Black M.D.s Hope AMA Apology Leads to Better Care for Minorities

The National Medical Association's (NMA) 2008 Annual Convention and Scientific Assembly in Atlanta in July was themed the “Elimination of Health Disparities Through History and the Collaboration of Health Professionals.” That—and a surprising, historic development in the same month—led the 25,000-member national organization of African-American physicians to revisit its past, recommit to its current work, and plan for the future.

Consider: the NMA was meeting in the city where it was born some 112 years ago—its creation necessitated by racial barriers that had been erected, starting around 1870, that made it impossible for most black physicians to join the AMA. The AMA, a mostly white professional association, was founded in 1847.

Fast forward to 2008: three weeks before the start of the NMA's July meeting, the history of its creation came into sharp focus when the AMA took the unprecedented action of publicly apologizing to the NMA—and black doctors past and present—for decades of racial discrimination and“ other dishonorable acts of omission and commission” practiced by the national office and some state affiliates.

The apology, posted July 10 on the AMA's Web site, reads in part,“ The American Medical Association (AMA) today apologizes for its past history of racial inequality toward African-American physicians and shares its current efforts to increase the ranks of minority physicians and their participation in the AMA.”

The apology to the NMA was followed by a seven-page, related article in the July 16 Journal of the American Medical Association (JAMA) titled“ African-American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide.” The article was written by bioethicist Robert Baker, Ph.D., of Union Graduate College–Mount Sinai School of Medicine in Schenectady, N.Y. Published in the same issue of JAMA was a related, footnoted commentary about the AMA's apology written by Ronald Davis, M.D., immediate past president of the AMA, and others.

What about the future? Where do the two organizations go from here?

“The professional well-being of black physicians has a direct impact on the health and welfare of their patients, many of whom are black,” said Annelle Primm, M.D., M.P.H. director of APA's Office of Minority and National Affairs, in an interview with Psychiatric News during her attendance at the NMA annual meeting. She is also a member of both the AMA and the NMA.

“The apology is great,” Primm said. “What's important at this time is that the AMA continues to demonstrate its commitment to help eradicate the continuing health care disparities in underserved black and other minority communities.” She said that such disparities took seed many years ago and grew due to institutional prejudice against black doctors and by default to the predominantly black communities they served and continue to serve.

The issuance of public apologies for admitted past discrimination and oppression—from countries, states, or institutions—is not new, though it appears to be happening more often. For example, in the same week as the NMA's annual meeting, the U.S. House of Representatives apologized to black Americans for slavery and decades of discrimination that followed; in June Canada apologized to its “first nations” people for a historical record of forcing generations of indigenous children to live in residential boarding schools where many were physically or mentally abused.

“We commend the AMA for taking this courageous step and coming to grips with a litany of discriminatory practices that have had a devastating effect on the health of African Americans,” NMA President Nelson Adams, M.D., said in a press statement.

During the NMA's annual meeting, Primm gave a presentation on disparities among blacks and other at-risk, underserved minority groups and the need for more blacks to enter the field of psychiatry and to join APA. She said despite the NMA's official acceptance of the AMA apology, some physicians she spoke with were still assessing it and reserving judgment; others, she said, were wondering: Why now? Why did the AMA need to create a committee to research this well-known historical fact? Why did it take three more years for the apology to be offered?

“Psychological research suggests that whites and African Americans tend to view changes in the racial milieu in different ways,” wrote Davis in his JAMA commentary. “Whites tend to see full equality of opportunity as an idealized goal, and they measure progress by comparing the present and the past, noting how far society has come; but African Americans and other nonwhites are more likely to see racial equality as a necessary condition for justice and to judge current racial inequalities against a future of equal opportunity, which still seems far off.”

AMA's apology is posted at<www.ama-assn.org/ama/pub/category/18773.html>. The NMA's statement accepting the apology is posted at<www.nmanet.org/images/uploads/Documents/NMA_Accepts_AMA_Apology.pdf>. An abstract of “African-American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide” is posted at<http://jama.ama-assn.org/cgi/content/abstract/300/3/306.>.▪