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Medical Association Apologizes for History of Prejudice

July 10, 2008 at 6:40 PM EDT
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The American Medical Association apologized on Thursday for its history of discrimination aimed at preventing African-Americans from gaining membership. Experts offer insight into the statement and the history behind it.

JEFFREY BROWN: For the better part of a century, well into the 1960s, black doctors were largely unable to become members of the nation’s leading physicians’ group.

Today, the American Medical Association issued a formal apology for what was called a, quote, “stain left by a legacy of discrimination.” The move is a further step in efforts to overcome disparities in the treatment of health of African-Americans that continue to this day.

Dr. Ronald Davis, the immediate past president of the AMA, helped lead the group’s efforts. He joins us from East Lansing, Michigan.

And with us here is Dr. Nelson Adams, president of the National Medical Association, an organization of African-American physicians.

Well, Dr. Davis, I want to start with you. What form did the discrimination take in the past? What specific practices made an apology necessary?

DR. RONALD DAVIS, former president, American Medical Association: We found through research that was done by an independent writing team that we set up in 2005 that it was really the combination of two policies that resulted in this discrimination, which kept most African-American physicians from being able to join and participate in the AMA.

One policy was on the part of some local medical societies that prohibited African-American physicians from being able to join those societies.

The other policy was on behalf of the American Medical Association, which said that, in order to become a member of the AMA, you had to already have become a member of your local medical society.

So it was really the combination of those policies that resulted in most African-American physicians from being disenfranchised from AMA membership and participation, and that’s one of the key findings that resulted in our heartfelt apology that we issued today.

Past practices led to apology

JEFFREY BROWN: And, Dr. Adams, why did that matter? What were the consequences? Start first with the consequences for the black doctors.

DR. NELSON ADAMS, president, National Medical Association: Well, certainly, there are two aspects that I think we need to examine. The first focuses on the physician. For physicians, it meant limited access to increased continuing medical education, number one.

Number two, in terms of cutting edge, if you will, facilities and treatment modalities, they were no longer made available. They were not made available.

One of the things that happened as it relates to patients is that, if the physician did not have access to hospitals and admission to those staffs was often linked to membership in county medical societies, we didn't then have access to in-patient services. Surgery, deliveries, the like, these things had to be done in other settings.

JEFFREY BROWN: So, Dr. Davis, why now? Why was there felt a need to do it now?

DR. RONALD DAVIS: Well, we set up an independent research team in 2005 to look at all of the AMA's internal documents in our archive, going all the way back to the year in which AMA was founded, 1847. It took that writing team a few years to conduct its work.

It presented its preliminary findings to a number of health care stakeholders in late 2007. It prepared a manuscript for submission to the Journal of the American Medical Association, which was ultimately accepted for publication in next week's issue of JAMA, the journal of the AMA.

And so once that writing team put together its paper, came out with its conclusions, we were able to take a look at that, go through self-examination at the AMA, self-reflection, recognize the wrongs that had been committed, acts of omission, acts of commission, and apologize for them.

But what's most important here is what we can learn from the past in order to build a better future. And I think the message that comes out of today's apology is that today's AMA has zero tolerance for discrimination in health care, whether against physicians or patients.

And we look to the future to build a positive future with groups like the National Medical Association, with outstanding medical leaders, like my good friend, Dr. Nelson Adams, where, for example, we've partnered to form a commission to end health care disparities, which now has more than 50 national health care organizations that are part of it, to build awareness that there are disparities in the delivery of health care based on race and ethnicity.

And we need to go about developing and implementing strategies to reduce and ideally eliminate those disparities so that every American will be able to get high-quality health care, regardless of race, ethnicity, gender, sexual orientation, or any other characteristic.

Mending wounds by going forward

JEFFREY BROWN: Let me ask Dr. Adams to help connect the dots here between the disparities and this report on discrimination. To what extent did the discrimination lead to the kind of poor results or actual lack of health care and treatment for blacks? And to what degree has that stayed with us?

DR. NELSON ADAMS: Well, let me first say greetings to my good friend, Ron Davis. This apology is accepted by the National Medical Association for acknowledging the ills of the past.

As Ron said, I think, though the past is important -- and in the spirit of Sankofa, we look back, but we really take this opportunity to look forward, because that's really what it's all about, not so much what happened yesterday, but what's going to happen today and tomorrow.

The lack of access to care impacts everyone. It certainly impacts those who don't receive the care. And that lack of access ends up resulting in poor outcomes. And those outcomes persist from one generation to the other. That's on the physical side.

On the emotional and behavioral side, when fear of the system or lack of access to the system is in place, even when the opportunities arise, oftentimes folk don't make themselves available to that.

So I point to what is known in many circles as the Tuskegee experiment. There was some care going on, but it wasn't good care, and there are three things that I think we really need to focus on.

One is the fact that we need more minority physicians, African-American physicians in particular. In 1910, there were more African-American physicians per capita than there are today.

We also need to make sure that all of us come together, as Ron spoke to earlier, to eliminate health disparities.

And, thirdly, we've got to do that in a culturally competent, culturally sensitive, and culturally congruent way. And I think that, if we can team up to do that, that represents the low-hanging fruit. That is what is going to help us address what has happened in the past.

Diversifying physician population

JEFFREY BROWN: Well, Dr. Davis, pick up on that, because I saw numbers today that backed that up. It was less than 3 percent of the country's doctors and med students are black; less than 2 percent of the AMA members are black. That's today. And that's out of a population, 13 percent of the population.

So what specifically happens now to change both the medical community and the kind of disparities we're talking about in terms of treatment?

DR. RONALD DAVIS: Well, first of all, in the spirit of transparency and self-examination, we need to have the available data to see where we are today and where we need to be tomorrow.

And so we gather statistics on the physician population in general, on AMA members, on AMA leaders, and we publish that every two years. And it's that kind of information which tells us that, in 2006, 2.2 percent of practicing physicians and medical students were African-American, which obviously is way lower than in the general population.

We are doing slightly better among AMA leaders who are members of our key committees and leaders of our key sections, where we have 5 percent African-Americans.

But we can't rest on any laurels here, and we have to strive for a future where we have as much diversity in the physician population as we have in the general population.

And, fortunately, we are launching programs, most or all of which are in partner with the NMA and the National Hispanic Medical Association, to increase the numbers of minorities in medical school and among practicing physicians.

For example, we give scholarships to several minority medical students, totaling $10,000 each, to help them, at least in a modest way, deal with rising tuition and growing indebtedness that medical students face. And the average medical student graduate faces $130,000 of indebtedness. So we're giving out grants, and that's one small role that we are playing.

JEFFREY BROWN: All right, so...

DR. RONALD DAVIS: Also, we, the NMA and the AMA, are sponsoring a program through the commission to end health care disparities called Doctors Back to School, where we send physicians...

JEFFREY BROWN: All right, Dr. Davis, I'm sorry...

DR. RONALD DAVIS: ... minority physicians to schools to talk to kids about how they, too, can become a doctor.

JEFFREY BROWN: All right, Dr. Davis, I'm sorry to interrupt you, but we have to leave it there. Doctors Ronald Davis and Nelson Adams, thanks very much.

DR. NELSON ADAMS: Thank you.

DR. RONALD DAVIS: Thank you.