Heather Irobunda, M.D., a board-certified ob-gyn in New York knew she wanted to be a doctor since she was a child — about the time her experiences of racism began. Graduating top three in her class from high school, she was urged—by school officials and others — not to apply to certain colleges because she "wouldn't get in." She applied anyway. In college, she was told not to pursue medicine because "it wasn't for her." She went after it anyway.
"Throughout my career, there's always been this sentiment of, 'oh, I don't think that's for you,' with no real reason as to why it's not for me," says Dr. Irobunda.
Statistics would suggest that this "reason" was because she's Black. In the United States, just 5 percent of all active physicians are Black; and just 2 percent are Black womxn.
The medical community is, in short, sorely lacking in diversity. And the instances of racism in the medical field aren't always presented as the microaggressions Dr. Irobunda experienced. The prejudice and misunderstandings go much deeper.
For example, half of white medical students and residents actually believe Black people have thicker skin or less sensitive nerve endings than white people, according to a study published in the Proceedings of the National Academies of Science. Perceptions like this can be incredibly damaging to the care that Black patients receive — not to mention further the systemic racism that already exists in the industry.
"In some studies, Black patients report less time spent with providers, reduced patient-centered care, and reduced shared decision-making during their appointment, all of which have a direct effect on [patient] outcomes," explains Nadine J. Barrett, Ph.D., director of the Office of Health Equity and Disparities at the Duke Cancer Institute.
Dr. Irobunda seconds this with her personal experiences. For example, she says she's overheard doctors suggesting Black women care more about their nails and hair than their health, and in medical school, she remembers a doctor telling students that racial groups displayed pain differently.
Then there are the blatant examples of racism doctors themselves face. For instance, a few years ago while working in a rural upstate New York community, Dr. Irobunda had a white patient refuse her help because she's Black.
"They didn't think I was good enough — and that was before I even rendered them care," she says. "They saw me and they said no." Leadership at the clinic didn't back her up and the patient was switched to the care of a white provider.
Then, Dr. Irobunda went home and cried. "People don't realize how much that hurts," she explains. "This is who I am. I was born with this skin."
The truth is, the benefits of Black doctors and healthcare providers are enormous — and a lack of them, as well as the racism that permeates medicine, is a monumental issue with serious ramifications.
Here's just a glimpse at the ripple effect of a mostly-white medical field, explained by Black voices in the field — plus, what you can personally do to push for diversification in the medical industries.
Across the board, statistics don't bode well for the health and wellbeing of Black Americans.
"In medical education, we're always trying to find a very objective reason for why disease happens or why outcomes are poor in certain groups of people," explains Dr. Irobuna. She says that in her medical education, she was taught that the reasons poorer health outcomes exist in Black people are, in large, because of genetics. "But when you start looking into the social science research, you realize that that's actually not really true — and that it has a lot to do with health disparities instead," she says.
And a lack of Black providers has lasting consequences on the disparities that already exist.
"One of the possible consequences of a lack of African American providers is African Americans not seeking services because they're unable to find someone who looks like them or who they feel they can connect with," says Richelle Whittaker, L.S.S.P., L.P.C.-S., an educational psychologist at Providential Counseling & Consulting Services, PLLC.
In mental health, specifically, she notes many African Americans do seek out services from practitioners of other races only to feel unheard and stereotyped. This can be enough to cause someone not to seek help again, she notes. (Related: Accessible and Supportive Mental Health Resources for Black Womxn)
As a result, Black patients may feel more isolated and less trusting of the care they're receiving, explains Dr. Gary. "They fear being experimented on by medical establishments," she says.
"Historically, and arguably currently, the healthcare system is not always a trustworthy place for Black patients," adds Barrett. And if you have a doctor who you feel like you can't effectively communicate with, that can erode trust, eroding, in turn, the opportunity for a Black patient to openly discuss their health and priorities, both critical elements of good care, she explains. (This is all extremely relevant in mental health care, as well.)
When implicit bias takes over in non-Black providers, it negatively affects the care that a patient gets — period, says Dr. Irobuna.
Still, an even more alarming concern is what happens when there's no diversity at the top — where decisions are being made. Dr. Irobunda says while she's been actively addressing the racism and disparities in the healthcare system during conversations she's had with decision-makers, she knows she's not able to be omnipresent every time it matters. "What if I wasn't there?" she says. "If there aren't people with different opinions, who come from different backgrounds, certain thoughts get perpetuated and become free-flowing. There's no one there to check it."
Dr. Gary adds: "Wherever there is a paucity of diversity at the top, the pipeline too, suffers the downstream effect of that lack."
Magdalena Cadet, M.D., a New York City-based rheumatologist and internist at NYU Langone Medical Center says the joy and excitement she feels from Black patients when she introduces herself as "doctor" is palpable. "Their faces light up because they know that there is someone present who can better relate to them, empathize with their struggles, and is willing to work harder to reduce the healthcare disparities that currently exist."
Experts agree that Black providers are a critical piece of the puzzle in reducing bleak health disparities.
"Black patients who receive care from Black doctors report greater trust, better communication, and perceive less bias than those who see non-Black providers," says Barrett. "Studies show that these interactions are longer, associated with more positive affect, and more satisfaction." Overall, higher quality doctor-patient interactions lead to better health outcomes for ~everyone~ (taking your meds, following up on care, the likes).
Black providers offer benefits that white providers simply cannot. Black mental health providers, specifically, can provide an environment of trust, openness (where someone could discuss racism, prejudices, or stereotypes), and cultural competence, says Whittaker. "Clients may feel a sense of camaraderie or community where some things don't have to be explained."
On top of a wealth of professional experience, the personal experiences of Black providers may resonate with Black patients.
"In my personal experience, Black patients have considered me as their daughter, and I become a trusted advisor to help them navigate their overall health outside of their cancer," says Dr. Gary. "I have personally had Black patients begin to cry with grief, yes, but also with relief that a Black cancer surgeon will be rendering their care at a time when they fear most for their lives."
Dr. Irobunda recalls pregnant patients who have come to her crying, afraid that their baby's health or their health will suffer at the hands of the medical system. "They say, 'I trust you to be able to understand me, but you can't sit in the room with me the whole time.'"
She says she hears these concerns — and, to this extent, suggests that one of the biggest benefits of diversity in healthcare is having voices who can make changes at *all* levels of the system, making sure there's diversity training and other structures in place to address these racial issues.
"When represented in leadership roles, Black providers bring diverse perspectives to the decision-making table of healthcare facilities, which directly impacts health outcomes," explains Barrett.
In short, diverse racial representation matters more than you think. "It does make a difference to these individuals that there is a health care provider who looks like them," says Dr. Cadet. "It gives patients hope that the world is committed to providing equitable healthcare for all."
The topic of getting more Black doctors into the medical field and doing away with the systemic racism that exists there and elsewhere feels like a big one, and it is. Still, there are ways that you can enact change — even in your day-to-day life. Below, three tips from the experts in this piece.