By Leah Small Virginia Center for Investigative Journalism at WHRO
Medical student Jaz-Munn “Jaz” Johnson, dressed in scrubs, headed to the Hillside Court public housing complex in Richmond on a recent Saturday.
Johnson and other students from the Virginia Commonwealth University School of Medicine volunteered to teach parents in the public housing community about safe sleep practice for infants. They passed out toys, pajamas and covers for babies.
Johnson, who is Black, paced the sidewalk inviting residents to come inside the development’s community center for the giveaway and health information. His bright personality contrasted with the late morning’s overcast sky.
Johnson, dressed in scrubs, developed an easy rapport with the Black Hillside Court residents.
“My man,” Johnson said, introducing himself to a resident walking by, ”if you have children or family members with children, come by.”
The man later returned to pick up new pajamas for his niece.
The quick bonds between Johnson and community members seemed like simple gestures in a day of volunteering and lifting the well-being of a poor, largely Black community. Studies show this connection works – despite general mistrust of the health care system, Black patients trust Black doctors. Trust brings better health outcomes.
But despite historic changes in education and economic opportunities over generations, the percentage of Black doctors in the U.S. has failed to grow. African American physicians represent just 5.4 % of physicians nationally, despite Blacks representing about 14% of the U.S. population.
Since 1900, the proportion of Black doctors in the U.S. has increased by just 4 percentage points, rising from 1 to 5 percent of all physicians, a UCLA study found. Since 1940, the portion of physicians who are Black men has not grown.
In Virginia, nearly 8% of the state’s more than 22,800 active physicians identify as African-American. The ratio of Black doctors to Black patients in the state is about one to 1,000.
Recruiting more Black physicians is one way to combat the health disparities experienced by patients of color in the U.S. And reducing the gap doesn’t just help people of color: health disparities annually cost an estimated $93 billion in excess healthcare spending, and $42 billion in lost productivity.
Johnson knows the arduous path through medical school. Before volunteering at Hillside, he was up at 5 a.m. to study. He’s drawn to public service, he said, something instilled from his childhood spending Sundays in church with his mother. “It’s really not about me,” Johnson said, “we’re blessed to be a blessing.”
Virginia schools – from elementary to medical schools – are trying to encourage more promising young Black men like Johnson to become doctors. The challenge remains: will it be enough to meet the needs of Virginia’s underserved rural towns and urban cities?
Confidence in health care lacking for Black families
The Black community harbors long-standing distrust of U.S. health care and the medical establishment. More than half of Black Americans say they don’t trust the U.S. health care system, and 7 of 10, believe they are treated unfairly by it, according to recent surveys.
The roots of the misgivings are well-documented. The Tuskegee Syphilis study, in which treatment for syphilis was withheld from hundreds of Black men for decades to observe the course of the disease, and the forced sterilization of women of color, are still large in the Black cultural consciousness.
Modern inequalities continue to reflect unfavorably on the health care system. Black babies born in the U.S. are two times more likely to die than white infants — even when born to Black mothers who are more educated and financially stable than their white counterparts. Physician bias is also shown to negatively impact health outcomes for Black patients, who are routinely undertreated for pain compared to white patients, findings by the University of Virginia show.
When Black patients see Black doctors, they fare better, and trust is a huge factor, said Vanessa Sheppard, a health policy expert from the VCU School of Medicine.
“(A trusting) environment facilitates more patient engagement in their care to ultimately get the care that they need,” Sheppard said. “This is whether they need to advocate for themselves or gain the support needed to follow care recommendations.”
Some Black physicians have continued the tradition of the small community, family practice.
Dr. Richard Jackson, a Richmond primary care physician, represents the third generation in a family of Black doctors whose practice, Dominion Medical Associates, dates to 1911. Located in Richmond’s historically Black Jackson Ward neighborhood, the Jacksons have served primarily Black and poor patients for more than a century—building trust with families through generations.
“Now grandparents tell their children, the children tell their children and it becomes a tradition I guess, that (we’re) just where you go for health care,” Jackson said. “I think that trust factor is very important, especially in a minority community when it comes to health care. A doctor may tell you to do something; if you don’t trust the doctor, chances are you’re not going to do it.”
Jackson has broadened the practice’s scope to include collaborating with the Food and Drug Administration and drug companies in clinical trials for therapeutics targeting hypertension and diabetes, among other ailments — many chronic diseases that disproportionately impact African Americans.
Nationwide, Blacks account for only 5 % of enrollment in clinical trials, which impacts data on the efficacy and safety of drugs for all people.
“You talk to (patients) and let them know the advantage of the clinical trial and how it might help them,” he said. “And they have to believe what you’re saying, bottom line.”
Brenda Jeffers-Spain, 79, and her family have been patients of the Jackson's for over three generations. She recalls Jackson’s father, Reginald, making house calls when her mother was ill and attending her father’s funeral. Jeffers-Spain said she trusts that Jackson will listen to her and thoroughly investigate the cause of her health care issues.
“I’ve always had a Black doctor all my life; I feel like your own people would be looking out for you better,” Jeffers-Spain said. “In some circumstances, the color of your skin has a lot to do with the services you receive.”
Recruitment by Virginia medical schools
Some experts worry a nationwide shortage of physicians will widen in coming years, although there are some signs that enrollment among Black medical students has picked up.
The shortage of physicians – from primary care doctors to specialists – could hit crisis levels in the U.S. by 2034, according to a 2020 report by the Association of American Medical Colleges.
But Black student enrollment in U.S. medical schools grew during the Covid-19 pandemic. In the fall of 2021, the number of prospective doctors who identified as Black rose 21%, and represented 11.3% of the total student population in the U.S.
Enrollment of Black students at Virginia’s four medical colleges matched the national average of 8%, according to school data.
Eastern Virginia Medical School and the University of Virginia School of Medicine exceed the national level with Blacks representing roughly 10 % of enrolled medical students. VCU and Virginia Tech’s Carilion School of Medicine fell behind the national average at 6.4% and 2.6%, respectively.
Many new Black students may have been motivated by the spotlight the pandemic put on social justice issues and the rise of Black Lives Matter, admissions experts say.
Dr. Michelle Whitehurst-Cook, professor and dean of admissions at the VCU School of Medicine, said the pressures Covid-19 put on the health care workforce encouraged potential students of all races to enroll.
“I think watching physicians and nurses struggle with Covid, is sort of like war when people go into the service, because I think it really did stimulate people to want to help as a health care provider,” said Whitehurst-Cook, who is Black. “(The pandemic) also gave students a little bit more time to think about, is this what I want to do, (and) more time to study for the MCATs and get their applications in.”
Medical schools across the country are devoting substantial resources toward recruiting Black students, and Black men in particular. Schools have dedicated more scholarships to students of color, who more often struggle with the cost of attending medical school. They have established pipelines to enroll premedical students from historically Black colleges. Mentoring programs also play a role.
Virginia medical schools have taken similar approaches to attracting talented young Black students, reaching them as early as middle school.
EVMS places a priority on mentorship, said Dr. L.D. Britt, chairman of surgery at the school and the first African American in the country to hold such a position. “We (African Americans) have a lot of people going into nursing and allied health professions, and I’m very encouraged by that,” Britt said. “But I would be even more encouraged if we had more people pursuing my discipline, which is surgery and medicine.”
The L.D. Britt Premedical Scholars program at EVMS identifies aspiring physicians from undergraduate freshman year at Norfolk State and Hampton University and pairs them with Black physicians for mentorship through medical school. Endowed scholarships fund students from under-represented groups. The Hummingbird program, started by EVMS graduate LaKeisha Majette, pairs EVMS student mentors with teens interested in health sciences at Maury High School in Norfolk, a majority Black school district.
VCU has also allocated scholarships for underrepresented students. The university’s pre-matriculation programs give students coursework to prepare them for the rigors of a medical school curriculum. And the university’s Black Men in Medicine program focuses mentorship and academic advising efforts on Black male undergraduates who want to study medicine. Virginia Tech has focused on increasing overall Black enrollment. In 2017, Tech started the Black College Institute, a program for high school students geared toward community service and college preparation. The University of Virginia offers nearly 20 endowed scholarships to academically gifted Black students.
While improving access at the higher education level is important, most of the roadblocks to Black students attending medical school are encountered well before undergraduate education, according to a UVA study published in 2010.
Researchers found that the gap between the number of Black and white students entering post-baccalaureate medical studies can be traced mostly to pre-college factors: Parent education levels, attending K-12 schools with lower per-pupil spending, higher poverty rates, and lower average scores on standardized tests. Much of the work to close the gap should be focused on these factors, said researcher Jessica Howell, a former UVA professor.
“The flow of Blacks into the health care professions has been reduced at an early stage in the educational pipeline, so we must go back in the pipeline to open up that spigot," Howell said. "This research and other research confirm that you have to go back further in that pipeline than many people realize."
Alleviating the bigger issues depends on dismantling systemic problems rooted in racism, said Dr. Eric Freeman, a VCU medicine professor. “I think we have to have honest, heartfelt conversations about structural racism, discrimination and access to education,” said Freeman, who is Black. “And look at other potential barriers for Black men (in particular) whether that’s health care access (or) educational disparities.”
“My grandbaby is going to be a doctor”
While the health inequities highlighted by Covid-19 bolstered longstanding efforts to recruit more Black doctors, universities, physicians, educators and public health professionals are still up against centuries of disparities.
But it’s an important fight for community health, advocates say. Racial and ethnic minority physicians are more likely to practice primary care and to work in underserved communities, a study published in the Journal of Health Care for the Poor and Underserved found.
In Richmond, the Jackson family medical tradition may be nearing an end: Richard Jackson’s five children so far have chosen careers outside of family medicine.
Jaz Johnson’s family history reveals what helped him overcome challenges and make it to medical school. Johnson grew up in a middle class home: his mother had a career in the military, and his father was a professional photographer.
But both of his parents grew up in poverty — his mother in South Side Chicago and father in upstate New York. Johnson’s matriculation into medical school was a triumph for the family.
“There were times when my grandmother would be on the phone and she would almost be in tears prior to her passing because she would just think about, man, I have a doctor in my family. My grandbaby is going to be a doctor,” Johnson said.
Johnson’s studies at VCU are funded by the National Health Service Corps Scholarship Program, a program designed to bring more primary care doctors to underserved communities. He’s pursuing a career in pediatrics, and sees the specialty as a way to address health and social justice issues that plague Hillside Court and other low-income communities. He wants to focus on tackling the long-term health consequences for Black youth in the criminal justice system.
“I see (medicine) as an opportunity to really just be in somebody’s corner and not look at them for what they did, but to be able to see … this doesn’t define you,” Johnson says. “And to hopefully be that person to show them a different route.”
This step forward for Johnson was one taken by his entire community — friends from high school and childhood, church, family and mentors.
“They all felt like this victory isn’t just Jaz’s victory, this is our victory as well,” Johnson said. “And I took joy in being able to share my victory with my village, with the people who I had gotten to this place with.”
Correction: An earlier version of the story stated the share of Black doctors in the U.S. has risen 4% since 1900. The share of Black doctors in the U.S. has risen four percentage points since that time.
