There are many reasons why Dr. Michael Forbes is concerned about the lack of black physicians in Pittsburgh, but one can be summed up in two words: fried chicken.
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Gerome Gloster and Carol Duncan-Gloster are husband and wife and pediatricians at Alma Illery Medical Center in Homewood. That's Ayanna Howard-Burke, who's just 2 months old and was brought in for a checkup, in Dr. Duncan-Gloster's arms. (John Beale, Post-Gazette) |
Forbes, who is black, can speak first-hand about the affection he and others share for the dish. He also knows that blacks have a greater risk of premature deaths from heart disease and that a lifetime of fried chicken dinners can contribute to the problem.
So, cautionary words about the links between diet and disease are important, Forbes says. But he also can see how a white doctor talking chicken with a group of black patients could quickly go from the frying pan into the fire.
"If I get on TV and say, 'I know in my community we love eating fried chicken. I love fried chicken. But it sets us up for disease,' that just sounds better," said Forbes, a pediatric critical care specialist at Allegheny General Hospital.
"It's not that if you're white no one listens to you. If you're black there's just one less hurdle to overcome," Forbes said. "Getting more black physicians into the community is absolutely essential to changing the disparity."
The fried chicken factor is just one reason why training more minority doctors is key to fighting racial and ethnic health disparities, local doctors say. Yet national trends show that just the opposite is happening -- there were fewer blacks enrolled in medical schools during 2001 than 10 years earlier. The decline dates to the mid-1990s.
Minority physicians are more likely to practice in some of the communities hardest hit by the health disparities. And once they start practicing, they can serve as important role models. What's more, more diversity among physicians -- along with better training for non-minority doctors -- could help patients feel more trust in the medical system.
"People tend to gravitate toward health-care professionals who look like themselves and possibly identify with what they're going through," said Paula Davis, assistant dean of student affairs and director of minority programs at the University of Pittsburgh School of Medicine. "So, there's a greater likelihood that people who have treatable illnesses will go and be seen ... if they feel comfortable getting regular checks from their doctor."
Improving the numbers
Blacks make up about 4 percent of physicians -- significantly less than their 12 percent share of the U.S. population.
Dr. Robert Bennett, president of the Gateway Medical Society, an organization of black physicians in the region, estimated that the local percentage is roughly in line with the national average. The medical society will be raising money this fall to expand its scholarship program, which helps minority students make the financial leap into medical school.
In 1990, the Association of American Medical Colleges set a goal of diversifying the physician workforce by graduating a total of 3,000 under-represented minorities from medical school by 2000. Under-represented minorities include African Americans, Native Americans, Mexican American/Chicanos, mainland Puerto Ricans and Hawaiian/Alaskan natives.
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Dr. Edward James, who has operated a primary care practice in Coraopolis for 41 years, shows students around his Coraopolis Health Center during career day. With him are Gayle Ball, an associate professor of Dental Hygiene at the University of Pittsburgh and students (left to right) Jeff Singer, John Kim and Harold Cain III. (Lake Fong, Post-Gazette) |
Dr. Jordan Cohen, president of the association, said medical schools were on the path to meeting the goal until affirmative-action roll-backs in Texas, California and other states during the mid-1990s. The legislative changes in those few states had a chilling effect at other medical schools, Cohen said, because admissions committees began fearing lawsuits from white students rejected in favor of minorities.
"By using those affirmative-action tools over the years, we [were] able to identify many students who otherwise wouldn't have gotten into medical school who have turned out to be excellent students and then excellent physicians," Cohen said.
So, medical schools in the past decade not only fell short of the 3,000 by 2000 goal, they also took small steps backward in the number of black accepted applicants and entering students. In 1992, for example, there were 1,197 black students who entered medical school classes. In 2001, the number was slightly lower at 1,170. The high-point for new black students came in 1994, when medical schools welcomed 1,309 black students.
The University of Pittsburgh School of Medicine refused to release complete numbers about black applicants, entering students and graduates from Pitt over the last 10 years.
But Davis, the minority programs director, said that in 1992 Pitt received 417 applications from underrepresented minorities and 17 of those students entered the medical school class. In 2001, there were 413 underrepresented minority applicants and 20 entering students.
"On average, we'll usually wind up with 10 to 11 percent of the class with underrepresented minorities," she said, adding that the total class size is usually about 148 students. "Last year, it was 14 percent. The low was 8 percent."
The medical school was criticized last year during a special meeting of the Allegheny County Medical Society on minority health by Dr. Morris Turner, an obstetrician in East Liberty.
Turner told about 100 people gathered for the meeting that he and several of his minority peers who graduated from Pitt during the early 1970s ended up practicing in minority communities here. But as his retirement nears, Turner said, he doesn't see "a parade of individuals coming to relieve me or my present colleagues."
Davis countered that the medical school has been successful in training more minority physicians, but many have chosen to practice elsewhere.
"We find a lot of students who are looking for an environment where there is a larger and better established African-American middle class, and they don't necessarily see that in Pittsburgh," Davis said.
The Pitt medical school has made progress since the early 1990s in bringing in a respectable number of minority students who are strong enough to make it through their training and go on to competitive residency programs, said Dr. Robert Thompson, an obstetrician/gynecologist in private practice in Oakland.
But the rapidly escalating cost of medical school tuition has emerged as another barrier to training minority medical students. Medical school graduates leave their training with as much as $200,000 in debt. During the strong economy of the late 1990s, young African Americans could travel quicker and more assured paths to high-paying careers.
"These trends are real and I think they work to exclude minorities," Thompson said.
Getting the local kids
Recruiting native Pittsburghers to the medical school is one strategy that has yielded some success, Davis said, pointing to former students Renee Hickman and Yvette Lynn Taylor.
Hickman is from Monroeville and Taylor from Highland Park. Both graduated from Pitt medical school in 1998 and went on to family practice residencies at UPMC Shadyside. In March, they opened a family practice on Frankstown Road in Penn Hills.
"I do see this as giving back to our community," Hickman said. "I can remember being in medical school and having African Americans stop me on the street after seeing my white coat and say, 'I'm so proud of you. It's so good to see one of us becoming a doctor.' "
Gerome Gloster and Carol Duncan are two more examples of black physicians who've stayed in Pittsburgh.
After meeting in the eighth grade at Reizenstein Middle School, Duncan and Gloster remained friendly acquaintances through high school and at Pitt. As Pitt seniors, they wound up together in a physical chemistry class and Gloster repeatedly proposed study dates. Duncan brushed him off until the first exam came and Gloster aced it. Suddenly, it was Duncan proposing study dates and the couple soon started dating.
They married after graduating from Pitt medical school in 1992 and completed residencies in pediatrics at Mercy Hospital. Now, the pediatricians work for the Alma Illery Medical Center, practicing in Homewood, the Hill District and the North Side.
"Having minority physicians and health-care workers lets the children see that they can maybe become a physician or have some other career -- it helps them set goals," Gloster said.
He pointed out, however, that just being black doesn't guarantee a good relationship with minority patients. Whatever their race, doctors will earn the trust of minority patients if they listen, care and show respect.
Getting the history down
That same idea is the driving force behind a project at the Center for Healthy Hearts and Souls in Wilkinsburg to record an oral history of African American experiences in health care. Funded by Pitt's Center for Minority Health, the oral history project has convened several focus groups since March and heard stories from about 100 patients and providers.
Organizers are now reviewing the tapes, picking out common themes and, after convening the focus groups again, will create a script that dramatizes some of the stories.
The script will be acted out by the Kuntu Repertory Theatre at Pitt and videotaped, so it can be viewed by medical school students and hospital groups.
Dr. Bruce Block, a family medicine doctor at UPMC Shadyside, said organizers of the project were compelled to act after hearing so many stories from African American patients who felt a lack of respect from health-care providers.
"You really do have to put a lot of energy in developing respect and trust," Block said. "And no one is trained in doing that in a thoughtful way, even though that can be trained."
Correction/Clarification: (Published Aug. 24, 2002) The president of the Association of American Medical Colleges is Dr. Jordan Cohen. He was misidentified as Jared Cohen in Tuesday's article about a shortage of African-American physicians.
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