African American physicians are looking for action to back up the
words of apology recently tendered by the American Medical Association
for more than a century of racial inequity and bias.
In accepting the AMA's apology, the National Medical
Association (NMA), which represents minority physicians, urged the AMA
leadership to work with them on three initiatives: recruiting more
African American physicians, reducing health disparities among
minorities, and requiring medical schools and licensing boards to make
cultural competency mandatory for medical students, residents, and
practicing physicians.
"We really want to use this apology as a springboard,"
said Dr. Nedra H. Joyner, chair of the NMA board of trustees and an
otolaryngologist in Chicago. These changes will be critical to reversing
racial health disparities that have led to poorer health outcomes in
African Americans, she said.
"Talk is cheap," said Dr. Carl Bell, professor of public
health and psychiatry at the University of Illinois at Chicago.
Dr. Bell said he is hopeful that the AMA will take meaningful
action to reduce health disparities, but is unimpressed by the apology
alone. He would like the AMA take a stand on issues that would advance
minority health in the United States. For example, he said, the AMA
should push for single-payer national health insurance, be stronger in
challenging the pharmaceutical industry, do a better job of promoting
public health, and support research into minority health and mental
health issues.
Dr. Warren A. Jones, who was the first African American president
of the American Academy of Family Physicians, agreed that further action
will be needed but called the AMA's apology "appropriate"
and "timely." This is not an apology of convenience, he said,
but a signal of a change in the mind-set of the AMA leadership.
The AMA can help ensure that cultural competency becomes a tool in
the medical armamentarium in the same way as the stethoscope or the
scalpel, he said. "Now is the time for the AMA to put its resources
where its mouth is," said Dr. Jones, executive director of the
Mississippi Institute for Improvement of Geographic Minority Health.
The AMA offered the apology in July to coincide with the release of
a historic paper in its flagship journal that examined race relations in
organized medicine (JAMA 2008;300:306-13). The paper was prepared by an
independent panel of experts convened by the AMA in 2005. The panel
reviewed archives of the AMA, the NMA, and newspapers from the time to
provide a history from the founding of the AMA through the civil rights
movement.
The paper notes instances where AMA leadership fostered racial
segregation and bias. For example, in 1874 the AMA began restricting
delegations to the organization's national convention to state and
local medical societies. This effectively excluded most African American
physicians because many medical societies, especially in the South,
openly refused membership to them. In the 1960s, the AMA rejected the
idea of excluding medical societies with discriminatory practices.
During the civil rights era, the AMA was seen as obstructing the
civil rights agenda, the paper noted. In 1961, the AMA refused to defend
eight African American physicians who were arrested after asking to be
served at a medical society luncheon in Atlanta.
The independent panel applauded the AMA for its willingness to
explore its history, but noted that the legacy of inequality still
affects African American physicians and patients. For example, in 2006
African Americans made up 2.2% of physicians and medical students, less
than in 1910 when 2.5% were African American.
In a commentary, Dr. Ronald M. Davis, immediate past president of
the AMA, acknowledged the "stain left by a legacy of
discrimination" and outlined what the AMA is doing to eliminate
prejudice within the organization and improve minority health (JAMA
2008;300:323-5).
Dr. Davis said that the AMA leadership felt it was important to
offer the apology to show the "current moral orientation of the
organization" and lay down a marker to compare current and future
actions.
The AMA has in place policies that explicitly prohibit
discrimination in membership and support funding for
"pipeline" programs to engage minority individuals to enter
medical school. In addition, in 2004, the AMA, the NMA, and the National
Hispanic Medical Association jointly formed the Commission to End Health
Care Disparities. That group has been working to expand the
"Doctors Back to School" program, which brings minority
physicians into schools to encourage students to consider careers in
medicine.
The ultimate goal is to have as much diversity among physicians as
in the general population, where African Americans make up about 12% of
the U.S. population, Dr. Davis said. "Obviously, we have a long way
to go," he said.
TALK BACK
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Association's apology for its history of racial discrimination?
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BY MARY ELLEN SCHNEIDER
New York Bureau
COPYRIGHT 2008 International Medical News
Group Reproduced with permission of the copyright holder. Further reproduction or distribution is prohibited without permission.
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