Analyzing the deficit of African-Americans in academic medicine [PODCAST]

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“The lack of diversity in academic medicine is a significant issue that can compromise our patients’ health and the education of our training clinicians. There is a vicious cycle in which there are few black academic physicians, leading to seemingly fewer available mentors for black students, which in turn leads to even less of them pursuing careers in academic medicine. As a medical community at large, it is imperative that we understand the implications of this problem, not just on the black patient population, but on the nation as a whole. Its effects ripple through our economy and finances, public health/disease transmission, and educational infrastructure. Knowing this, it is more important now than ever that we promote diversity in academic medicine and to be more specific, that we encourage students, residents, and fellows to pursue such careers.”

Mary Branch is a cardiology fellow.

She shares her story and discusses her KevinMD article, “Analyzing the deficit of African-Americans in academic medicine.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Mary Branch. She is a cardiologist, and she wrote the KevinMD article “Analyzing the deficit of African-Americans in academic medicine.” Welcome to the show.

Mary Branch: Thank you for having me. Your blog has been extensively a cathartic experience for me throughout my medical training, and I’m just thankful to have this continued platform.

Kevin Pho: Well, thank you so much for sharing your voice. We’ll get into your article in a little bit, but first off, can you just share your story and journey to where you are today?

Mary Branch: Sure. I’m actually a fourth-generation African-American physician, so for several generations we have practiced medicine and focused on the health of the African-American population. I’m from Youngstown, Ohio, and then I went off to prep school when I was younger. A lot of my education was in New England. I went back to Case Western for medical school and throughout my training.

Now I’m in North Carolina. I’m a cardiology fellow, and my focus now is on patients with cancer. I focus on the effects of chemotherapy, cancer therapies, and radiation on the heart, and make sure that we’re paying closer attention to these patients, following them before therapy, during, and afterwards when they’re survivors, just to be their champion and ensure that their heart stays healthy throughout the entire process. So it’s a very motivating mission, and I’m just thankful that I have the opportunity to do this.

Kevin Pho: So we’ve read about some of the challenges African-Americans face during medical education, or in medicine in general, or some of the challenges that you faced during your own medical journey.

Mary Branch: Sure. I’m fortunate in that I am a fourth-generation African-American physician, so I knew internally that it was possible for me to pass medical school and to be a physician. But sometimes, throughout my journey, it’s been challenging to have those cheerleaders, to have those folks that say, “Of course you can do this.” They give you the benefit of the doubt: “You’re still learning, but we know that you can do well.”

Unfortunately, even starting as early as high school and college, there was some doubt when I didn’t do well on a test or an exam, that maybe this path wasn’t for me: Am I sure I really want to do this? There wasn’t always a lot of support around the fact that of course you can go into medical school. A lot of people have a bad exam day or something like that, because it’s more about the exam. Practicing medicine is an art, and it requires a lot more than being able to take a test.

So I was fortunate in that I had a mother who was an infectious disease specialist, and she was always someone that I could talk to, to lean on, and to just stay confident, to know that if this was something I was pursuing with the right mission and the right intention, I could just continue with my journey.

But again, I think a lot of it was just the lack of mentorship and the lack of sponsorship throughout medicine, where I had to really be my own champion. My colleagues in medical school also had to. We just had to kind of huddle together and support one another. Unfortunately, we didn’t always have the authority figures and leadership to be as supportive as we were of each other internally. So I’m thankful that I had that, but I think there are a lot of folks that don’t always have those people who are encouraging them into this particular field. So that’s what I hope to change.

Kevin Pho: Now, you’re nearing the end of your medical education journey, your last few months of fellowship. For those starting out, particularly minorities, what kind of places do you advise them to look for mentorship and support?

Mary Branch: I think that’s an excellent question. It’s all about the numbers. If a place talks about diversity inclusion, that may just be kind of lip service. But if you really want to know if the place is going to support you: They are hiring faculty of color. They’re hiring faculty who are African-American. They are in different fields, in diversity inclusion but also maybe other fields, genetics, anything really. I think having the numbers, hiring people, shows you that they support you. They support the people who look like you and who come from your culture, and know that you are perfectly capable, and they value you.

So if a program says, “We’re trying to do diversity inclusion,” you don’t know if this is something that they’re just interested in for now, and maybe that’ll change. But if they’re hiring folks, if you have alumni that you can talk to extensively, that’s what I would recommend: to really kind of reach out to the alumni. Again, you can find sponsors and mentors of many different races, but I think having the leadership believe in you, specifically because they’ve worked with other people like you, is very, very helpful.

Kevin Pho: And you talk more about that in your KevinMD article. It’s titled “Analyzing the deficit of African-Americans in academic medicine.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Mary Branch: Sure. I think through my journey, again, it’s because I felt a little bit isolated, and I really wanted to point out the lack of African-American physicians in medicine, namely because that can impact patient care. So the article talks about how there’s a deficit of African-Americans in the medical system, and a lot of this takes intention to change. This requires, again, recruiting faculty; this requires nurturing students and providing sponsorship and mentorship. It requires lots of intention.

The importance of this is that they’ve done studies, particularly in Oakland, and have found that when African-American patients have African-American physicians, there’s a little bit more of that trust factor. I talk about that a little bit in the article. The issue with hesitancy, when you have an African-American patient and a non-African-American physician, is that we historically have been mistreated as patients in medicine. If you think about the Tuskegee project or Henrietta Lacks, these are cases of folks who were experimented on and not really cared for appropriately. So it’s important at least to have a hospital where you have representation of African-Americans, so patients can trust that they’re going to be taken care of. That was the main point of the article.

Specifically in cardiology, of all heart disease deaths, 23 percent are African-American, according to the CDC. African-Americans consistently make up about 13 percent of the population, but fewer than 3 percent of African-Americans are cardiologists. So this is a pretty striking difference in the statistics, and I think this is something that really needs to change, especially as the population is aging and as heart disease is progressing. I think a lot of it has to do with the prevalence of hypertension and obesity. We really need to make sure that we have patients that are seeing providers that they can trust. Certainly providers of any race can be trustworthy, but knowing that this is a hospital that supports people of color, I think, can help the patient feel reassured that they’re in a place where they feel safe.

Kevin Pho: You wrote this article six years ago, back in 2015. Has anything changed in the interval since then?

Mary Branch: Yes, it has. I think back then it wasn’t talked about as much. It was something that I just noticed but kept to myself. It wasn’t something that I talked about with my research PIs or anything like that. It’s just something that I noticed. I would look around in a room, and as the African-American, you always look around: “Who else looks like me? Nobody.” Wherever you go: “Nobody here.” You’re always counting, and you’re one of three or something like that. That’s just kind of important. It implies a lot of different things.

So now organizations like the American Heart Association have real intention. They realized, with COVID, that disparities were really striking in real time. They said, “Well, this really is an issue. We need to deal with the COVID before the COVID,” which was health disparities, and how this led to this divide. It didn’t just happen. This is years and years of inequity. So now I think there’s a little bit more intention, there’s more grant funding focused on health equity, and there’s more support.

So thankfully, because I’ve been on this train for so long, I’ve gotten opportunities now to write an AHA statement about this issue, to be one of the leaders, and to have a bigger platform to discuss this further. I also blog for the AHA, and they’ve been very supportive of anything that I have to say in terms of health equity and cardiology. So what’s happened between now and then? I think there’s a little bit more awareness globally, and there’s a little bit more intention in how we can make changes. People are a lot more transparent. They don’t just say “bias”; they say “racism.” People really want to get to the root cause of why we’re having these issues, and so I’m thankful for that.

Kevin Pho: So we have a lot of leaders of academic facilities listening to this podcast, so you have a platform to talk to them. Tell us what more needs to be done, from today, that goes beyond lip service to diversity, equity, and inclusion programs. What more needs to be done? Is this simply hiring more minorities, hiring more African-American physicians? Give us an example, some actionable things that you want to see done.

Mary Branch: Right. I think it’s the whole pipeline. To get to cardiology, you have to go to medical school, you have to do an internal medicine residency, and then you have to do a cardiology fellowship. Sadly, a lot of times we lose folks along the way. So to get more African-Americans in medicine and internal medicine, you really have to start the nurturing early on.

So in medical school, just believing in folks, giving folks the benefit of the doubt, having sponsorship and mentorship, reaching out, saying, “Hey, do you want to do this research project with me? That would be great.” It could be on anything. It doesn’t have to be on diversity or equity. It could be on C. elegans, whatever you want to do research on. Just simply reaching out and being intentional that you want to include a certain amount of women in your lab, a certain amount of people of color in your lab. That’s what the American Heart Association is doing with their papers. They’re being very intentional: “I want this certain makeup of people.”

So if you start in medical school, and you start that nurturing and have social events, you really get to know people as people, and you find ways to relate with one another and realize that we’re all just human beings. I think if you start early, if you’re intentional, then again, your hiring practices should also reflect what your intentions are. I think that is what I would like to articulate globally to different hospitals. Because in turn, you’re going to have improvement in patient care. You’re going to have new and novel ideas of how to deal with issues, health disparities specifically, in the community, because you have representatives from the community.

We talk it because we live it. I mean, there’s no other way to describe it. We live this; we live it every day. So it’s not just lip service; this is who we are. So certainly you would need somebody who’s part of this community to try to change it. You need somebody who’s part of it. That’s the only way to really change it, if you really want to change it.

Kevin Pho: We’re talking to Mary Branch. She’s a cardiologist, and she wrote the KevinMD article “Analyzing the deficit of African-Americans in academic medicine.” For those African-American high school students and college students considering a career in medicine but just aren’t sure about medicine because of some of the issues that you discuss, what’s your advice to them?

Mary Branch: Yeah. My advice to them is, if you get an opportunity to shadow with a physician and realize that you purely love this, that this is your mission, I would encourage you to really work on some of the imposter syndrome things that we deal with internally. That’s going to be your most important weapon: to know internally that you’re enough. When you pick up on bias, know that that’s not reflective of you; that’s reflective of their views of you.

But if this is your mission, and you pursue your mission with a great strategy, and you reach out to your network, and you just find the right strategy for you, folks will support you. Some may not. That’s just kind of the way it goes. I always say you have two haters and one supporter. You use the ratio of how it goes. But just know that this is just something that has to do with other people and nothing to do with you.

So if this is your mission, and you know that you are needed, because you are needed, then you just keep going, and you reach out to folks like myself. I’m happy to share more emails of people like me who are supportive and have a supportive network for these folks, and they can always reach out to us for questions, for encouragement, and to cheerlead them along.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Mary Branch: My take-home is, I think, again, as we’re coming into a new era where we recognize that diversity inclusion is important, to those that are in that position: I really want to encourage you to not just hold a title, but to really have the intention to make change, to ruffle feathers. If that’s truly your mission, then do it fearlessly. If that’s really what you want to do, then take the risk. If that means that you may lose that position, at least you did what you felt was right. When you think about your end in mind, I think that’s what’s more important than just holding a title.

So I think that we would all benefit. It’s not a zero-sum game. We all benefit from diversity. Patients certainly benefit from diversity, the community benefits, and so I encourage us to be fearless, to move forward, and to do what’s right. Do the right thing.

Kevin Pho: Mary, thank you so much for sharing your time and insight, and thanks again for being on the show.

Mary Branch: Thank you.

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