The shortage of Black physicians in the United States is no accident. It’s the product of a long, deliberate history of exclusion, institutional racism, and policy decisions that systemically undermined Black Americans’ access to the medical profession.
A Legacy of Exclusion
The American Medical Association (AMA), once the gatekeeper of American medicine, played a central role in barring Black physicians from the profession. Membership in the AMA required acceptance into local medical societies, which almost universally excluded Black applicants. The lone exception—the National Medical Society in Washington, D.C.—was itself excluded from AMA proceedings in 1870 simply because it admitted both Black and white members. This act effectively shut Black doctors out of professional networks, medical journals, and advocacy opportunities.
AMA membership wasn’t just symbolic; it shaped professional opportunities. Without it, Black physicians found it harder to gain credibility, hospital privileges, or positions in medical institutions. As the AMA’s influence over licensing laws and medical education grew, so too did the barriers for aspiring Black doctors.
The Flexner Report’s Devastating Impact
In 1910, the Flexner Report—funded by the Carnegie Corporation and implemented through the AMA—ushered in sweeping reforms in medical education. Its author, Abraham Flexner, set high standards for medical schools but brought deeply racist assumptions into his evaluations. He recommended the closure of five out of seven Black medical schools, arguing that Black doctors were needed not for equality, but for “self-protection” of white society against diseases.
Within 15 years, most of the Black medical schools had closed. The remaining two—Howard University College of Medicine and Meharry Medical College—could not keep up with the growing demand for Black physicians. The report’s ripple effects are still felt today. One estimate suggests that the closures reduced the number of Black doctors by 10,000 to 30,000 over the 20th century.
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Structural Barriers Beyond School
Even for those who managed to complete medical school, new licensing requirements introduced more hurdles. Aspiring doctors now needed internships, typically secured through personal connections and relationships with faculty and hospital staff. For Black graduates, these relationships were rare. Hospitals were often segregated, and internships at white hospitals were out of reach.
Black women faced even steeper obstacles. Dr. Isabella Vandervall, who graduated in 1915, wrote about being rejected from four internships solely because of her race. “A huge stumbling block… has suddenly been placed in the path of the colored woman physician,” she lamented.
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Long-Term Consequences
The compounded effects of exclusion and systemic barriers created a self-perpetuating cycle. Fewer Black doctors meant fewer role models for the next generation. The absence of institutional support and mentorship discouraged aspiring Black students from entering medicine. Even as educational barriers slowly eroded, the lack of opportunity and representation continued to hinder progress.
As of today, Black Americans make up around 13 percent of the U.S. population but only about five percent of physicians. The consequences go beyond representation. The lack of Black doctors contributes to widespread medical mistrust among Black communities and worsens health outcomes. Numerous studies show that when Black patients are treated by Black doctors, their health outcomes improve significantly, from lower cardiovascular death rates to reduced infant mortality.
What Patients Can Do: Tips for Navigating the Healthcare System
Until the medical workforce becomes more representative, patients—especially Black patients—may need to take extra steps to receive equitable care. Here are some practical tips:
Seek Culturally Competent Providers: Use directories like BlackDoctor.org’s Find a Doctor to find providers who understand the cultural context of your health concerns.
Bring an Advocate: A trusted friend or family member can help take notes, ask questions, and ensure your voice is heard during appointments.
Don’t Hesitate to Get a Second Opinion: If you feel your concerns aren’t taken seriously, it’s okay to find another provider who will listen and act.
Keep a Health Journal: Document your symptoms, treatments, and conversations with doctors. This can help you track progress and support your case if you face resistance.
Know Your Rights: You are entitled to respectful, unbiased care. If you experience discrimination, you can file a complaint with the Office for Civil Rights at the U.S. Department of Health and Human Services.
Support Pipeline Programs: Consider donating to or volunteering with organizations that support Black medical students. Increasing representation starts with expanding opportunity.
A Path Forward
The story of Black physicians in the U.S. reveals how seemingly neutral reforms, like standardized licensing exams or clinical internships, can have racially disparate outcomes when implemented in a discriminatory system. The Flexner Report may have raised educational standards, but it did so by decimating the infrastructure that supported Black medical professionals.
Reversing this history means more than issuing apologies—it requires systemic investment and policy change. For individuals, however, advocacy, education, and informed healthcare decisions can make a difference—until the system fully delivers the equity it still owes.
