Creating a Segregated Medical Profession: African American Physicians and Organized Medicine, 1846-1910

Abstract

An independent panel of experts, convened by the American Medical Association (AMA) Institute for Ethics, analyzed the roots of the racial divide within American medical organizations. In this, the first of a 2-part report, we describe 2 watershed moments that helped institutionalize the racial divide. The first occurred in the 1870s, when 2 medical societies from Washington, DC, sent rival delegations to the AMA's national meetings: an all-white delegation from a medical society that the US courts and Congress had formally censured for discriminating against black physicians; and an integrated delegation from a medical society led by physicians from Howard University. Through parliamentary maneuvers and variable enforcement of credentialing standards, the integrated delegation was twice excluded from the AMA's meetings, while the all-white society's delegations were admitted. AMA leaders then voted to devolve the power to select delegates to state societies, thereby accepting segregation in constituent societies and forcing African American physicians to create their own, separate organizations. A second watershed involved AMA-promoted educational reforms, including the 1910 Flexner report. Straightforwardly applied, the report's population-based criterion for determining the need for phySicians would have recommended increased training of African American physicians to serve the approximately 9 million African Americans in the segregated south. Instead, the report recommended closing all but 2 African American medical schools, helping to cement in place an African American educational system that was separate, unequal, and destined to be insufficient to the needs of African Americans nationwide.

Getting In, Getting Hired, Getting Sideways Looks: Organizational Hierarchy and Perceptions of Racial Discrimination

“…Becoming a doctor in a medical facility means having personal experience in acquiring the credentials, education, and training required for that position. For black doctors, this process of credentialing engenders intimate knowledge of how structural discrimination spans various settings, including educational and training processes (for historical perspective, see Baker et al 2008, 2009; Washington et al 2009). Unlike black nurses and black technicians, black doctors’ extensive, lengthy credentialing process exposes them to multiple ways potential black doctors can encounter discrimination in various educational settings: black students, for instance, have fewer opportunities to take relevant courses (Carmichael et al 2006), fewer mentors and role models (Alfred et al 2005), face racial tokenism and stigma (Chang et al 2011), and have less cultural knowledge in navigating medical education (Lareau 2015).…”

Projected Estimates of African American Medical Graduates of Closed Historically Black Medical Schools

“…14 This challenge was compounded by ongoing segregation within the medical profession and the educational system in general. 18 , 31 The AAMC requirement that medical school matriculants have a 4-year high school diploma, for example, was associated with a decrease in historically Black medical school enrollment that started as early as 1906, 4 years before the publication of the Flexner report. 18 Nevertheless, in the first decade of the 20th century, several historically Black medical schools across the eastern US persevered and expanded.…”

Traditional Herbal Medicine, Pharmacognosy, and Pharmacopoeial Standards

“…The AMA, an organization founded exclusively by the mineral doctors, in their first set of bylaws, adopted specific language that excluded from the professional organization, any "irregular" physicians whose "practice is based on exclusive dogma.," a clause, which at the time was specifically directed at homeopathic physicians who were at the time successfully competing with AMA physicians [9]. The AMA, an organization founded exclusively by the mineral doctors, in their first set of bylaws, adopted specific language that excluded from the professional organization, any "irregular" physicians whose "practice is based on exclusive dogma.," a clause, which at the time was specifically directed at homeopathic physicians who were at the time successfully competing with AMA physicians [9].…”