The past year of covid-19 drew attention to the small percentages of Black people in some health-related professions, including physicians, a situation Arkansas' three medical schools are working to improve.
A 2019 medical study titled "Does Diversity Matter for Health? Experimental Evidence from Oakland" and published in the American Economic Review found that care for Black patients improved when they visited Black physicians. The study states that one reason for this was improved trust and communication.
Blacks make up 13% of the U.S. population and 15% of Arkansas' population. According to the Association of American Medical Colleges, 5% of U.S. doctors are Black. In Arkansas, 85% of general practitioners are white, and physicians of other races make up the rest, according to the Arkansas Minority Health Commission.
"We have been offering scholarships to minorities in hopes of increasing diversity in the health-related profession, because studies have shown minorities will go to physicians more if someone understands their culture and speaks their language," said ShaRhonda Love, executive director of the Arkansas Minority Health Commission.
The majority of workers in health occupations are white, according to the 2019 Arkansas Health Workforce Report by the Minority Health Commission. The report said there were six professions -- general physicians, specialty physicians, nurses, pharmacists, podiatrists and social workers -- in which the proportion of white workers was less than 90%.
Optometrists were 97% white, making them the least-diverse professionally. Social workers were 77% white and 19% Black, making them the most diverse in 2018.
Dr. Sara Tariq, associate dean for student affairs of the College of Medicine at the University of Arkansas for Medical Sciences, said Blacks have made up 5% of medical students in each class in the past five years.
"This is a low number, and we are not pleased with it," she said. "Black Arkansans make up 15% of the state but only 5% of the medical school. That is not a good result."
African Americans admitted to the Arkansas College of Osteopathic Medicine in Fort Smith average about 3% of the class participants, reaching 8% in 2018 and then 1% the next year. The school has had four classes since its inception in 2017.
Shane Speights, a site dean for the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University in Jonesboro, said Black students make up 6% of classes at the medical school, which was formed in 2016.
These numbers are about the same nationally. A 2019 study on diversity in medicine, conducted by the Association of American Medical Colleges, showed that only 5% of physicians in the U.S. and 7.2% of medical students were Black.
That lack of diversity has been amplified during the pandemic, as medical officials realize the lack of trust that the Black community has for the medical profession and how a more diverse workforce could address it.
"If you happen to be a Black student in Phillips County, you might never see a person who looks like you in the medical field," Tariq said. The lack of diversity, "I think it's multiple things, including role modeling, exposure and education. It's the pipeline that we always talk about in the medical field."
"It's beyond just the Black community," said Benny Gooden, senior executive assistant to the CEO at the Arkansas Colleges of Health Education in Fort Smith. "We need doctors who are willing to work in areas of high concentration of non-Caucasian [people], and that is something that we are working on."
FEW OTHERS IN FIELD
Asia Colen, a Black student at the New York Institute of Technology College of Osteopathic Medicine in Jonesboro, was born in Pine Bluff and educated in Little Rock. The graduate of the University of Arkansas at Pine Bluff said she always dreamed of following in her mother's footsteps and entering the medical field.
"I always wanted to be a doctor," she said. "I used to dress up as one as a kid. It helped that I was raised by a doctor so I was there for her entire journey through medical school and residency training."
Colen said that even with a parent in the medical field, when she visited a doctor, she rarely met anyone who looked like her while growing up.
"I had representation because of my mother, but my doctors for the most part weren't Black," she said. "I didn't see a lot of myself. My mother constantly reminded me when I started to pursue this career in high school that there wouldn't be a lot of people of who would look like me."
Dakory Lee, a medical student at UAMS, said he was exposed to Black professionals in medicine at an early age because of his family, and he knew that becoming a doctor was something he could accomplish, but he didn't meet his first Black doctor until 2016 while at UAMS.
"The exposure was the biggest thing for me," he said, adding that he can see how not having that exposure could have led to him not giving a medical career even a thought.
Dr. Harvey Potts, an assistant professor at the Arkansas College of Osteopathic Medicine in Fort Smith, said the lack of diversity in the field needs to be addressed.
"When we know our demographics have changed over time, then we have to meet the demographics that we see from our patients," he said. "We know there is a great gap. If we know there is a gap in our provider demographic, then we have to close it."
Love, of the Minority Health Commission, said that for things to change, people in minority groups should be exposed to diversity in medical fields early in their lives.
"There is a saying that 'you can't be what you can't see,' and there is a lot of truth in that," she said. "The more we can expose the younger populations to variety and diversity in the health-related fields, the better. "
Potts said exposure is another word for mentorship.
EARLY EDUCATION KEY
Dr. Keneshia Bryant-Moore, associate professor and assistant dean for diversity, equity and inclusion at UAMS, said there are also deep social issues involved in the lack of diversity in the medical field.
"The education system plays a major role in this because you don't see the same education in terms of preparation when it comes to medical school," she said, referring to variations in learning from one school system to the another.
Lee, the UAMS medical student, said when he attended Parkview High School in Little Rock, he noticed how differently he was treated compared with other Black students in his grade.
"I was put in certain advanced placement classes in middle school, and I think part of the reason I was put in those classes was because, one, I was a smart kid, but also because of my parents being involved in my education early on and having a strong financial backing," he said. "I noticed in middle school if I got in trouble for something, I didn't get the same punishment as some of the other students who didn't have the same backing as me."
Increasing the number of Black medical professionals means preparing students for such careers years before they graduate from high school.
"We have an education system in our state that is certainly ranked in the bottom 10 in the nation consistently," Tariq said. "We have got to provide better opportunities for our students across the state to have better opportunities to qualify for medical school."
Potts, the assistant professor at the school in Fort Smith, said access to quality education is key for students being able to qualify for medical school.
"We know that we have a metric or measures that you must meet to get access to higher education," he said. "The gatekeepers are high-stakes exams. The ACT, the [Medical College Admission Test], board exams and specialty board exams. The educational systems have to be a certain quality to prepare you for those exams."
Colen said UAPB, like many historically Black universities, didn't have specific courses dedicated to preparing students for medical school.
"I know these institutions don't have the structure or guidance in place to prepare you for medical school," she said. "Even with the experience I had, there was a lot I didn't know when it came to medical school applications."
Potts said reaching out to historically Black colleges and universities is a step toward diversifying the medical field.
"We have to partner with historical Black colleges and universities for early support as the gatekeepers for medical school, then we can transform our provider population," he said. "This could change the outcomes for our society."
Potts said the Fort Smith school reaches out to underserved areas by using groups like the Student National Medical Association and the campus's Black Student Health Alliance.
"The SNMA here on campus are involved in the pipeline programs, and they go out to these schools and explain the medical field," he said. "The Black Student Health Alliance is doing the same thing, and they are partnered with the mayor's office. These groups are focusing on underserved areas by going into middle schools."
Gooden said the medical school in Fort Smith has an official who goes out and talks to students as young as eighth-grade about the possibility of going to medical school.
"You don't get into medical school when you are a senior in college. It starts when you are in junior high," he said. "But you first have to imagine yourself becoming a medical doctor, then you got to know what it entails and then you got to prepare yourself for it at an early age. This is for all kids. If they haven't had that thought process, and they haven't done the things to prepare, then you won't get admitted and you probably won't finish. It's a pretty daunting task to take on.
"But they have to know that they need to start enrolling in the hardest classes, advanced placement classes and things that will challenge them. Do that in high school, then they are ready for college. Once they are qualified for college, you have to get on track and take the hardest classes to prepare them to take the [Medical College Admission Test]."
"The people who get into medicine have to have a commitment to it," he said.
Lee said his career path changed in 2015, when he saw a bone marrow biopsy in El Paso, Texas, while in the Army National Guard as part of his training as a lab technician.
"I went to the biopsy, and it was for a young Black man who was suffering from lymphoma," he said. "I didn't think of cancer as affecting people who weren't old or smokers, but I was seeing a young, healthy Black man who was suffering from it. I decided then that I was going to go into medicine."
Lee said after he finished basic training, he returned to the University of Arkansas. He was on the fence about whether to finish his doctorate or go into medicine, but then he realized the importance of the position he was in.
"I saw a lot of studies about Black patients having poor outcomes because there wasn't a lot of Black people in medicine," he said. "That was the last nail in the coffin. I realized I could make a bigger impact because I could help more Black patients."
The value of having a family support system became more obvious when Lee said he started to move his career path into medicine.
"I have a lot of classmates in medical school who have parents who work in the medical field or the education system, and they could tell you exactly what to do," he said.
Lee said he didn't know the intricate process of applying for medical school until after his third year of college, when he returned from basic training.
"It was where I noticed the differences because a lot of the other students knew the process from day one," he said. "They knew the clubs you can join, the honor societies to be in. None of my friends were interested in that, and I didn't know any of those things. ... Luckily I had a mentor at UofA that put me in contact with the right people."
Colen said she unsuccessfully tried twice to get into medical school.
"When I graduated [from UAPB], I tried to find as many health care jobs as I could get," she said. "I took a couple of years off from applying and worked as a pharmacy tech. I decided to resubmit a third time for medical school, and I told myself if I didn't get in, I was done."
Colen said she applied to schools all over the South before getting accepted at the medical school in Jonesboro.
Tariq said the low numbers of Black medical school residents is multifactorial.
"I think we start with less applicants to medical school from minority communities," she said. "A lot of highly qualified Black students go to other medical schools out of state because there is more scholarship opportunities there that we don't offer here in Arkansas."
"There are limitations that come from the lack of financial resources," Potts said. "There must be job opportunities for the parents so they can also give this job opportunity to their children."
FEW IN NUMBER
Lee said he knew about the low number of Black people in medical school before he enrolled, but it still came as a shock.
"It's definitely weird," he said. "I naturally tend to go towards other Black people since I am a Black person, but since our population is so small, it makes it a small pool for me. It's stressful because it can be hard to find someone you relate to. Of course I have white friends, Asian friends and Latin friends, but some of the experiences that I think of as a big deal, they don't see things the same way. Sometimes it makes me wonder if I am thinking irrationally, but no, we just have different experiences."
Colen agreed. "I had a diverse friend group and I never felt out of place while in school, but when I went to different settings, I could tell," she said. "When I go to different places across the state I would be mistaken for a technician or a nurse even though I made it a point to say I was studying as a physician. I think it's just so unfamiliar to see an African American physician."
Colen said she grew up in diverse areas, so moving to a place that was predominately white in Northeast Arkansas was a challenge at first.
"I wasn't used to being the only one or two of anything," she said. "It was an adjustment for me, but I was determined to stay true to myself."
Speights said that at the end of the day, it's not just about the number of Black students the medical school accepts, but the number who graduate.
"That is why it's important to have a more stringent focus on having the resources available for students to be successful and graduate," he said.
Speights said the school in Jonesboro has started a master's in biomedicine sciences to give a second chance to students who need more support before entering medical school.
"These are really great students that would make excellent physicians, but they just need more support at the college level," he said. "The worst thing we can do is accept a student, and they don't finish their four-year journey."
REASON TO STAY
Tariq said it's important to find potential medical students in Arkansas' Black community because people who graduate from local schools usually stay within the state.
Speights said members of Jonesboro school's first class are still doing their residencies, and a high number of them stayed in the Delta region.
"It's a big deal because statistics show that 80% of students will stay in the state they do their residency in," he said. "This is why we must ask what we can do to encourage students to stay in the region. As a state we need to start medical residencies in needed areas of family medicine. That is why we started a school in the Delta region because we needed doctors in the region, and then we can start residencies in the region.
"The Delta region is a significantly economically- and health-care-wise depressed area of the country," Speights said. "The federal government has designated it as a place of need. We have lower education levels, lower health care, housing, food insecurities and clean water, all in the Delta region."
Lee said the biggest thing he wants to accomplish is to show other young Black people that a medical career is an option. He also wants to help create a residency program in Southeast Arkansas.
"I want to work in the Delta and build that area up," Lee said. "My ultimate goal is to mirror a program that UAMS started in Northwest Arkansas. The residency program there specifically works with uninsured Marshallese patients, and I think that is cool because a lot of companies in Northwest Arkansas take advantage of that population and don't give them the benefits they need. UAMS brought more doctors to the area and helped these people out, but southeast Black people have these same problems."
Colen said she hopes to start a community clinic in her hometown of Pine Bluff one day and use her diverse background as a bridge of trust between Black people and the medical community.
"I believe with my story and background, I will be able to relate and connect with people allowing them to trust me more," she said. "I can connect with them instead of just trying to tell them what to do and give them some medicine. I can say I understand because I have lived and experienced the best of both worlds."