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 Adys Mendizabal, MD, assistant professor in the Institute of Society and Genetics and the Department of Neurology at the University of California, Los Angeles. Besides her study of movement disorders and clinical interest in Huntington disease, she's interested in a research career focusing on genetic epidemiology and health outcomes in Huntington disease and other movement disorders. Mendizabal has become heavily involved in diversity and inclusion efforts throughout the years, with an emphasis on health equities education, health care disparities research, as well as residency recruitment efforts.
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?
It is difficult to point out only one DEI champion. Throughout my training, I’ve seen many DEI champions in different capacities.
In medical school, I remember Dr. Melanie Cosby, one of our clinical psychologists and now Director for Diversity and Inclusion at Temple University Medical School. Not only did she provide mental health support to URM students, but throughout my time in the school, she became a pivotal role model of advocacy and encouragement for students to find their voice as student leaders and raise our concerns to the administration. Along with Dr. Cosby, Dr. Kathleen Reeves, a non-URM pediatrician and dean of student affairs, also listened to URM student voices, advocated for increased URM student representation, and increased financial support through scholarships. Since I graduated, Temple Medical School has had one of the country's largest numbers of Black and Latinx medical students. I credit Dr. Cosby and Dr. Reeves for that accomplishment.
From a mentoring standpoint, I always sought mentoring from Black physicians. As a medical student, I was mentored by Dr. Alliric Willis, a surgical oncologist and now vice dean for faculty affairs at Thomas Jefferson College of Medicine. He provided valuable career development mentorship, including aid in writing personal statements, mock interviews, and general career advice tailored to Black students entering the medical field. From a career and research standpoint, I had the pleasure to be mentored by one of the leaders in the field of neuro-epidemiology and health services research in neurology, Dr. Allison W. Willis from the University of Pennsylvania, and now Chief of Neurology at the Philadelphia VA. Through her guidance and mentorship, I learned research methods and frameworks for studying health disparities in neurology and how to communicate these findings and needs to broader neurology audiences. Also, in residency, I was mentored by Dr. Roy Hamilton, who has advocated for increased representation and TRUE inclusion of URMs in the field of neurology and has raised awareness on the Diversity Tax students, trainees, and faculty of color experience. Last but not least, Dr. Sharon Lewis, Assistant Dean for Diversity Recruitment at the University of Pennsylvania’s medical school, also served as an overall career, life mentor, and support.
As a faculty member at UCLA, I continue to be fortunate to work with other DEI champions in neurology and medicine, including Dr. Charles Flippen, the first Black Neurology program director and an advocate and sponsor of Black neurology faculty at UCLA. In medicine, I have the pleasure of working and being mentored by leaders in health disparities and community-based participatory work in medicine, such as Keith Norris and Arleen Brown. I look at them as career role models, DEI advocates, and champions. All of them devote their time to young URM faculty. They provide us with mentorship beyond the typical “research” mentorship, but also how to navigate the inherent challenges of being a person of color in medicine while advocating for our well-being and rest as we embark on a career in academic medicine.
How are we actively trying to combat racial disparities toward black individuals seeking a career in medicine? For is, does one stand out as the most impotant to tackle?
I think combating racial disparities involves a multi-modal approach. We must increase black physicians' recruitment at all levels (student, trainee, junior faculty, all the way to leadership positions such as Deans and Chairs). But, we need to ensure there are systems in place to ensure there’s TRUE inclusion, support, and retention of black individuals in medicine. We cannot simply increase the recruitment without having 1) Black mentors, 2) implicit bias training for ALL faculty, 3) a diverse, inclusive, open-minded faculty, 4) financial support (appropriate salary and compensation, particularly for any DEI work, but also student loan assistance/repayment and/or medical school scholarships 5) educational resources and 6) free mental health resources for black individuals. I think all of it is important and needs to be in place to ensure that medicine is a safe environment for black individuals to practice.
How can we do better at attracting Black individuals to the field?
The increased representation and visibility of black neurologists! I remember thinking, “I’m interested in studying health disparities in neurology, but I don’t see a lot of Black neurologists, nor do I think neurologists study disparities (beyond stroke).” When I came across the work by Dr. Allison W. Willis, a black neurologist, I saw myself represented in the field, further encouraging me to pursue neurology and a field in health disparities research. At the time, I would google neurology residency programs and look at the pictures/about me sections for the residents and faculty. I ultimately picked a residency program where I identified three black neurologists and a racial and ethnically diverse residency class. Since then, residency programs have known that diversity is essential in attracting black neurologists to the field. With the pandemic, I have seen how residency programs highlight the presence of Black residents in their programs. I have also seen the creation of groups focused on mentoring and supporting Black students interested in the field of neurology/neuroscience. Black in Neuro and the Society of Black Neurologists are networks allowing black students to interact with black neurologists and neuroscientists. Having organized networks of black neurologists supporting each other and students is one of the ways that we see more interest in the field. And word of mouth. As a resident, I was highly involved in recruiting black students into our residency program. Every year my heart would break just a little when I would see so many of them go to Emory. Long story short, Emory has a long track record of recruiting black residents into their residency program, leading to their reputation as a supportive and inclusive residency program, meaning students will naturally gravitate towards it.
In what ways is the field lacking? There are not enough black faculty to mentor the students, and institutions are not doing enough to recruit or retain black faculty. We’re starting to see institutions with more black trainees than faculty. For example, here at UCLA, until the 2022-2023 academic year, Dr. Charles Flippen was the only black neurologist in our health system (luckily, now he’s one of four!) Yet, there are black residents in almost every residency class and black fellows in different subspecialties. That leads to a bottleneck in mentoring and the well-described diversity tax. One black faculty mentor can try to mentor all black trainees, but they also have other responsibilities associated with their academic promotion. Plus, they also have lives outside of work. Yet, institutions are not recognizing black faculty's work in mentoring in meaningful ways. We’re way past the “Certificates” and “Awards” of recognition for DEI and URM mentoring work. To effectively mentor, black faculty need protected time for these efforts and higher salaries. Promotion metrics need to see this work in the same light as the number of grants and publications. As a result, Black faculty may often be stretched too thin and unable to mentor other black trainees effectively. The lack of black mentors leads black students and trainees not to have adequate support systems. Some may also rely on non-URM mentors, many of which have not done enough anti-racist/implicit bias work to be able to understand and guide black students appropriately. Even if not black faculty, institutions must ensure that allies and non-URM faculty interested in mentoring black students have the tools necessary to provide inclusive, anti-racist mentoring and guidance.