To honor Black History Month, NeurologyLive® spoke with influential Black clinicians on the leaders they look up to, the ongoing fight to overcome racial disparities, and ways to encourage diversity in health care.
Black History Month, a time dedicated to celebrating and honoring the contributions and sacrifices of African Americans, is observed every February in the United States and increasingly around the world. African Americans have played a central role in US history, including in medicine. Notable pioneers in medicine include Mary Eliza Mahoney, the first Black professional nurse in the US, as well as Solomon Carter Fuller, known as the first Black psychiatrist, who was a research assistant to Alois Alzheimer and reported the ninth case of Alzheimer disease ever described.
Across neurology specifically, there have been several other barrier-breakers, including Alexa Canady, who became the first Black woman to become a neurosurgeon in 1981, and Audrey Shields Penn, a neurologist and emeritus professor who was the first Black woman to serve as an acting director of an institute of the National Institutes of Health. While these individuals have helped open the door for a more diverse and inclusive society, challenges remain to building a more equitable environment in health care and beyond.
As part of our efforts to recognize contributions both past and present, NeurologyLive® spoke with several Black leaders in the neurology community to learn more about their experience in health care, what or who has inspired them, and how they are helping their communities overcome disparities.
We're pleased to feature insights from Jon A. Cokley, PharmD, BCPPS, a pediatric neurology clinical pharmacy specialist at Texas Children’s Hospital and a neurology instructor at Baylor College of Medicine. An HBCU alumni, Cokley has been both an invited speaker for numerous neurology lectures, and as an invited author in neurology and neurocritical care, including discussions on health disparities, inequities, and barriers to care for black patients living with epilepsy. Cokley currently serves as the chair for Underrepresented Ethnicities in Neurocritical Care and Intersectional Concepts Committee of the Neurocritical Care Society. As one of few African American males focusing on pediatric epilepsy research, he hopes his work can help increase awareness, and address biases that exist in healthcare and hopes to help foster a dialogue that can be more inclusive for the benefit of patients living with epilepsy.
Is there a figure you've looked up to as a champion of diversity, equity, and inclusion while growing up or in your professional career?
Growing up, my inspiration was Dr. Percy Lavon Julian. Despite numerous racial and academic barriers, Dr. Julian’s perseverance allowed him to become one of the most notable chemists in American history. Initially barred from pursuing a doctoral degree on the basis of not allowing black students, he went on to receive his PhD from the University of Vienna and became one of the first black millionaires in the US. His role in the synthesis of medicinal substances from plants for more affordable mass production is credited as one of the top 25 accomplishments in American chemistry history. This research led to the development of such compounds as progesterone, an essential hormone used to avoid miscarriages and preterm birth, issues that disproportionately impact black maternal and infant mortality rates.
In my professional career, I strive to surround myself with individuals committed to using their platform to address built and social environments that impact patient outcomes. Dr. Adam Milam is one of such individuals. In addition to researching strategies to improve diversity in the medical workforce, Dr. Milam has leveraged his work to help guide state legislation to help promote health equity to shape behavioral health outcomes in adolescent patients. He is committed to using his expertise to reduce health disparities and health inequities. I strive to do the same for patients with neurological conditions.
How are we actively trying to combat racial disparities toward Black individuals seeking a career in medicine?
The proportion of black neurologists hasn’t changed in over a decade. Despite accounting for 13.6% of the US population only 4.8% of neurologists are black. This number is even more restrictive in neurosurgery. Lack of diversity significantly impacts disparities in care and health outcomes for underrepresented minorities. Fear of treatment; lack of access to care, particularly to care from specialized providers that look like you; and distrust of health care providers are among leading disparities in epilepsy surgery and epilepsy care. Addressing representation serves as a countermeasure to these concerns.
As a whole, many programs are beginning to document demographics on the pathway to address diversity efforts. While this is helpful in understanding where you are as an institution, I often charge that this isn’t the most important task to tackle. In order to change the demographics and improve patient care, we need to focus on the culture of medicine. Emphasizing inclusive leadership, increasing representation particularly at leadership levels, increasing retention efforts, addressing racial disparities in disciplinary actions for medical students, residents, and faculty, and minimizing minority taxes are among some of the areas that need to be addressed in order to have a lasting impact on the landscape of health care.
How can we do better at attracting Black individuals to the field?
Despite having 172 medical schools and 70 dental schools in existence, more than 70 percent of black doctors and dentists graduates hail from a handful of historically black colleges and universities (HBCUs). Previous changes including the Flexner Report, increasingly stringent educational standards implemented by the American Medical Association (AMA), and subsequent increases in educational costs resulted in the closing of many vital HBCU programs. Further historical inequalities such as redlining practices and discrepancy of pay are just some of the factors that contribute towards nearly a 10-fold discrepancy in net worth of Black families compared to their white counterparts. This significant disparity often limits the possibility of considering a career in medicine for many Black undergraduate students.
There are programs that have been implemented to attempt to address racial disparities. Some that come to mind are The Ohio State University URiM student scholarship. This scholarship is dedicated to providing opportunities for medical students from historically excluded or underrepresented backgrounds. Columbia University and Oregon Health and Science University have programs dedicated to medical students pursuing careers in neurology and neurosurgery. At a national level, the AMA Center for Health Equity was established. The AMA and other similar organizations have rallied to uphold race and ethnicity as a component of holistic review to allow for the creation of a more diverse work force.
While these programs seek to provide much needed clinical opportunities and resources for Black students in medical school, they don’t take into account significant historical barriers to pursuing careers in medicine. Despite these initiatives, only 11 medical schools are noted as having a percentage of Black students similar to US population statistics according to US News & World Report. Current estimates project it will take over 60 years of sustained doubling of students to correct the demographical deficit of Black physicians. In order to increase diversity not just in neurology, but in medicine as a whole, more effort is needed to offset the massive cost of medical education in addition to a shift in focus on retention of underrepresented students. This requires a collaborative effort, that includes increasing the percentage of Black students matriculating through medical school at non-HBCU institutions.