When Dr. Robert L. Johnson graduated from medical school in 1972, the only Black people in the audience were his family, his girlfriend and her family. Johnson was the only Black student in his class at the College of Medicine and Dentistry of New Jersey.
“It had always been my experience,” says Johnson about being the only Black student at his college and in the advanced classes he took in high school.
Now the dean of Rutgers New Jersey Medical School in Newark, Johnson has a passion for enrolling a diverse student body. Greater diversity in medical education improves the interracial competencies of all students, Johnson says.
“If the class has more minority students in it,” Johnson explains, “then the other students in the class become better at identifying issues with minority patients and responding to minority patients and treating them.”
New Jersey is a state of diversity in multiple ways. But in hospitals and medical offices, the Garden State does not match the range of its population.
Half of New Jersey’s active doctors are white, according to state data from the Association of American Medical Colleges (AAMC) for 2019–2020, the latest available. That compares with a white population of nearly 62 percent, according to the 2020 U.S. Census. Black doctors are 5.3 percent in New Jersey versus 12.4 percent of all residents. The discrepancy is even higher for Latinx and Hispanic individuals, who make up 4.4 percent of doctors in the Garden State, but 18.7 percent of the population. However, Asians are 23.3 percent of active doctors in New Jersey, while they represent only 6 percent of the state’s population. Women are 37.8 percent of active doctors in New Jersey, according to AAMC.
Johnson noted that research shows minority patients receive better care from health care providers who look like them. “The patient [of color] feels more comfortable with the minority physician,” Johnson says. “And because of that, they’re more able to engage in the whole process of health care. People don’t get better just as a result of what the doctor does; they get better because they work with the doctor to achieve the things that need to be achieved to receive excellent treatment.”
Dr. David S. Kountz, senior associate dean of Diversity, Equity, and Inclusion at Hackensack Meridian School of Medicine, points to similar research. He notes that diversity doesn’t mean only Black doctors take care of Black patients. The impact goes much further, for all patients.
“To have true health equity, to have similar outcomes, it’s important to diversify the workforce. It’s not just a feel-good thing. It’s really very vital to improving the care that all patients receive,” says Kountz, who is also co-chief academic officer for Hackensack Meridian Health. “It’s almost a life-and-death situation that, if we’re all serious about improving outcomes for every patient, then one way to get there is to ensure that we diversify the workforce.”
Michellene Davis is a go-to person for people seeking a doctor of color. A former executive at Robert Wood Johnson Barnabas Health, Davis knows the Garden State’s medical landscape—and why someone may prefer having a doctor who looks like them.
“I get calls from individuals of every walk of life, everywhere on the socioeconomic ladder, asking me to help them find physicians of similar backgrounds, physicians of color,” says Davis, noting there is a special interaction between patient and physician. “When it is one of seeing the whole patient, when it is one that is nonjudgmental, when it is one that also understands cultural nuance and welcomes it into the space, then you have an opening up for a much more transparent discussion. You have the opportunity and the ability to establish real trust.”
Davis says the apprehension, even mistrust, comes from historical racial inequality in medicine—from the Tuskegee experiment, which observed Blacks’ untreated syphilis, to forced sterilization of women of color.
“This is not folklore. This is real American history. It is something that is extremely well known in certain communities,” says Davis, president and CEO of National Medical Fellowships.
One way to diversify the physician workforce is to increase the number of students from underrepresented minority groups enrolled in medical schools. New Jersey’s medical schools are working to widen the pipeline of minority students who will consider a career in medicine. Efforts include ensuring more minorities enroll in college and do well there, which means improving academic achievement in high school and even as early as preschool, according to Johnson.
“The types of learning abilities that students need in medical school begin at preschool. Your academic abilities are set there. If your parents read to you, if you are exposed to educational achievement, if educational achievement is encouraged in both your school and your family, those are the types of things that result in students who are able to graduate from college and get into medical school,” he says.
Rutgers New Jersey Medical School has a variety of initiatives, including a summer program where minority high school and college students work in research labs to gain exposure to the medical field.
Hackensack Meridian School of Medicine is relatively new, enrolling its fifth class in July. But already the school has a six-week summer program for high school students from under-represented backgrounds that focuses on exposing them to role models in medicine. Participants meet doctors of diverse backgrounds and learn about pathways to becoming a physician, all with the aim of motivating the students to pursue a medical career, says Kountz. The medical school plans to expand its programming to reach students even younger than high school.
Diversity is emphasized to all students pursuing medical degrees. Students enrolled in Hackensack Meridian School of Medicine learn about social determinants of health to understand a patient’s background and the dangers of implicit biases.
“We teach our students—all of our students—about biases, and we ask them to be reflective on this and realize that it’s important to learn about one’s bias,” says Kountz. “While it’s not easy to overcome them, it’s important to recognize them.”
Nationally, the population of medical school students is becoming more diverse. For the 2021–2022 academic year, the number of Black first-year students increased by 21 percent, while incoming Latinx students increased by 7.1 percent, according to AAMC.
Davis believes the increase is due, in part, to members of the BIPOC (Black, Indigenous and people of color) community realizing they were more harshly impacted by the pandemic, as well as to the protests that occurred after the murder of George Floyd in 2020. “The same students who were marching in the streets during that summer then decided to march right into medical school admissions offices,” she says. “They wanted to not just throw up a hashtag or be in a march; they wanted to change the world. They decided…, ‘I can make certain that for the next pandemic I’m on the front lines.’”
Minorities are more likely to face a financial burden when enrolling in medical school, which makes the scholarship a key tool for attracting students, Johnson says. Davis’s organization, National Medical Fellowships, provides scholarships and support for underrepresented students in medicine and the health professions. NMF aims to increase the number of BIPOC physicians to better reflect the diversity in the nation.
As medical schools strive to increase the diversity of their student bodies, they create competition with each other. But Kountz and Johnson keep the larger picture in perspective. “There is just intense competition. It reinforces why we need to grow the pipeline, because otherwise, we’re robbing Peter to pay Paul,” says Kountz. “But if I do a pipeline program, and a student ends up going to Johnson’s medical school, that’s still a success, right?”
Diversity initiatives don’t end in medical school. Davis says efforts must go beyond hiring BIPOC doctors to creating an environment where these physicians can excel. Those efforts include raising awareness around implicit bias, especially among hospital managers.
“If folks want to recruit just for recruitment sake, they’re going to see churning happen. That rate of turnover is going to continue to exist in the organization,” says Davis. “It requires a certain level of investment and awareness and work done at these entities in order to ensure that people can come on board, bring their talent and their authentic selves, and be able to thrive and not just survive.”
Sharon Waters is a frequent contributor to New Jersey Monthly.
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