For Dr. Steven McDonald, being a black man in a white coat has never been easy.
An emergency department physician in New York City, McDonald has had to thicken his skin against the slings and arrows he suffers as an African American working in a predominantly white profession: Workplace slights, both obvious and subtle, from colleagues’ questioning his qualifications – couched in polite small talk – to bigoted white patients asking for another doctor.
But the gut punch comes when McDonald finds himself on the floor at New York Presbyterian Hospital, watching the hospital’s mostly white staff treat a stream of Black patients – some with COVID-19, others without a primary care doctor, many without health insurance.
“It’s like being hit on all sides,” says McDonald, who’s also an assistant professor of emergency medicine at Columbia University Irving Medical Center. Black “people giving care, like myself, feel this incredible glass ceiling bearing down upon us. And then at the same time, the (Black) patients have it much worse – without jobs or health insurance, without food security, without appropriate telecommunications to make appointments.”
The relentless stress of seeing Black people struggle, up close and in real time, while coping with the discriminatory weight of being an African American professional – a type of “Black tax,” in other words – is not new, McDonald says. COVID-19, he says, “just made it more visible.”
As the coronavirus pandemic grinds on, it continues to put unprecedented stress on health care workers of all colors nationwide and around the world. The problems of exhausted caregivers range from a lack of personal protective equipment to reports of burnout and deteriorating mental health, even suicide.
African American physicians, however, are carrying a second burden: the medical profession’s unresolved issues with race. That weight, they say, has gotten heavier amid a raging pandemic that’s disproportionately affecting Black people and exposing long-standing disparities tied to the nation’s checkered racial history.
Aside from the psychological stress of marathon shifts treating patients with a highly contagious, potentially deadly disease, experts say Black physicians are more likely than whites to practice in underserved communities – work that typically brings them face to face with the people and places where the virus is having the largest impact. Medical facilities in these areas also tend to have fewer resources to treat patients, experts say, and often have lacked enough equipment to protect caregivers from the virus.
Because of this, African American doctors face a disproportionate risk of contracting the virus compared with their white colleagues. At the same time, they tend to have more health conditions that could lead to severe illness if they do come down with COVID-19, and are less likely to receive top-quality care if they are hospitalized.
Unless these types of issues are addressed, researchers warn, the ranks of Black physicians – already miniscule, at just 5% of the profession and 7% of all medical school students – could shrink even further.
The pandemic “may erode the meager progress that has been made in increasing the number of Black physicians,” according to a commentary by Dr. Molly Carnes, director of the Center for Women’s Health Research at the University of Wisconsin-Madison, and Amarette Filut, an associate researcher at the center. Academic Medicine, the journal of the Association of American Medical Colleges, published the commentary online in July.
It’s a threat because “Blacks are overrepresented among cases of COVID-19, Black physicians care for relatively more Black patients often in settings with less access to (coronavirus) testing and personal protective equipment, and Black physicians have more comorbid chronic conditions that increase their own susceptibility to mortality from COVID-19,” according to the commentary.
The disparities highlighted by the pandemic have not been a surprise to most Black doctors and others in health care, “given our long-standing heightened awareness of them,” says Dr. Damon Tweedy, an instructor at the Duke University School of Medicine and author of “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.”
Yet because COVID-19 has put racial disparities in even more stark relief, the powers that be have “a clear opportunity for advancement of the health and wellness of Black people,” says Tweedy, an associate professor of psychiatry and behavioral sciences at Duke and a staff psychiatrist for the Durham Veterans Affairs Health Care System.
It’s a positive sign that new President Joe Biden has acknowledged such problems, Tweedy says, but it can be “fatiguing” to know it took “a dramatic constellation of events” – the pandemic, along with months of protests for racial justice following the deaths of George Floyd and Breonna Taylor at the hands of police – “for there to be needed movement in this area.”
Some African American physicians confirm the pandemic has intensified the everyday headaches they encounter, almost from the moment they don a lab coat and stethoscope. They can even be forced to insist that Black patients get better care – including friends, family members or themselves.
In his book, Tweedy recalled that on his first day of medical school at Duke, a professor assumed he was a janitor who could fix the classroom lights. In an essay published in The New York Times, McDonald objects to the notion that the pandemic should stop protests for racial justice. “These protests are the first dose of medicine needed to rid the system of metastatic racism,” he wrote, and the “false choice” of pitting the protests vs. the pandemic “is to ask me to choose my skin color or my health.”
Dr. Teresa Davis, an assistant professor in the Department of Emergency Medicine at Rush Medical College in Chicago, says she has “definitely been called the N-word” by patients or family members in the exam room. A white COVID-19 patient “became very upset,” she says, when Davis refused to prescribe hydroxychloroquine – a medication ineffective against COVID-19 that President Donald Trump had hailed.
“She felt like I did not know what I was talking about,” Davis says. To her, “I was incompetent for not giving her these medications that, by that time, had clearly been debunked.”
Dr. Joia Crear-Perry, an OB-GYN and founder of the National Birth Equity Collaborative headquartered in New Orleans, is the daughter of two health care professionals: “I’m a physician, my mother’s a pharmacist, my dad’s an ophthalmologist,” she says. Yet “I’ve had to fight too many times for my parents” with white doctors.
Tweedy, Crear-Perry and others also point to the death of Dr. Susan Moore to show how vast the racial divide in medicine has become.
Moore, 52, tested positive for COVID-19 in late November and was admitted to a hospital in the suburbs of Indianapolis. Suffering from neck pain and shortness of breath, Moore said her white doctor seemed to be downplaying the severity of her illness and rejected her request for pain medication; his refusal, she said, “made me feel like I was a drug addict.”
Moore pushed back, asking to be transferred to another hospital, and said she was then given a scan that did reveal issues. She posted an agonizing sickbed video describing her treatment. “I put forth and I maintain if I was white, I wouldn’t have to go through that,” she said.
Moore was discharged from the hospital on Dec. 7. But she was readmitted to a different hospital when her condition deteriorated hours later, she said. Within two weeks, she was dead.
An outside panel has been convened to review Moore’s treatment at the hospital in Carmel, run by Indiana University Health. Some Black doctors say Moore’s death provided shocking, firsthand video evidence of problems Black patients have complained about for generations. Indeed, multiple studies indicate patients of color often get suboptimal treatment from white doctors; Moore’s case went viral, the doctors say, because her skin color trumped her medical credentials.
“What really hurts is knowing that this highly educated Black physician was sick and doing her best to advocate for herself – and was not heard,” says Wiley, who specializes in infectious diseases. If someone like Moore can be dismissed, she says, “what happens to our patients with low health literacy?”
Dr. Danielle Hairston, who coordinates Howard University‘s residency program for medical students studying psychiatry, says the case was a stark reminder of “the systemic racism that exists in medicine” and how doctors of color struggle to fight it.
“We like to think that, ‘Oh, I can pull the doctor card to save myself, or my friends or my family,’ which I shouldn’t have to,” she says. “It’s not like I’m pulling it so I can get a better room. You’re saying this to literally get the standard level of care.”
In an email to U.S. News, Filut and Carnes of the Center for Women’s Health Research argue that the systemic racism African American doctors face, inside and outside of the exam room, threatens to thin their ranks at a time when they are needed most. Research has shown Black patients respond better to physicians of the same race – an important factor during the pandemic – but that match is already difficult to achieve, and will be harder still if frustrated Black doctors choose to walk away.
Persistent workplace discrimination can lead to physicians of color feeling isolated and invisible, say Filut and Carnes, who have studied Black doctors’ reports of on-the-job mistreatment and bias. “While many shared examples of overt prejudice, subtle forms of discrimination were more common,” including “microagressions” – insinuations they were hired because of their race and not their talent, for example – that can drive up stress and weaken immune systems over time.
“We found, for example, that Black physicians were consistently getting rated in patient satisfaction surveys as lower than their white colleagues on ‘cleanliness of the clinic’ even though clinic rooms are randomly assigned,” Filut and Carnes say. “This is how stereotypes work. Cleanliness gets to a deep seated stereotype about Black people as it was used to justify Jim Crow laws for decades.”
That’s evidence of the “minority tax” doctors talk about – the invisible cost of working in predominantly white environments, Filut and Carnes say. Besides enduring insults and slurs, “they are also expected to take on work related to diversity when that may not be relevant to their research or career interests,” the researchers say.
Amid the pandemic, the burden of care placed on Black physicians, coupled with a dearth of resources for many, places them at greater risk of mental health issues tied to the crisis, “including anxiety, depression, and posttraumatic stress disorder as well as imposter syndrome, loneliness, and survivor guilt,” Filut and Barnes write in their commentary.
If the profession fails to recognize the stressors or offer additional support to Black doctors, they tell U.S. News, “it will contribute to the continued underrepresentation of African Americans in the physician population” in America.
“We need a cultural change” on the individual and institutional levels, they say, one that’s akin to anti-smoking efforts that have driven cigarette use steadily down. Ultimately, the profession must recognize that racism, on either end of the stethoscope, “is like lighting up a cigarette,” Filut and Barnes say. “It is bad for everyone’s health.”
Still, while the social and economic disparities exposed by COVID-19 have become Topic A in the medical community, Hairston doesn’t believe help for Black doctors is coming soon.
“I’m a doctor and I’m a Black woman,” Hairston says. “But first, I’m Black. “You’re trying to provide better care, but you’re still also a victim of the systemic racism that exists,” she says. “It’s definitely challenging.”
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