Year 4. February 18.
Celebrating Black Physicians — And Making Pipeline Progress
Black physicians are essential to the health of our communities. This is not just a platitude; it is supported by quantitative evidence, such as a study published in 2023 in JAMA Network Open showing that there are significantly smaller mortality gaps between Black and White residents in counties with even just one Black primary care physician — and that those improvements are greatest in counties with high rates of poverty.
While there are of course many possible explanations for this phenomenon, it nonetheless makes the case for diversifying the physician workforce, as does an abundance of other evidence showing that culturally concordant care results in better outcomes in people from communities of color.
Yet there are far fewer Black physicians than communities need to thrive. According to 2018-2022 data from the Health Resources and Services Administration only 5.3% of physicians are Black, despite making up around 14% of the population. In states with some of the largest Black populations, that disparity is even worse: Nearly 40% of Mississippi’s population is Black, but fewer than 10% of its doctors are.
There are many reasons for these disparities, and they affect all points of the medical career pipeline. Many of our own faculty in the DoM are specialists in this realm; they conduct studies that reveal the barriers faced by prospective Black physicians, demonstrate the vast impact of revoking affirmative action programs on workforce diversity, and much more.
Some of them are also experts by way of personal experience. While no two Black physicians’ journeys are alike, it is fair to say that being one of just a few in number can be lonely and it is essential that we guide and mentor aspiring physicians and physician scientists in their pursuit to becoming a leader in medicine. Mopelola Adeyemo, MD, MPH, an assistant professor in the UCLA Department of Medicine (DoM) Division of Clinical Nutrition and highly accomplished researcher of health disparities in prevention and treatment of obesity and metabolic disease, wishes she had known that she wasn’t the only one who sometimes felt isolated during medical school and residency.
“Often I was the only woman, or the only Black woman,” Dr. Adeyemo recalled. She eventually came to recognize her experience as a strength: “I had a voice that was unique and added perspective — both in the research realm, where we think about how to include different communities, and with being able to relate to my patients with regards to their lived experiences as a woman, an African American or an African American woman.”
Pipeline Progress
Progress in improving Black representation among U.S. physicians has been slow. A 2021 analysis of historical trends in the racial diversity of physicians showed that the proportion Black physicians has increased by only 4% in the past 120 years. That could partly be blamed on pipeline problems, including some that affect even those who largely make it through: Black medical students are almost twice as likely to drop out of medical school than white students and are more likely to be forced out of residency.
Those statistics may be traced back to institutional barriers as well as more subtle ones. That includes a higher bar for Black students and trainees to “prove themselves” than the one placed on students from other racial and ethnic backgrounds, as General Medicine and Health Services Research Assistant Professor Max Jordan Nguemeni, MD, MS, an internist whose health equity work placed him on Forbes’ 30 Under 30 in 2021, explained.
“In my experience as a Black trainee, it felt like you had less room for error,” Dr. Nguemeni said. “People give you less grace. It’s anxiety-inducing.”
Other challenges begin long before medical school. Utibe Essien, MD, MPH, associate vice chair for equity, diversity and inclusion in the DoM and an assistant professor in residence at DGSOM — and a 2024 National Academy of Medicine Emerging Leader in Health and Medicine — believes that many Black students who would like to be doctors simply don’t have the means to defer making a salary for the many years required to go through medical training, particularly in academic medicine.
“A lot of people don’t have the generational wealth or support to be able to continue through that journey,” Dr. Essien explained. “They have to back out and cut their losses. I think that’s probably under-discussed.”
The Power of Mentorship
While it doesn’t solve every problem, Dr. Essien believes mentorship is essential to boosting Black representation in medicine. Endocrinologist and health services researcher Estelle Everett, MD, MS, who was recently accepted to the prestigious Harold Amos Medical Faculty Development Program, agrees.
“I’m a first-generation college student, the first to have gone to medical school, and so there are many things that I did not know,” Dr. Everett recalled. “My mentors have given me critical guidance when things got challenging. I think having the right people in your corner and aligning yourself with people who have your best interests at heart is most important.”
Susanne Nicholas, MD, MPH, PhD, a nephrologist, professor of medicine and immediate past president of Women in Nephrology, is a first-generation physician as well. Her journey through the medical education system stoked her passion for helping others find their way.
“I got involved in mentorship because I didn’t have role models who were physicians or mentors to really educate me about the things and steps I needed to take to be successful in my career,” Dr. Nicholas explained. She now helps expose high school and undergraduate students to laboratory research through the National Institutes of Health’s STEP-UP program and mentors early-career faculty through the DoM Office of Inclusive Excellence’s JAM Council program.
Dr. Adeyemo, too, went through much of her early career without mentorship, though she now is surrounded by what she considers a whole team of mentors to call on for advice. She has made a point to provide guidance to students and early-career faculty, including individuals in her L.A. community beyond UCLA.
“There are students who I’ve worked with who just sent me an email and told me that they’re interested in the project I was working on, and we’re still working together today,” she said.
Closing the Gap
As Black History Month prompts us to reflect on the challenges and triumphs of Black physicians and physician-scientists, I would like to celebrate the phenomenal work that Black members of our faculty are doing not only around issues of health equity, but also in basic science, clinical and translational research. Furthermore, they are outstanding clinicians who are integral to our mission to provide world-class patient care.
The UCLA Department of Medicine aims to be part of the solution to improving Black representation among physicians and in academic medicine. Closing this gap will require broader changes that address some of the fundamental challenges associated with inequality in medicine.
While no one can solve systemic challenges alone, each of us can do our part to help all members of our DoM community feel welcomed and included. I encourage all of you to review the anti-racism resources compiled by the DoM Office of Inclusive Excellence and to continue to have important conversations about what we can do — both as individuals and collectively — to continue to foster an environment where everyone, from students to senior faculty, can do their very best work.
Addressing Disparities in Black Women’s Heart Health
In addition to Black History Month, February is also American Heart Month. It is well established that Black individuals have higher rates of cardiovascular disease than other demographics, particularly Black women. Many faculty here in the DoM are involved in research or clinical projects that aim to illuminate and improve this disparity, including Karol Watson, MD, PhD, who serves as director of the UCLA Women’s Cardiovascular Health Center, the UCLA-Barbra Streisand Women’s Heart Health Program, co-director of the UCLA Program in Preventive Cardiology, and director of the UCLA Fellowship Program in Cardiovascular Diseases. She answered some questions about heart health in Black women and what clinicians can do to improve morbidity and mortality in this population.
1. Why are the rates of heart disease and heart disease-linked mortality greater among Black women than other demographics?
Cardiovascular disease affects 47.3% of Black women and Black women have a higher burden of cardiovascular disease compared with women of other ethnic groups.
Much of this is related to risk factors as Black women have higher rates of hypertension, obesity, and sedentary lifestyle. But even when you control for all medical comorbidities, Black women still have higher rates of cardiovascular disease and much of these disparities are related to social determinants of health.
2. Over the course of your career, what progress has been made in closing the morbidity and mortality gap in Black women’s cardiovascular health?
Over the past several decades a lot of research has been done highlighting and cataloguing these disparities but unfortunately much less research has been done that provides definitive interventions that can reduce these disparities.
3. What challenges still remain?
Remaining challenges include the socio-political climate that de-legitimizes disparities research. Also, so many of the causes of these disparities are social and require societal change.
4. What are some effective strategies clinicians can take to help improve these disparities?
For now what clinicians can do is aggressively treat all risk factors in all of their patients at cardiovascular risk. Clinicians should also consider the social context of each of their patients and address social determinants whenever possible.
Patrick Frierson
Next I would like to spotlight the tremendous work of Patrick Frierson, senior program manager for the UCLA DoM Office of Inclusive Excellence. Patrick joined the DoM in late 2023 to lead equity, diversity and inclusion programming for faculty and staff. He has since become indispensable to the DoM community, fostering growth and a sense of belonging through programs like his beloved “Lunch & Learn” and “Leaning Into New Knowledge (LINK)” series. These programs help staff build relationships and learn more about workplace issues that are of interest to them, such as showing up authentically and bridging generational gaps.
They also exemplify Patrick’s personal and professional goals: to give people new knowledge that helps them connect.
“When it comes to teaching or engaging with people, it’s really important to help them get on the same page as the other folks they’re working with and to give them a sense of connectedness,” he said.
Patrick’s passion for people began in childhood, when he developed a fascination with psychology. He was galvanized to apply his interest to improving health equity while working during college at a community-based participatory research lab that studied health disparities and evaluated programs.
“I was blown away by everything I was learning and seeing, especially how not only can you partner with communities to impact social change but that research is a really powerful mechanism to do it,” Patrick said. He initially enrolled in a PhD program for clinical psychology, studying the physical and mental health impacts of racism on Black male students in predominantly white spaces, but soon realized he was most excited about finding interactive ways to promote education around diversity, equity and inclusion.
“I love connecting with people in groups,” he explained. “Education and engagement are some of the most important things to me, and I think they’re really powerful tools.”
Patrick’s research-oriented mindset continues to enhance his work in the DoM. In addition to adding more resources and opportunities for engagement, one of his goals for the Office of Inclusive Excellence is to use data to track staff members’ feelings about their workplace. That information could be used to inform future directions, like in-person events and even mentorship programs.
“I want to build programs that connect people with each other and with important concepts and conversations that can help us all excel,” Patrick said.
I am grateful to Patrick for his dedication to building a DoM community where everyone thrives. If you are a staff member who has not yet had a chance to attend a Lunch & Learn or LINK session, I encourage you to do so when the next round of events is announced. These are wonderful opportunities to learn and grow.
Dale
P.S.
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