Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.
Imagine being told in a medical school interview that your desire to provide care for Black people and patients from marginalized communities would be a “poor use of your medical education.” When this happened to me five years ago, I thought maybe my interviewer was just testing my commitment to this cause, so I politely doubled down. I spoke further about how institutional racism plagues America and how being able to participate in the transformative work to combat it was a major reason I was drawn to a career in medicine. My interviewer rebutted my conviction with an unamused smile, suggested that we agree to disagree, and abruptly charged onward with his next question.
My interviewer’s apathy toward anti-Black racism did not come as a shock to me. This would not be the first time, nor would it be the last time, my identity as a Black man and hopes for a more just and equitable world for Black people would be dismissed. Black people in America live with the collective understanding that institutions established to educate, protect, and serve the people of this country are also designed to neglect and harm us. Unfortunately, my interviewer’s apathy toward institutional racism is shared by countless individuals in positions of power who could address it and other forms of institutional oppression if they ever cared to.
Black people in America live with the collective understanding that institutions established to educate, protect, and serve the people of this country are also designed to neglect and harm us.
Understanding that no institution could offer me a completely anti-racist education, I matriculated at another medical school the following year, prepared to make my career ambitions a reality. As a student, I, alongside Black classmates and allies, organized in the face of anti-Black racism as it would manifest in the practice of segregated care within our medical institution, lecture materials that propagated the debunked myth that race — rather than racism — is a determinant of health, and more recently, police brutality.
Across the country, Black medical students and allies have organized in a similar fashion at their institutions. I’ve been in many GroupMe’s, Slacks, email threads, and local as well as national conference calls with other students sharing our best practices and supporting one another. Medical education values knowledge on the pathophysiology and treatment of diseases most doctors will never encounter in their careers. However, it offers close to no teaching on the history of racism in medicine, nor does it adequately equip students and trainees with anti-racist practices to dismantle the ongoing institutional racism we will encounter daily in our careers. We understand that institutional racism has been killing Black patients for centuries, and, as future doctors, we want to ensure that not only are we are not complicit in promulgating this public health crisis but that we are actively working to end it.
The COVID-19 pandemic has forced America to confront institutional racism head-on by laying bare the inequities that have led to a disproportionate impact of the coronavirus on communities of color. Furthermore, the recent anti-Black racist murders by vigilantes and the police — of George Floyd, Ahmaud Arbery, Breonna Taylor, and Tony McDade, among many others — occurred when many Americans were asked to stay at home, making them a captive audience to the age-old crisis that is white supremacy and institutional anti-Black violence. The combination of a global pandemic and the harrowing virality of anti-Black murders by the police may have finally broken through the institutional apathy that has long stymied real progress toward eliminating racism and racist policies.
We understand that institutional racism has been killing Black patients for centuries, and, as future doctors, we want to ensure that not only are we are not complicit in promulgating this public health crisis but that we are actively working to end it.
Conversations that have previously gone no further than the echo chambers of like-minded individuals quite literally have grown legs and marched through the streets occupying mainstream attention. Anti-racism has become the theme of book clubs, corporate campaigns, sporting events, and even department grand rounds at medical centers. Black medical students, faculty, and trainees have capitalized on our institutions’ newly lent ear and synchronously pushed for change alongside our comrades who took to the streets. For the first time in a while, I began to feel cautiously optimistic that medical schools would begin to make long-overdue changes in favor of racial justice.
This optimism, however, is tempered by my understanding of the adaptive capitalistic equilibrium in which American institutional “progressiveness” exists. Adaptive in that institutions will make only the necessary minimum adjustments needed to continue to operate within the present times, and capitalistic in that institutions will attempt to inject marketability into activism to financially protect or even benefit themselves. I fear that no matter how far people might push institutions toward change, any progress will likely be transient, and the country will soon find itself back where it was originally. If medical institutions are committed to anti-racism, they must act with humility and embrace discomfort — even, perhaps, some disequilibrium.
In medicine, we would never ask a psychiatrist to reconstruct a patient’s torn ACL. Instead, we would refer that patient to an orthopedist with more expertise in that condition. Similarly, medical schools must know when to solicit the expertise of anti-racist experts as well as be prepared to point to racism within their institutions if they ever hope to successfully cast it aside.
Medical schools need to join with their students in dreaming of a more racially just and equitable America, and that starts by dreaming of more racially just and equitable institutions of medicine.
Confronting institutional racism must also involve implementing new approaches rather than relying solely on the same old approaches that have allowed racism within medicine to persist and thrive. In a 2013 speech at the University of Chicago, activist Angela Davis said, “The process of trying to assimilate into an existing category in many ways runs counter to efforts to produce radical and revolutionary results.” Our usual reliance on urgent and short-lived task forces and subcommittees to address issues are certainly a start but alone will fall short. These efforts attempt to reform or assimilate antiracism into institutions that were not designed to be antiracist. If institutional anti-racism is truly the goal, we must be prepared to use new approaches that will allow us to uproot and dismantle medicine’s racist foundation and lay down a new foundation of anti-racism.
Medical schools need to join with their students in dreaming of a more racially just and equitable America, and that starts by dreaming of more racially just and equitable institutions of medicine. Black students have given their schools clear demands that should be enacted with serious intentionality and devoid of apathy. My hope is that schools will meet these demands and relieve Black medical professionals of the burden of always leading this charge without compensation, so we can freely focus on our patients and careers as our White and non-Black colleagues do.
Medical schools have the opportunity to be on the right side of history by producing generations of newly minted anti-racist physicians and by working to dismantle institutional racism in medicine. It is finally time to invest in this imaginative work with action, funding, and policies so we can work to end the age-old public health crisis that is anti-Black racism.
Taiwo Alonge is a senior medical student at Columbia University Vagelos College of Physicians and Surgeons. He will be applying for residency in psychiatry this fall and has interests in child and adolescent psychiatry, public health and public policy, and health equity. Follow him on Twitter: @TaiwoPAlonge.