African Americans know that color matters in regard to almost everything in this country. Medical care is no exception.
The evidence more than bears this out. Two examples stick with me: an Oakland study showed that Black male patients fared better with Black physicians—they were more likely to undergo preventive care and accept flu shots from Black doctors. Another example is even more stark: a study of more than two million birth records in Florida showed that Black infants had significantly higher survival rates when cared for by a Black doctor. This is critically important, because Black infants are three times more likely to die before their first birthday than white infants.
It’s clear that when it comes to treating patients of color, the color of the doctor matters. As I’ve come to terms with this reality–from both the research and my own personal experience with my ailing mother’s end-of-life care–I’ve become more attuned to what needs to change.
Our system of funding healthcare starves communities of color of medical care. Those same systemic forces–of valuing the lives of people of color less than others–have kept people of color from pursuing medical careers. This affects the overall health of communities like South L.A. But when you see a problem clearly, you can do something about it–and we are tackling it head-on.
First, let’s be clear on how we got here. The average community has 10 times more doctors than South L.A. We are missing 1,300 doctors, the majority of them specialists—and all of them are needed to address the health conditions of our one million residents.
This deficit of doctors is a result of concentrated poverty and underinvestment in healthcare for low-income communities for decades. California’s Medicaid program has among the lowest provider payments in the country, paying pennies on the dollar compared to Medicare and commercial insurance. This financially punishes doctors working in low-income neighborhoods, condemning communities of color to fewer providers. Without access to doctors, we see higher rates of unmanaged chronic conditions, and ultimately poorer health, such as South L.A.’s epidemic of untreated diabetes.
Given these inequities, it’s not surprising that trust in our healthcare system is eroded for communities of color, who regularly – and historically – receive subpar treatment. Trust challenges are part of why Covid vaccines still lag in the Black community.
One way to rebuild patient trust and improve outcomes is to recruit doctors who reflect and understand the communities they serve, but this is too rare. Only 5% of doctors in America are Black, and there are fewer Black men in medical school today than 40 years ago. In 1978, 3.1% of medical students were Black men; in 2019, that number was even lower, at 2.9%. There are many reasons for this, but a significant one is the cost of pursuing a medical degree.
As a hospital and health system, MLK Community Healthcare has been chipping away at this deficit of physicians, especially for doctors of color. We’ve developed a successful approach that reduces barriers to practicing in our underserved community, but it isn’t sustainable without government action to improve provider payment rates in the Medicaid program.
In 2016, we started our own medical group to bring primary and specialty care providers to South LA. With the help of private philanthropy, we have been able to attract talented physicians, many of them African American and Latino, by paying them market compensation. Keeping these physicians will depend on California providing adequate payment for doctors who treat mostly Medicaid patients. Doctors in low-income communities like ours can’t cross-subsidize low-paying Medicaid patients with higher paying commercially insured or Medicare patients, as can be done in more affluent communities.
In July we will welcome our very first cohort of internal medicine interns and residents to train at our hospital. We know that doctors often stay in the areas where they train, so this program is critical to bringing more doctors to South Los Angeles.
Elected leaders have the responsibility to enact policies to correct inequities. Public insurance programs like Medicaid should not pay less for medical care because someone is poor, and we should educate and train more doctors of color. Raising Medicaid reimbursements to parity with Medicare is a critical step in addressing these inequities. So is subsidizing medical education and training for students of color. Young people shouldn’t have to incur hundreds of thousands of dollars of debt in order to pursue a medical career. Ironically, once a student takes on that level of debt, her or she is effectively prevented from practicing in a low-income community where reimbursements are low.
I am determined to close the healthcare gap in South L.A by bringing not just more doctors, but doctors of color. My next step is to convince our elected representatives that people in our communities deserve doctors who are paid the same as in other communities.