It was welcome news in higher ed and medical circles when Xavier University in Louisiana announced last month that it planned to open a medical school. The announcement followed a similar statement by Morgan State University in Maryland, which announced last year that it would open a college of osteopathic medicine. By doing so, the two historically Black institutions will bring the total number of HBCU medical schools to six—still a tiny portion of the 170 medical schools in this country, the majority of them at predominantly white institutions.
The new HBCU medical schools represent a significant development nonetheless, given the small number of Black doctors in the United States. Despite making up just 2.3 percent of the total number of medical schools in the U.S., HBCUs produced 9.8 percent of the Black medical school graduates in 2019, according to the Association of American Medical Colleges. That number is down from 27 percent in 2002, before a wave of new medical school openings began, increasing the number of overall graduates.
Efforts by several major predominantly white institutions, or PWIs, to recruit and graduate more Black students are also expected to increase the number of Black doctors over the next decade, which may also eventually improve the access to and quality of health care that Black people receive. Meanwhile, first-year enrollments in medical school by Black students in the 2021–22 academic year rose by 21 percent, from 2,117 to 2,562, compared to the previous year, according to the AAMC.
Those positive signs do little to diminish the many other challenges that remain in terms of increasing the number of Black doctors. A 2015 report by the National Institutes of Health estimated an impending shortage of 33,000 primary care physicians by 2035. Black medical educators point out that Black communities will bear the brunt of those shortages.
“While we can be excited and happy, as I am, that HBCUs with the capacity to do so are starting [medical schools], we cannot let up the pressure on the existing medical schools in doing a better job in training a diverse student body,” said James Hildreth, president of historically Black Meharry Medical College in Tennessee.
“There’s no way in the world—if Morgan starts a school, if Xavier starts a school—that is still not going to provide the number of diverse medical trainees that we need,” Hildreth said. “The other existing schools have to do a better job. That means changing how they evaluate students for admittance, but also paying more attention to the pipelines they draw the students from.”
Morgan State and Xavier, which are planning to open their medical schools in 2023 and 2025, respectively, would join Meharry; Howard University College of Medicine in Washington, D.C.; Morehouse School of Medicine in Atlanta; and the Charles R. Drew University of Medicine and Science in Los Angeles as historically Black medical colleges in the United States.
Xavier and Morgan State also are part of a wave of nine institutions over all that have announced plans to open medical colleges. The list includes Marist College in New York; Duquesne University in Pennsylvania; the University of California, Merced; and the University of Texas at Tyler, among others. Between 2001 and 2019, 29 medical colleges opened in the U.S., according to the AAMC’s count in early 2020.
Making sure that the new and existing colleges attract diverse applicants, and accept and graduate them, is the challenge. The historically Black colleges still produced the most Black graduates; between 2009 and 2019, Howard and Morehouse graduated more than 400 each, while no predominantly white institution graduated as many as 300 during that time frame, according to the AAMC. Of the four undergraduate institutions supplying medical colleges with the most Black entrants this academic year, two were HBCUs—Howard (first) and Xavier (fourth). (The University of Florida was second and Georgia State University was third.)
Wayne A. I. Frederick, president of Howard and a professor of surgery at the College of Medicine, believes bias in medical school admissions at PWIs is a problem and helps explains why they produce fewer black doctors.
"While news of increasing diversity in medical school classes was certainly welcome, it was largely greeted with cautious optimism," he wrote in an op-ed in March after the AAMC reported the increase in Black first-year medical school enrollment. "There is much concern that these numbers could ultimately reflect an anomaly rather than the beginning of a long-term trend. Additionally, after Black medical students successfully enroll, we must do more to provide financial and emotional support to ensure they graduate."
Frederick wrote that the Howard's medical school received a record 7,502 applications for fall 2021 and made admission offers to 4.3 percent of applicants, and 122 enrolled.
"Despite how competitive our school has become and the limited positions we have available, 79 of our new enrollees were only admitted to one medical school—ours. Whether they were rejected from other schools or finances prevented them from applying to other institutions, the majority of our students would not have attended medical school this fall had we not accepted them. We are proof that, with the right admissions process, even exclusive and selective institutions can be accessible to anyone, not just the privileged."
A 2020 survey of medical school admissions officers illustrated Frederick's point. The survey found that while medical schools were largely supportive of the Black Lives Matter movement, less than half of the schools had programs for recruiting Black students. Of the medical schools polled, 88 percent said they issued statements to express solidarity with the Black Lives Matter movement, but only about half (48 percent) said they had specific programs to recruit Black applicants. One admissions officer without a program said, “At the time, the population of Black residents in my city does not warrant a specific stream for Black applicants.”
Reynold Verret, president of Xavier, said the overreliance on HBCUs as feeders of Black med students is an indication that obstacles exist not only at the admissions level but in the pipeline to, through and out of medical school.
“The med schools do not drive the pipelines themselves,” said Verret, a biochemist and immunologist. “It’s the four-year colleges, and the four-year colleges don’t drive those pipelines, either. It’s K-through-12.”
The majority of medical colleges still have low numbers of Black applicants, enrolled students and graduates. The percentage of Black medical students and Black doctors has stalled at roughly 5 percent for several years, which is well below the 13 percent Black population in the U.S.
Verret said he and other leaders at the university view starting a medical school as a core part of an HBCU’s mission.
“Representation and trust are fundamental to equity in mitigating the disparities we’re aware of in health in the United States,” he said. “With the COVID pandemic especially—if there was any doubt about it, it hit you in the face.”
But Verret and many others in the medical community believe that HBCUs alone cannot produce enough doctors to close the racial gap.
“What’s important in this whole American crisis, the predicted shortages, is that the onus cannot be solely on HBCUs,” said Norma Poll-Hunter, the AAMC’s senior director for workplace diversity. She praised Xavier’s and Morgan’s plans but said, “It does not relinquish the responsibilities for all the other medical colleges. They need to really move the needle.”
That needle is indeed moving at some institutions. New York University’s Grossman School of Medicine made arguably the most dramatic move to diversify the demographics of its classes when it began offering free tuition in 2018. Applications rose 47 percent in the first year, and by 102 percent for applicants from underrepresented groups—142 percent for Black applicants.
Black enrollment has more than doubled, from 28 students to 67, and risen from 3 percent to 5 percent in the last 10 years at Stanford University School of Medicine, according to Dr. Reena Thomas, the university’s associate dean for diversity in medical education. Over all, the proportion of students from underrepresented groups has risen from 15 percent to 24 percent in that time frame. She said the numbers were the result of intentional, across-the-board efforts that did more than pay lip service to diversity, equity and inclusion.
“What I have realized is that the momentum for change picked up because everybody was focused on it,” Dr. Thomas said. “It wasn’t single offices or single groups. It was a collective, unified front, advocating for this change together. That’s why we’ve been so fortunate. And I have to admit, I don’t think every single academic institution has.”
Dr. Thomas, a neurologist and neuro-oncologist, started working in her current position in August 2020, when the COVID-19 pandemic was still in its early stages and racial and health-care disparities started coming into view as people of color, especially African Americans and Hispanics, started getting sick and dying at disproportionate levels. She noted that Stanford’s diversity push was already underway through initiatives such as a research partnership with Meharry, in place since 2017, and dedicated support groups for Black students, graduates, residents, fellows, faculty and staff, and a planned program for HBCU medical school students to spend the summer doing research and clinical work at Stanford.
“The history of medicine has been tragic,” she said. “These issues have not just come out of the blue—they have been embedded within medicine throughout its history. And I think the pandemic just brought this to the surface in a way that nobody could deny, nobody could turn away from it.”
Colleges have tried different strategies to draw Black students to the medical profession, at as early an age as possible, in some cases. Hildreth pointed to Meharry’s Pipeline Programs, which include outreach and mentorship programs targeted at middle school students.
“Children cannot get really excited about something they’re not exposed to, and they cannot believe it is possible for them,” he said. “It’s easier to believe something is possible for them if they see people who look like them in those roles already.”
Verret noted the importance of colleges being willing to work with Black students who arrive without the educational background of some of their white peers, and with first-generation students who are navigating unfamiliar territory.
“Students come with all sorts of precollegiate gaps, so when you come to Xavier, we will meet you, and we’re going to fill those gaps. We know that talent is not apportioned socioeconomically,” he said.
The mentoring and support for Black students has to continue throughout medical school and beyond, Dr. Thomas said, adding that of the core tenets of diverse medical education—recruitment, retention and inclusion—the latter is the most vital.
“I think the inclusion is definitely the most challenging. We don’t just want to bring students here to Stanford and not have them thrive. Succeed, thrive, be mentored, feel that inclusion at all levels. And that’s something that we’re constantly still working on.”
Growing the number of historically Black medical colleges to six in the next few years will make a difference in increasing the number of Black doctors– but not as big a difference as all the other colleges pulling their weight and diversifying their student bases. Xavier and Morgan State are moving into that territory, Poll-Hunter said.
“On a national level, we see it as a good thing, because the need is there.”