A paucity of Black physicians is shortening the lives of African Americans—and politicians are starting to take note. Senators Roger Marshall (R-Kans.) and Bernie Sanders (I-Vt.) have proposed the Bipartisan Primary Care and Health Workforce Act to address the broader shortage of primary care physicians. The bill allocates funding to medical schools for increasing the number of primary care physicians and requires 20% of its funding to go to Minority Serving Institutions, including historically Black medical schools. This provision aims to increase the number of Black primary care physicians.
It’s an important first step toward addressing the longstanding and disproportionate lack of Black physicians. The origins of this shortage lie in three aspects of professionalization and “reform” of medicine that took place from the mid-19th through the early 20th centuries. These changes made it harder for Black physicians to become licensed and discouraged them from even trying. Understanding this history can provide a useful guide as lawmakers work to try to address this shortage and reduce the racial heath disparities that are so damaging to Black Americans.
At the time of the American Medical Association’s founding in 1847, most people viewed medicine as more of a trade than a profession. The white male physicians who founded the AMA hoped a professional organization raising and enforcing standards would also raise the prestige—and consequently, the pay—for doctors. Seeing the presence of Black doctors as a threat to these goals, the AMA's leaders quickly moved to prevent them from becoming members of their new organization.
This push epitomized the racism and bigotry animating the AMA in this period. During its antebellum years, six of 14 AMA presidents came from slaveholding or border states, and half of the group's meetings were in the South. The message was unmistakable: the AMA saw enslavement as an acceptable status for Black Americans.
The AMA worked assiduously to keep Black physicians out. The organization required membership in a local medical society to join, and virtually all local societies barred Black members. A rare exception was Washington, D.C.’s National Medical Society. At its 1870 annual meeting, however, the AMA got around this potential loophole by refusing to seat either Black or white representatives from the National Medical Society explicitly because it was an interracial organization. (In 2008, the AMA formally apologized for its contributions to racial inequality in medicine; the organization now recognizes racism as a "serious threat to public health" and has taken steps to support equity in medicine.)
Without AMA membership, Black physicians had fewer professional opportunities, which made pursuing medicine less desirable since it would be harder to make a living.