Aaron Doctor, a bright and ambitious young African-American man, grew up in a black community in South Carolina’s Lowcountry, but he was 21 years old the first time he met a black doctor, a man whose wife was also a physician.

“I didn’t think black people could be doctors,” said Doctor, 29.

Doctor, as his name aptly suggests, is a fourth-year student at the Morehouse School of Medicine who wants to become a physician specializing in women’s health in underserved communities. The number of people who look like Doctor pursuing careers as physicians across the nation, though, is declining, which is creating a public health problem.

A 2015 Association of Medical Colleges study shows that between 1978 and 2015, the number of black males entering medical school dropped from 1,410 to 1,337, even as the number of black men earning college degrees rose.

During those years, the numbers of Asian and Latino male doctors rose.

The year 1978 also served as a 36-year high in the number of African-American, 542 men to graduate from medical school. Only 515 graduated in 2014. Although African-American men make up six percent of the country’s population, they make up fewer than two percent of the nation’s 18,000 medical school students—257.

There are various reasons for the falling numbers, say medical and education leaders who are issuing a call to action. For example, black students are not being groomed to study and excel in science, and black men are more often opting for other college degrees such as business. Also, a higher percentage of African-American families, compared to whites, don’t have the wealth to finance up to 10 years in school, and some students are affected by ongoing issues with racism.

The decline is important for two larger questions of public health and the African-American community. Black male doctors have an outsize impact in communities that have limited medical services. They tend to serve those communities more than their colleagues.

And black male doctors have an outsize impact on the health of black males, a particular underserved population. African-American men have the shortest life span of any demographic group. And poor or poorly educated black men have higher rates of chronic illnesses like diabetes and heart disease, which can be effectively treated if caught early. Many black men don’t visit doctors or don’t get the medical care they need. At the same time, a recent survey found black males are more receptive to medical recommendations from another black man.

“We all tend to connect with someone we have something in common with,” said Dr. Valerie Montgomery Rice, president of Morehouse School of Medicine, where 25 percent of its 541 students are African-American men.

Rice is raising awareness about the need and importance of African-American male doctors and is helping develop a local pipeline program to bring men into the profession. MSM is working in the Atlanta Public Schools system to steer more black students toward careers in science, technology, engineering and math (STEM). And Rice has been speaking about the issue in recent months at local Rotary clubs and to national organizations.

Norma Poll-Hunter, the Association of American Medical Colleges’s senior director of human capital and the author of the 2015 study, called the organization’s report a “clarion call.”

“We talk a lot about impact of diversity on the physician workforce,” she said. “We know that black doctors made a difference in the health-seeking behavior of black men. We know that black male doctors are more likely to work in under served communities. We have significant health disparities, and if we had more individuals, we could put a dent in that.”

GEORGIA BETTER OFF THAN MOST

When Kia Smith’s son Cameron Bothwell turned 18 and enrolled as a freshman at Morehouse College this fall, she went looking for a doctor she could trust and that they both felt comfortable with Cameron going to alone.

That meant a black male doctor. She is still looking.

“I am looking for someone who he can relate to and who can ask him questions around his sexual health in a way that he feels comfortable,” Smith said. “I know my child, and I know that he is not good at asking the questions, unless he feels comfortable.”

Chances are, with Smith living in Atlanta, she will be able to find a black male doctor. More than half of the state’s 1,189 black male doctors are in five metro Atlanta counties. The task is more difficult in other parts of Georgia. There are at least 50 counties with no black doctors.

Nationally, there are 16 states with fewer than 100 black doctors.

Georgia is also second in the U.S. in the percentage of all doctors who are African-American at 12.7 percent. Only Washington, D.C., with 14.5 percent of doctors being black, has a higher percentage.

“Why it is important to have black males?” asked Dr. Art Raines, an orthopedic surgeon in Atlanta who also serves on the admissions committee of the University of Michigan’s medical school. “I can tell you that we relate differently and are more sensitive to the needs of our black patients. We look at minority patients more as human beings rather than just a shoulder, a knee, or someone with an illness. Our patients sense that. There is a need for us. The more of us out there, the more visible we are, the more impact we can have on our communities.”

WHY FEWER BLACK MEN?

The reasons for the small percentage of African-American men going to medical school and becoming doctors often begins early in life.

Dr. G. Richard Olds, who is white, has been working for 40 years to train doctors, particularly first generation college students or those from traditionally under-served communities. Olds, president of Saint George’s University in Grenada, said the gap begins in middle school. African-American students aren’t taking, or aren’t being encouraged to take enough math and science courses.

Once African-American students enroll in college, more women earn degrees in careers that could lead to becoming a doctor, some research shows.

The National Science Foundation tracked the percentage of African-American students who pursued college degrees in science and engineering in a 2012 study. Although more male students said upon entering they planned to get degrees in those subjects, more African-American women earned degrees, by a 2 to 1 ratio.

“The sisters have been really good about staying more focused and keeping their noses to the grindstone, better than the brothers,” Raines said.

In 2014, 62 percent of African-Americans who applied to medical school were women, far outpacing any other ethnic gender group. That aligns with data from the National Center for Educational Statistics, showing that 64 percent of all African-American undergraduate students are women.

The cost of medical school is also a factor in losing students to other professions. The average graduating debt of medical school students is $183,000, and with interest and payments, an MD can easily run up to a half-million dollars.

Dr. Anwar Osborne, Emory University’s assistant residency director and an emergency room doctor at Grady Hospital in Atlanta, Ga., said the cost can push smart kids into fields with quick paydays like business and finance.

“So where do the smart brothers go after high school? If you are bright on paper, you have a lot of options,” Osborne said. “There are a lot of things about medicine that are not great.”

Osborne said on top of that, he still supports his mother, while many of his non-black colleagues are supported by their families.

“I gave up 10 years of my life to pursue this through medical school and my residency program,” Osborne said. “That is a big ask for people who don’t have much generational wealth, So a lot of people that are bright just don’t get the opportunity. It even takes money to take an SAT prep course.”

Many medical schools select students solely on their grade-point average, not whether the student has the temperament to be a good doctor, Olds said. Most black students Olds said he’s encountered enroll in medical school with a mission to serve in their communities.

“Remember, we’re talking about someone who received a 3.9 (grade-point average) versus a 3.7,” he said. “There’s not really a big difference.”

ARE YOU ON THE KITCHEN STAFF?

Raines, who is a partner at Atlanta’s Resurgens Orthopaedics, said another problem is the lack of empathetic educational support and mentors for black men in college.

“At the majority schools, the few blacks that are there are discouraged from applying to medical school,” Raines said, adding that when he asks black premeds about coming to medical school, they often tell him that advisors have already told them that the chances of them getting admitted are slim. “The counseling is different at HBCUs and majority schools.”

The majority of top African-American medical school applicants come from HBCUs like Xavier University, which sends more African-Americans to medical school than any other school in the country, and Ivy League schools.

Between 2010 and 2014, more black men from Morehouse College, 148, applied to medical school than any other undergraduate program in the country—followed by the University of Florida, Howard University, and Xavier.

“Was it difficult? Yes. Is it still,” said Dr. Philippe Zamor, a Charlotte-based hepatologist who attended medical school at Boston University. “I felt isolated in medical school. We had a strong network, but having gone to a non-black medical school, I found my experiences isolating.”

Even seemingly small things could be a challenge, Zamor said. Like not having access to exams and study guides that were passed down to white and Asian students from predecessors that he didn’t have access to.

“Or, during my residency when I would walk into a patient’s room for an exam and they thought I was part of the kitchen staff,” Zamor said. “I remember telling a classmate, an Asian girl from California, and she was in utter disbelief. It was her surprise that I found so stark.”

Remedies have included more mentoring and outreach to get students interested in science at an earlier age. Olds said medical schools need to recruit more students from diverse backgrounds, particularly rural communities.

Once every three months, Morehouse School of Medicine does an activity with students from Atlanta’s Tuskegee Airmen Global Academy to encourage the students in STEM. MSM also has summer camps and Saturday STEM academies to create the pipeline that may someday create more black doctors.

Raines said the lack of black doctors creates a lack of role models to emulate.

Raines’ first doctor, pediatrician James Collins, the former associate dean of students at Wayne State Medical School in Detroit, mentored him almost from birth. Like Collins, Raines also got his medical degree from the University of Michigan.

“I always wanted to be a doctor, and Uncle Jim counseled me. I was told what to do,” Raines said. “We see that all the time with our white colleagues. We are not even a generation removed from blacks being denied staff privileges at hospitals.”

Doctor, the MSM student, is doing his own pipeline work. He mentors students in his southwest Atlanta neighborhood, encouraging them to consider careers in science or medicine. He hopes to be one of many black male doctors young people in his community will meet before they become adults.

He is also the student director for the medical division of Hosea Helps, a non-profit that works in underserved Atlanta communities. He recalled being at an event where an older woman he previously helped called out for him.

“I want that guy to see me,” she said. “He’s my doctor.”

Doctor smiled when asked about the encounter.

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