a George Floyd memorial; this is but a small snapshot of the racial prejudice we experience from our peers. All of this contributes to Black students being overtaxed, compounded by the lack of diverse representation in medicine.4
Despite this, we are expected to go about our medical training and duties as if everything is business as usual. However, these traumas are rarely acknowledged in our daily interactions in our healthcare institutions, while at the same time we participate in working groups and task forces to discuss racial climate concerns and provide solutions.
Call to Action
SNMA has long provided a voice and support for Black medical students, and we call upon academic medicine to support Black students in medical school, recognize our contributions, and prevent early burnout. Medical schools are not providing us with the resources we need to heal from the trauma stemming from the heightened emotional impact of today’s climate and succeed academically in spite of it.
We need medical schools to invest in Black students, increase our numbers, and increase the diversity in faculty and leadership. We need diverse leaders who can make change and serve as role models for Black medical students. Black, Indigenous, and People of Color (BIPOC) members of the medical community tend to be relegated to positions of deans of diversity and inclusion, as if they cannot contribute their wisdom and skills to other areas such as deans of academic affairs, as chairs, division chiefs, and other roles. There must be representation of individuals of diverse backgrounds in all types of leadership positions who can identify bias and racism within our institutions and be empowered to provide solutions. By addressing this issue now, we will in part address the snowball affect it has on the future of academic medicine for faculty of color.5
Medical schools must ensure that all students know about the history of racism in medicine. This would include teaching students about the formation of systemic racial inequities and medical mistreatment of Black people by this country. It is crucial to provide context to the patients we see today; without it, we cannot give Black patients the quality comprehensive care they need. This educational content will train everyone to speak out against injustice, and it will build the next generation of physicians of all races and ethnicities who will stand up boldly for what is right when it concerns the health and well-being of communities of color.
Acknowledgments: Eloho Akpovi, MS; Kameron Matthews, MD, JD; Thomas Pak; and Melissa Palma, MD, for help with editing.