The Black Physician Experience in the U.S.

Presented by The Journal of Clinical Psychiatry.

Elizabeth Clayborne is currently a faculty member at the University of Maryland School of Medicine Department of Emergency Medicine and the founder and creator of NasaClip.

Access clinical resources and learn more at Psychiatrist.com/Black-Physician-Experience.

Elizabeth Clayborne, MD shares her guidance for confronting the inevitable external bias and racism that will be experienced by physicians of color. For her, the effort starts early on in navigating her own internal biases…primarily believing in herself, her ability, and her valid place in medicine. Her guidance, which is beneficial for future doctors and those in practice now, talks about her commitment to maintaining professionalism in every aspect of her work, and seeking out and finding mentorship.

Presented by The Journal of Clinical Psychiatry.

Elizabeth Clayborne is currently a faculty member at the University of Maryland School of Medicine Department of Emergency Medicine and the founder and creator of NasaClip.

Access clinical resources and learn more at Psychiatrist.com/Black-Physician-Experience.

Only 4% of physicians are Black, a disproportionate ratio compared to the Black population in the U.S. that psychiatrist Ayana Jordan, MD calls “abominable.” As we explore the Black physician experience in the U.S., Dr. Jordan explains the “minority tax” not faced by other physicians. The minority tax is evident in how physicians of color must “navigate a racist healthcare system,” are “constantly asked about credentials,” and are “constantly second guessed.” This creates psychological stressors that can include leaving medicine or academia entirely, especially when left without proper peer or institutional supports.

Presented by The Journal of Clinical Psychiatry.

Elizabeth Clayborne is currently a faculty member at the University of Maryland School of Medicine Department of Emergency Medicine and the founder and creator of NasaClip.

Access clinical resources and learn more at Psychiatrist.com/Black-Physician-Experience.

Black patients have an inequitable experience within the U.S. healthcare system that isn’t adequately talked about, says Ayana Jordan, MD. The psychiatrist explains there is inherent mistrust rooted in historic and current maltreatment. She shares hard truths that must be faced by providers in order to bridge the health equity gaps that negatively impact care and outcomes:

• Black patients don’t receive the same amount of time with their physician as white patients
• Black patients who express pain are more likely to be discredited
• Within mental health, Black patients are less likely to be diagnosed with a mood disorder

Ayana Jordan, MD shares a reading list that can help explain the inequities that exist in healthcare and give all clinicians and healthcare providers the tools to affect necessary change. She says these books explain how bifurcated the system is across racial lines, and can give a really good appreciation of “what we’re dealing with and understand the need to practice differently.”

• Social (In)justice and Mental Health, by Ruth S. Shim, MD, MPH and Sarah Y. Vinson, MD
• Medical Apartheid, by Harriet A. Washington
• Black Man in a White Coat, by Damon Tweedy, MD

Every physician and healthcare provider should take Harvard’s Implicit Association Test (IAT), insists Ayana Jordan, MD. “Once you have an understanding of your inherent biases, your own internal judgments that you operate from…once you bring them from the subconscious to the conscious…doesn’t mean you’ll change your bias, but you’re more likely to make better choices,” she explains.

Those better choices can have a much-needed impact on the delivery of culturally-informed care, which can improve outcomes and the overall healthcare experience for patients of color.

Dr. Jordan implores that this is one of many critical steps clinicians and other HCPs can take “to take better care of patients who are not part of the majority white experience.”

Psychiatrist Ayana Jordan, MD describes how she manages instances of racism when she’s on the job in the hospital and other healthcare settings. She describes routine scenarios where she’s referred to by her first name, but other white coat physicians are called by their doctor title. It’s forced her to use “speaking up for myself muscles,” and she’s grateful that when she introduces that level of consciousness, people get it.

The response is often likened to “Thank you for bringing that to my attention because I will do things differently.”

Dr. Jordan refers to this as “Calling in not calling out,” saying it’s important to let people know their racially motivated actions/behaviors/language are not OK.

The journey to become a physician can be daunting, but Elizabeth Clayborne, MD and Russell J. Ledet, PhD have some invaluable insights to share that can help the next generation of doctors overcome the “too hard, too expensive, I won’t make it” mindset. They each speak to the value of mentorship, whether seeking out a pairing via The 15 White Coats or by “proactively bugging people” for shadowing, recommendations, and other knowledge sharing. Put in the effort and people are happy to support you.

"Be committed. It will require some resilience." Done!!!”

Russell J. Ledet, PhD, a graduate of an HBCU, visited the Whitney Plantation outside of New Orleans with a colleague and his eight-year-old daughter. Her ah-ha moment after that visit inspired The15WhiteCoats.org. She told her dad, “I finally understand what it means and how important it is to be an African-American doctor in America. Think about it, we just came from a place where, historically, people like us were unslaved, not allowed to read or write or do mathematics and to think about how far we’ve come that I’m riding in the car with two black doctors…that’s wild! That’s a long way to come.”

Dr. Ledet tells about the now iconic meeting of 15 Black doctors who met at the Whitney Plantation in 2019, and the non-profit organization that has born of that experience to not only support, mentor, and champion Black medical students, but to plant the seeds to drive our youngest students to pursue a career in medicine.

Structural racism directly decreases economic growth accessibility in a similar way red lining reduces access to housing. Russell J. Ledet, PhD explains how high earning jobs don’t typically go to minority populations, and it’s that systemic inaccessibility that hinders these individuals from moving up social and economic ladders.

There are tremendous financial benefits to becoming a physician not just personally, but for the Black community at large to improve ethnic concordance, which occurs when a patient’s races matches that of their physician.

How can hospital leadership or those in positions of power in healthcare systems mitigate burnout for Black physicians? Ayana Jordan, MD explains systemic changes that must be made.

At the federal level, how healthcare is financed must change entirely. Reimbursement rates in predominantly Black areas are less than those that are predominantly white. Equitable payments should be issued regardless of patient population.

At the local level, end “tokenization” in predominantly white spaces, which can feel “very violent.” She recommends “cluster hires,” where a group of minority physicians and providers are hired together so that these individuals have peers with shared experiences, backgrounds, and relatable support.

And finally, “Trust Black physicians when they say they’ve been maltreated” by other physicians, patients, or administrators. There should be processes and resources for reporting verbal assaults and actionable responses like paid leave or psychiatric support.

In 2021, the largest and most diverse class of hopefuls applied to U.S. medical schools. A celebration to be certain, one Elizabeth Clayborne, MD calls a “unique opportunity to maximize and benefit from.” But, it’s nothing more than a flashy headline if the acceptance rates don’t also match a largely diverse class of new medical students.

Russell J. Ledet, PhD describes a situation with a free market on one end–where anyone is welcome to apply–and a plug on the other–which has limited access to few available spots. He says the change must come by “changing who the decision makers are and how the decision makers think,” and that includes more diversity in the selection committees themselves.