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Clarence Fluker: Welcome to “Beyond the White Coat: Making the Rounds,” presented by Community Health Connect, an AAMC program that facilitates conversations on issues related to health disparities, social determinants of health, and other public health concerns in the District of Columbia. I'm Clarence Fluker, director of community engagement here at the AAMC.
Today, we'll be talking about the underrepresentation of Black men in medicine. Joining us is my AAMC colleague, Dr. Norma Poll-Hunter, senior director of the workforce diversity portfolio, and two of our community partners.
Dr. Malcolm Woodland joins us from Young Doctors DC. Young Doctors DC is a multigenerational mentoring, education, and pipeline to health careers program targeting Black high school boys in Southeast Washington, D.C.
André Smith is a master of health sciences student at Meharry Medical College in Nashville, Tennessee. He's a member of the AAMC/National Medical Association-sponsored Black Action Collaborative Steering Committee. The Action Collaborative is a networking community that aims to increase the representation of Black men in medicine. Thank you for joining us.
Malcolm Woodland, PhD: Thank you for having us.
Norma Poll-Hunter, PhD: Yes. Thank you for inviting this important conversation.
André Smith: Yes. I'm excited about the conversation.
Clarence Fluker: Dr. Poll-Hunter, I want to start with you. You've done a lot of research on this topic — and despite efforts by medical schools, foundations, and the government to increase diversity in the physician pipeline, the numbers for Black men have remained stagnant. What are some of the issues at the root of this problem?
Norma Poll-Hunter, PhD: Clarence, I appreciate the framing of your question — “What are the roots of this problem?” — because it is about the roots. It's the roots of our nation: a country that was colonized, where indigenous communities were decimated and where we were … basically built our country on slave labor. So, at the root is this legacy of exclusion and racism that impacts Black men, but also other communities: American Indians, Latino, and Asian communities in the United States.
To start at the root, we must acknowledge that Black communities are often at the bottom of the list as it relates to access to economic opportunity, quality, public education, and health care services — and what we learned from our report really, which was a clarion call to this issue: underrepresentation of Black men — what we learned from Altering the Course was that issues could start as early as kindergarten: access to quality education; reading and writing skills; teachers who were supportive and understood how to be culturally responsive to the needs of boys; access to advanced placement courses; limited visibility to role models, whether it was in the media, the community, or even in health care settings; limited access to information about the pathways to medicine; and in some cases, either no access to advising or even receiving discouraging messages from advisors about the pathway to medicine.
Medical school is also a long-term costly investment and — really thinking about the potential financial barriers that exist along the way. And it's not just about the individuals and their experiences, but also thinking about the approach of medical schools, the use of the MCAT® score — but on the upside as well, Black men today have many more career options to pursue their interest in STEM and health care careers, so there are multiple factors that influenced this trajectory.
Clarence Fluker: Thanks for helping us explore what are some of the root issues of this problem. Dr. Woodland, your organization aims to address the underrepresentation of Black men in medicine by working with high school students. Can you tell us how that works?
Malcolm Woodland, PhD: For Young Doctors DC, we pick up at high school and we try and support kids through a number of different ways. One, our program is four years long, so kids start generally after they have the summer after their eighth-grade year of high school, or just after — excuse me, their eighth-grade year, just after their ninth-grade year of high school. They are exposed to mentors, they live on Howard University's campus, they shadow health care professionals, they take classes — both anatomy classes to support their knowledge about medicine and health, public health classes — and they also receive academic support for what they're going to be doing in school each and every day.
So, they live on Howard's campus during the summer, and we also train them to go back into their communities and be lay health care workers. So, they're taking people's blood pressure, they're taking people's blood sugar levels, they're learning about or taking people's signs of vascular disease — really just trying to get a good sense about what's happening in their communities and also be supportive. So, that's how Young Doctors works, and our goal is twofold: one to really support these young men and also provide the kind of mentors that Dr. Poll-Hunter was talking about.
A number of our mentors — people who work closest with the program — are African American men, are African American MDs and PhDs that can really talk about their experiences with these young people and help them understand, “What steps do you have to take — both academically, personally, and just as an African American man — to kind of make that jump?”
With Young Doctors, when we were developing it, we kind of had to make a decision, and I think all organizations with limited resources do have to make this decision.
So, we wanted to develop a program that had an impact that was a mile deep and an inch wide. We know that there are a lot of programs out there that have an inch-deep impact with a milewide radius.
And what we kind of came back to was — we felt like there were at least some organizations that kind of did the inch-deep and milewide work, and that's getting a number of kids and really pulling them in and kind of telling them what's going on. But we wanted to come up with the program, and we thought it was important to have a mile-deep program. Right? And we're working on, “How do we bring more kids into it?” but what we think is important is providing that support over a lengthy period of time and really bringing in those kinds of mentors that we think are going to be important.
Clarence Fluker: Dr. Woodland, that sounds amazing. I think your phrasing is spot on in terms of making sure that programs are doing the mile-deep work, specifically when targeting and working with young Black boys and young Black men in getting them interested in careers and the education necessary for a health career. I'm curious to know, what do you think are some of the specific needs of young Black men, in particular, who are interested in pursuing careers in health and medicine?
Malcolm Woodland, PhD: So, for me, great question again — it's a few different things. One of the biggest pieces is access to mentors, access to this lifestyle, and really kind of being able to see yourself in this position. The other thing is pipeline programs. I think programs like Young Doctors DC, like Mentors in Medicine, other programs that are out there too, or for diversity — I think those programs are so important in terms of developing a pipeline for young people from high school, from elementary school, that in some cases goes all the way through college and right into a doctoral level program. I think those are critical, especially when you think about the other pipelines that are out there, particularly for Black men. And one huge one is the school-to-prison pipeline, and I don't think we can really have a discussion about, kind of, African American men and where they are without thinking about the huge toll that is paid by African American men through that school-to-prison pipeline.
So, part of what I think needs to happen is a deconstruction of the school-to-prison pipeline and a construction, if you will, of other pipelines — and one being a pipeline to health care careers and a pipeline to medicine that we don't have and that I think we still need to build.
And lastly, and I think most important, is a safe space in these pipeline programs — a safe space for the development of African American boys and their ideas, and a space that really cherishes them. So, just a brief anecdote: Part of what we do is we take our young men to different universities throughout the country, and we took them to one university in particular — and I won't say the name of it, but it's a really prestigious university that has, I think, a strong medical school and is well renowned. And one of the things they did with us was — they allowed us to meet with several of their African American male students who were in their Black student union.
And there were four young men who came out: really, really talented guys who had super high scores on their SATs — I mean, really, young men who were high flyers, superstars — had done wonderful community work. I mean, when I sat back and listened to these guys, I said, "Wow, these guys really have it all together." And as I listened to them for a little bit longer — all four of them, when they started their undergraduate at this particular university, they all wanted to be physicians. At this point, they were all seniors — none of them wanted to be physicians anymore.
And what happened there? And what they told us was a few different things. One person said, “I struggled; I don't know if I can make it. I don't know if I'm good enough.” All of these ideas — and it was interesting because what ended up happening was — they stopped counseling our Young Doctors, and we started counseling them and talking to them about the kind of support that they need and “Is there any way that we can reach out to you guys?” because a couple of things happened there. One: We saw young men who were phenomenal, who would be excellent physicians, who — really, I could tell — had the ability to be able to do that work, but because they weren't in a safe space, they weren't in a place that supported them, they had the bottom pulled out from them — and then you end up with guys who say, “Maybe this isn't for me.”
And I think what you'll find — and certainly what we talk about with our Young Doctors a lot — is that you have to be able to push through some of that stuff, but if you're not in a position where you're being supported, it becomes very, very difficult to push through. So again, you need mentors, you need pipeline programs — and in those programs, in those spaces, they need to be safe for the development of African American males.
Clarence Fluker: Dr. Woodland just talked to us about the importance of African American men who are bright and talented and interested in careers in medicine continuing to push through. Mr. Smith, you are in the process of pushing through right now, as you were applying for medical school. Can you tell us about how that's going?
André Smith: Yes. All the above, that has been stated, I'm super inspired by it. But yes, I'm currently in this 2021 cycle; however, I do want to note that I did apply last cycle. However, I wasn't accepted to any schools, but it has been such an enlightening lesson. Me coming to Meharry to do this master's program — I think me being denied, it's a strong statement, but me being denied has been truly a blessing and it was intentional, because if I had started, I wouldn't be where I am today. So yes, I'm currently in this cycle, I have submitted my primaries and secondaries and hopefully I’ll hear back from some interviews soon, but yes, I'm grateful for my experience of being denied and then transitioning to strengthening my application and me as a person in this cycle.
Clarence Fluker: So I have two follow-up questions to that. I'd love to know — one, what initially inspired you to pursue a career in medicine, and what do you think may have been some of the barriers to you not being accepted the first time around?
André Smith: Yes. Super great question. So, a little backstory: I was raised by my grandparents, and my grandfather has a PhD in science education. He was a school teacher; they raised me. And so, being in his classrooms, going to his anatomy labs, seeing the bones in the jars — and I think my initial spark in medicine was through my initial spark in science. So, my initial spark in science was simply seeing him, a Black man, in science teaching students — inspiring others. So, my initial spark was through science, and then, I was raised by my grandparents, so they're always going to the doctors to get knee injections and all of those things. So, seeing how they interacted as elderly people — they were middle age to elderly — seeing them interact with the physicians was truly phenomenal. Their interactions, how they talked about different various topics — that inspired me: “Oh, I want to be someone just like that. I want to inspire whoever walks in my office to be inspired by who I am and grow those connections to inspire them to be great.”
And so, to follow up with your second question, some barriers — I feel as though, it's 2021, barriers being simply who I am, being a Black man who did not receive all the adequate resources. Yes, I still did undergraduate and in high school and did shadowing experiences, but at a point there is always a barrier. So, being a Black man who didn't always have the resources, who always didn’t have support as — such as the Young Doctors DC, phenomenal support — and I always didn't have their support, yes, I have gained it through the years, but there has been a key barrier. But I think the more optimistic side of that is seeing that — despite all the odds, despite not having that — you continue to pursue. And so, I did as well, and I hope that inspires someone else to continue to pursue.
Someone may not have Young Doctors DC, but also persevere through it and push forward, because there are patients who are in your future who will truly need you, and you will have their story and testimony to say, “I made it through despite all the odds, despite the barriers.” I'm so grateful for the programs that I've done, but also — the people who may not even have had the programs, push through for your future patients: Their life literally depends on you.
Malcolm Woodland, PhD: I'd like to just jump in briefly because you asked me a moment ago, kind of, “What does it take for African American males to succeed?” — and for the support, and as a psychologist, there's one more variable that I didn't put in there, but after hearing Mr. Smith talk, I said, “Wow, I have to mention that.” And that's the psychological variable. And that's the ability to thrive in the face of adversity or to be resilient.
What we call it in Young Doctors is sometimes even having a chip on your shoulder. This thing that is like, “Hey, you know what, even if people tell me I can't make it, I'm still going to push through. Even if I get rejected, that doesn't matter, I just need to reposition myself to be stronger and do better the next time.” So, in addition to these structural pieces — which are really important — there is a psychological piece, too, that I think is really, really huge with regard to helping young African American men be successful in these spaces.
Clarence Fluker: Thank you. I think the psychological piece is very important. And one of the things that you touched on — and Dr. Poll-Hunter touched on earlier as well — was, if you can see it, you can be it … and the importance of having mentors. Mr. Smith talked about his grandfather, who was an educator in the sciences. I'm curious about you, Dr. Woodland, did you have Black men who were doctors around you growing up that helped to inspire you and keep you on your journey, or was the lack of that part of why you're sowing the seeds into young people today to make up for what you didn't have?
Malcolm Woodland, PhD: No, it certainly wasn't the lack of it. I tell the Young Doctors every day: I'm paying a debt that was given to me. I've had so many people who have supported me in this process. I certainly reached out for them, and that's an important piece of learning how to develop mentors — you have to seek these people out and you have to really show them that you're worthy, quote-unquote, of being mentored … and how do you do that? You show them that you are committed and you will indeed do the work. But all of Young Doctors is me paying it forward, and I certainly would not be in the position that I'm in without a number of mentors.
Norma Poll-Hunter, PhD: If I could add to that as the only woman in the group and as a Latina, I think about my strong Puerto Rican father, and I think about all the strong Black men that I'm surrounded by, including my husband, and I think this notion — building on what Dr. Woodland said earlier and the psychology of this — is thinking about those safe spaces, but just being able to be your authentic self as a Black man, and how many times — whether it's in higher education or in medical education — there isn't that safe space to be who you are. It takes a lot of vulnerability, what Mr. Smith talked about in terms of his failure to say that publicly, right? So, thinking about masculinity — what does it mean to be a Black man in the United States and having those role models to see that — makes a big difference.
And so, I think the other part of it is — oftentimes, men do not seek out help. It's very good for us as women, for us to go seek out others — and part of our culture as well, to think it's OK to go to your abuela, to another community member — but for men, that's hard. And I think the fact — what Dr. Woodland talked about and what Dr. Smith talked about — is just reaching out to others; looking for support; seeking out those resources, that information. That's so critical. And I think that's something that we have to emphasize in our communities — that it's OK to ask for help, and even when someone says, “I can't help you,” or they close the door, keep looking, because that's what I hear from the narratives of many Black men that we've talked to, is like, “I continue and I continue.” So, I think that that's critical as well.
Clarence Fluker: Yeah. This is an issue that is nuanced and quite complex, right? It's like logical, communal, structural pieces that contribute to this still being a problem. And so, because it's a great problem, that means there also has to be a great response to it that requires work on behalf of a collective.
And I'm really interested in hearing from you all about, “What more do you think academic medicine could be doing to solve this problem and to support the work that each of you are doing?” And I'd like to start with you, Dr. Woodland. What do you think academic medicine could be doing to help support programs like Young Docs and to help alleviate this issue of underrepresentation of Black men in medicine?
Malcolm Woodland, PhD: Yeah. So, I'll underscore the point that you make — that this is a huge problem and the problem is big enough that everybody can take a piece of it. You can't start this discussion again without talking about the roots, as Dr. Norma Poll-Hunter pointed out, and also thinking about the school-to-prison pipeline and why there are so many African American men who just aren't available to be in these positions — to be in school, to even go on to medical school. So, that's the first piece of it. I'm not sure how much academic medicine can do about that, but they can certainly respond to it in their own way — but I think in particular, what academic medicine can do is twofold. One: Help to develop these pipeline programs and work to actually create that pipeline. So, are there pipeline programs that are indeed connected all the way through undergraduate to medical school? Where is that model and how do we construct that model? That's important.
The other piece of it is — and truthfully, I'll say the two things I'm saying are already done. One: There are pipeline programs out there; the other huge piece — and we haven't mentioned it today — is HBCUs. There are already universities that are doing this work and have had huge success. I'm in Washington, D.C., AAMC is in Washington, D.C. We have one that is just steps away from us, Howard University; Mr. Smith is at one, Meharry; Morehouse; I understand Morgan State is going to get one; and then obviously Charles Drew out in Los Angeles.
So, there are universities that have already set up that safe space — that have demonstrated success for African American men. So, my hope is that academic medicine will really push toward making sure that as many universities — as many HBCUs — that are interested and have demonstrated strength in creating positions can somehow be a part of a medical school or a pipeline to a medical school.
Xavier, right? To me, I'm not sure and I don't know the dynamics, but I don't know why Xavier doesn't have a medical school. Tougaloo College in Mississippi — teeny little college in Mississippi creates 50% of the African American doctors in that state. Where is their medical school? Where is their pipeline to a medical school? I know what they've done, but how is academic medicine responding to that? So, to me, pipeline programs and HBCUs who are already doing the work — connecting those two and — let's not rebuild the wheel: Let's go with what we know, and there are already wonderful people out there who are doing this work.
Clarence Fluker: Mr. Smith, do you have anything you'd like to add to that?
André Smith: I think all of the above that has been stated is great — but adding the aspect of the keyword “intentionality.” So, I'm from a small town in Mississippi; I've seen the programs that have been implemented, which is super great. But sometimes I feel as though we may — I'm not saying it happens all the time — but we may lose focus of the program. Sometimes programs meet to meet; sometimes programs have meetings to have meetings. Sometimes we just go about daily functions as though, “We're helping, we're helping,” but where's the intentionality, the following through, the engagement? Yes, I met with my premed advisor: How was I intentional in this meeting? Speaking as the advisor: Were you intentional? Where were you engaged with the student? Were you following through the aspect? Not just a check box. Yes, we're a HBCU, but let's not just check off the boxes. Yes, I'm their mentor, but let's not check off the boxes. So, I think that the key aspect — being more intentional, have the programs, but let's be more intentional about how we affect more Black men in medicine, because if we can be more intentional, we can allow for them to say, “Yes, I have their support.” If you have the support, you can push through; if you can push through, you can affect the future patients. So you see, it just goes on and on.
Clarence Fluker: Very interesting points, Dr. Woodland and Mr. Smith. Dr. Poll-Hunter, I want to turn back to you. The AAMC/National Medical Association Black Action Collaborative offers one answer to the call for academic medicine to do more. Can you tell us about the Action Collaborative and how people can learn about the work that you're doing, as well as youth programs and resources the AAMC does already have to offer?
Norma Poll-Hunter, PhD: Yes. I do agree with especially Dr. Woodland's point about the impact of pathway pipeline programs that really make a difference. We have research that shows that — that they make a difference in increasing diversity, especially among African American communities, Latino, American Indian, Alaska natives. However, we need to do more, because many of these programs existed since the late 60s, early 70s — and the Action Collaborative with the National Medical Association is about doing more. It's about identifying solutions where we leverage multiple stakeholders across different sectors. So, the way I like to put it as, for us, we're looking at a collective impact model that looks at the system. So, if you think about the basic computer that has an operating system, right, that is basically a communicator between the different programs and the actual structure — the computer itself — we're trying to change the operating system.
It's not just about the individuals in the system, but how that system operates and interacts with people, policies, and structures. And so, for us, we're taking a step back and saying, “We know what works, we know pathway pipeline programs work, but what is it about the system in which people are in — what does that pathway look like? And how could we change that pathway to ensure that it's more culturally responsive to the needs of Black men, that it's inclusive, that it really is all about helping individuals like Black men thrive in that pathway?” So for us, we're saying, “Let's look at the system itself and how we can change the system.” So, we're in the beginning stages of looking at that, but we're very optimistic about what we can do together.
And back to the point that was made earlier: This is a significant problem and each of us can take a piece of it. And so, looking at a collective impact model is considering how different organizations can come together and take a piece of it. What are the reinforcing activities? How can each of us contribute to this complex problem to really promote an action agenda to change?
Clarence Fluker: That is awesome. And I know, Dr. Poll-Hunter, that on the AAMC website and through some of the programs that are under your portfolio, we are currently doing some work — and we need to continue to do more, but could you tell us about some of the things that we currently already have in place?
Norma Poll-Hunter, PhD: Sure. So, anyone who's interested in learning about programs to support premed students can go to aamc.org/students, and you'll find everything you need to know about being successful along that pathway. We do have a range of programs. One significant one that we've been supporting for such a long time now, thanks to the Robert Wood Johnson Foundation, is the Summer Health Professions Education Program. So, it's one of those pathway pipeline programs mentioned by Dr. Woodland that have really made a significant difference. What's amazing about SHPEP is that the Robert Wood Johnson Foundation fully supports it, so it's free. So, I'll say it again: It's free for freshmen and sophomore college students interested in up to eight health professions. And so, it's a really amazing opportunity, so I encourage listeners who either are on that premed track, who know someone, who's supporting someone, who loves someone who's interested in medicine, just to visit our website, because we have a lot of amazing resources at aamc.org/students.
Clarence Fluker: Thank you. I have one final question for all of you. Should we be optimistic about the diversity of the future health care workforce? And I'll start with you, Dr. Poll-Hunter, and then love to hear from Dr. Woodland and close it out with Mr. Smith.
Norma Poll-Hunter, PhD: Well, my daughter has labeled me a serial optimist. So, that is just my general disposition, but I have to say I am super optimistic about the diversity of the future physician workforce, because I have amazing colleagues like Dr. Woodland, Mr. Smith — so many individuals who are committed to this and really seeing real change. Think about the students, the protests on the streets — you turn on the news and now you hear about, “What can we do to promote racial justice?” It's no longer an issue that's limited to certain communities. Everyone's thinking about this.
And unfortunately, a lot of it has to do with our current state — thinking about the murder of George Floyd and how we can no longer see this happening to Black men. And so, in that situation, we know that that wasn't you, it's been a long-standing part of our history and our current life, but I have optimism because we have so many people who are coming to the table now and saying, “What can I do? How can I make a difference?” And so, that's what keeps me optimistic.
Malcolm Woodland, PhD: Excellent. Yeah. First, I just want to go back, if you will, to pipeline programs and double down on the importance of programs like SHPEP in a couple of different ways, because I'm not the only founder of Young Doctors DC. There are a few other people who started this organization with me, and they're all graduates of SHPEP and its different iterations — SMDEP, MPEP, and now SHPEP. So, it's just a really important program, and I think we know a couple of things about African American doctors and also Hispanic doctors is — they are more likely to kind of go back and want to do this work in their communities and pay it forward. And, from what I've seen with SHPEP — both our collaborations with them on Howard University's campus and even several of their alumni — is they are indeed the ones who are going back, whether they are helping to develop a Young Doctors DC or working in those communities. So, I think that's hugely important, and again, another real huge point of these pipeline programs. So, thank you to AAMC and Robert Wood Johnson Foundation for supporting such an important program for so long.
The question though: Am I optimistic? Probably like Dr. Poll-Hunter, I'm always optimistic, especially when you're dealing with African American men. I think you can't do this work and not be optimistic, to be quite honest. And I think African American men, in particular, have had a way of — again, rising to adversity and in the face of adversity. We're the same group who created President Barack Obama to Malcolm X. And if you can create those kinds of figures who can push back against so much, then I'm certainly optimistic about the future.
I hope, though, like what Dr. Poll-Hunter and others are saying is true — is that we can use this moment collectively to support Black men, so you don't always feel like you are pushing a boulder up a hill. It would be nice to feel, at least for a little bit, we're kind of pushing downward a little bit and gaining some traction. So, I hope we can use this moment, at least, to maybe — I don't think we'll be pushing down, but maybe get some more hands behind that boulder that we're pushing up.
André Smith: And I think that analogy is amazing, because if we're pushing it up the hill and we have more people pushing it behind the hill, to push up the hill — guess what, we have optimism. And if we're optimistic, we are going to succeed. It's about perspective. So, if your perspective is, “We got this, truck through, truck through, truck through,” you're going to push up the hill till we reached the top of the hill and we have reached our goal. So, I think the question is, “Should we be?” And the answer is yes. And why? Because we can make it to the top of the hill.
And that hill is whatever you may see that are deficits or mishaps that are wrong. And so, if we can push up to the top of the hill, we can create generational change for our future patients. So, as I mentioned earlier, I think it's all about the perspective of how we see the future. And so, if we can create optimism and being optimistic can create the narrative that we are going to affect the future generations, our future society, and how we see it in the future … so, yes.
Clarence Fluker: Thank you, Mr. Smith.
One thing that you've emphasized a few times today that I think gets lost sometimes when we talk about the lack of representation in medicine by Black men and people of color — and like I said, you've talked about it two or three times today — is that, not only is it great because we have more Black men physicians, but we also know that that has a direct correlation to health outcomes for Black people. And so, it's not just like we're excited that we graduated some Black men, it's exciting that we have helped to improve the health outcomes for Black people in their communities, and that is really important. And for that reason, I am optimistic, Mr. Smith, just like you.
The lack of Black men applying to and entering the field of medicine is a long-standing challenge that we must continue to try to meet. It has been fascinating to hear about the roots of this issue and what you're doing to help Black men see medicine as a viable option for them. This has been an incredible conversation. Thanks for joining us today on “Beyond the White Coat: Making the Rounds.”
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