THE PLIGHT OF THE BLACK DOCTOR

FOR the members of the National Medical Association, 95% of them Negro, President Johnson's unheralded visit to their annual convention last week was the most signal recognition their organization had witnessed in all its 73 years. The 2,800 delegates and their guests roared approval as the President listed among his "five new freedoms" the right of every citizen "to get all the education that he can absorb." Equally attractive was the declared "right of every American to as healthy a life as modern medicine can provide." The N.M.A. had won a different sort of recognition earlier in the week simply by meeting in Houston, where its presence at the Shamrock-Hilton Hotel, and even in its pool, elevated some eyebrows. "I don't know what the whites are scared of," said one Negro doctor. "These are their kind of people. There are more Toms here than on a turkey farm."

The delegate was unduly harsh. If Tomism was evident, so was a determined effort by Negro doctors to achieve equal status with white physicians. The delegates winced when a Black Nationalist woman guest lashed out: "We're two nations! If we weren't, you wouldn't be here now, because there wouldn't have to be two medical associations." She was right. The N.M.A. was founded in 1895 because the Negro was being neglected by the American Medical Association, many of whose constituent county and state societies were lily-white. Still true to form, the A.M.A. sent no official representative to the N.M.A. convention.

Culture Block. For the Negro doctor in the U.S. today, this is a pinprick hardly worth remarking. He bears the scars of many deeper cuts. He is accustomed to being rebuffed by medical schools, by medical colleagues (especially hospital staff members and administrators), by medical societies, by white patients--and even by black patients, many of whom think a Negro doctor is good enough for their sniffles but not for their major complaints. The cumulative effect is that the number of black doctors, relative to the Negro population, is declining. The nation has only 7,000 Negro physicians. If there were proportionately as many as there are white doctors for white people, the number would be 30,000.

The situation in many parts of the U.S. is worse now than it was a couple of generations ago. In those days, says Chicago's Dr. Arthur G. Falls, 67, there was no discrimination in Northern schools. "I was born and raised in Chicago, and got a fine education in the public school system. I had no trouble getting into Northwestern and going on through its medical school. The decline of the Chicago public school system came later. Today, many Negroes wishing to go to medical school are ill prepared educationally. Even to be considered, the Negro must be in the top 1% of his class."

Dr. Falls might have added the cultural factor. He had the advantage of sound family background and a college-graduate mother. Admission tests are written with a white, middle-class bias, complains Dr. Hiawatha Harris, a black Los Angeles psychiatrist. He cites a young Negro candidate who went through two-thirds of the questions before he came to a subject that he knew anything about. That was science. The other questions were cultural, covering (among other things) yachting jargon and French expressionist painting. "Medical schools have been judging black applicants on an equal basis with whites in an effort to be fair," says Harris, "but we are going to have to recognize differences because black students have not come up in the same cultural environment."

A number of Eastern medical schools have recognized the justice of Harris' complaint. They are now accepting Negro and Puerto Rican applicants whose admission-test scores would have been considered too low for other candidates, and plan to give them special tutoring to help them catch up. Albert Einstein College of Medicine in The Bronx is giving free make-up courses between undergraduate college and med school. New York Medical College has set up a Medstart Committee to recruit interested Negroes and Puerto Ricans. New York University found itself this summer, for the first time in 30 years, with no Negroes in its entering class of 131, so it recruited four who may need tutoring in science. Columbia University's College of Physicians and Surgeons, with a class of 132, accepted four Negroes on the strength of routine tests, then added a fifth who had a substandard school record but showed unusual motivation.

Paid to Go Away. Even the most liberal Northern and Western schools have far fewer than the 11% black students that would match the proportion of Negroes in the population. Many have had "quota" systems for Negroes and also Jews. Most Southern med schools accept only token admissions to stay within the law governing federal support funds. Thus the vast majority of the nation's Negro doctors have been trained in two century-old medical schools created especially for them: Howard University's in Washington, and Meharry in Nashville.

At these two, not only is admission easier because an applicant is expected to be black, but subsistence is usually provided. In addition to student grants and privately endowed scholarships, there are scholarships financed by segregationist state governments.

This was the road that Dr. Robert Smith, 30, followed from a Mississippi hamlet to Howard. It led him back almost to where he had started. One of twelve children, Smith graduated from all-Negro Tougaloo College in 1953. The state then subsidized Smith at Howard by paying the school $1,500 a year for his tuition and making him a loan of $5,000, "forgivable" at the rate of $1,000 for each year he spends practicing in the state. Says Smith: "Mississippi would rather underwrite the education of Negroes out of state than let them into its own schools."

The loan presented Smith with a crisis of conscience. By taking it, he was yielding to the system that he detests. "But," he says, "if I hadn't taken it, I wouldn't be a doctor today and wouldn't be serving the Negroes of Mississippi." Serving them he is, in the heart of Jackson's Negro community of about 60,000, at an average rate of 40 patients a day. Most practitioners consider 20 patients a day a heavy load. "When you see 40," says Smith, "you obviously can't dispense the kind of medical care that you'd like to. To make things worse, white doctors dump Negro patients on black doctors--especially if they haven't any money, and most of them haven't."

Lost to Surgery. Smith has active staff privileges at one county and one private hospital, and limited privileges at Mississippi Baptist, meaning that he is restricted to the hospital's Green Annex, reserved for Negroes. He says he has to swallow hard every time he sends a patient there. It is still more frustrating if his patient needs surgery, for Smith is allowed to practice only in the annex, and of course the operating rooms are in the main building. Thus he has to turn his patient over to white doctors.

Only a few years ago, Dr. Smith would have had no hospital privileges, except in tumbledown quarters reserved for Negroes. For almost a century, "segregationists had a neatly effective exclusion device: hospital appointments were open only to members of the county medical societies. And the societies were exclusively white. For 29 years, the A.M.A. gently "urged" member groups to integrate, but few did. Smith was among the Negro doctors who embarrassed the A.M.A. by picketing its 1963 convention. The A.M.A. made its urgings a bit stronger. The Hinds County Medical Society was among those that yielded. It admitted Smith and two other Negroes, but many county societies still exclude Negroes for all practical purposes.

Even far from the South, winning acceptance for internships in the better hospitals is difficult, and getting residency training in the specialties is even harder. But what galls the Negro doctor most is the matter of appointments. As recently as 1962, some 58 of Chicago's hospitals accepted no Negroes on their staffs. It took court action, with Dr. Falls leading the attack, to break that blockade. Today, in Chicago as in other major cities, it is still far more difficult for a Negro doctor to get into a good hospital than it is for a white. Good Samaritan in Los Angeles, often cited as a good example, has five Negroes among its 473 doctors.

Dr. Elmer A. Anderson finished first in a competition for the medical directorship of a Los Angeles County hospital, but then the County Human Relations Commission had to exert pressure to get him appointed. Anderson believes that staff discrimination hurts doctor and patient alike. "If a doctor has a patient who needs some special treatment that he cannot provide, he not only loses that patient to another doctor, but in many cases he loses contact with the whole family as well. Not getting on a staff hurts a man's ego and destroys the relationship between patient and doctor."

The N.M.A.'s new president, Dr. James M. Whittico Jr., 51, had a head start as the son of a successful physician, is now a general surgeon and fellow of the American College of Surgeons and has staff privileges at nine St. Louis hospitals. But even he had a rough time in the 1950s, when two Negro hospitals were closed down and white hospitals were not accepting Negroes. And today, he notes, fully one-fifth of the other 65 black doctors in St. Louis have no staff posts. Whittico has had ten referrals from white doctors in 17 years. Only three of the patients were white.

Female Taboo. The choice of specialty is also limited. Los Angeles Psychiatrist Hiawatha Harris once dreamed of concentrating in obstetrics but soon found that this was the most tabooed field of all. In some medical schools, Negro students until recently were not allowed to go on obstetric rounds. Even city and county hospitals with mostly nonwhite patients, barred Negroes on the off-chance that they might have to examine a white woman.

"In a racist environment," says Manhattan's Dr. John V. Cordice Jr., "a Negro is better received where there's a minimum of contact with patients. For example, a radiologist--all he does is look at X rays. A pathologist is acceptable because he deals only with cadavers and specimens. A pediatrician is pretty well received; somehow, it's all right for a black man or black woman to handle children--an extension of the black-nanny syndrome."

Dr. Cordice's chosen specialty was thoracic surgery. No U.S. school was willing to train him, and he had to go to Paris. That got him into Kings County (Brooklyn) Hospital for two years, and later he was named chief of both thoracic and vascular surgery at Harlem Hospital. So far, so good--or at least, not bad. But then Columbia's P. & S. took over Harlem, in a well-meant but abortive attempt by the city to raise ghetto-hospital standards. Columbia's white administrators did not bother to consult or even notify Dr. Cordice. They simply announced that two of their brethren were taking over the thoracic and vascular divisions, but Dr. Cordice was told that he could stay on the staff if he chose. He did not so choose. Colleagues claim that he was sacked simply because he was not a member of the club.

Sicker at Birth. The campaign to improve the lot of black doctors is not simply a matter of matching numbers, status symbols, ego satisfaction, or even the doctor's self-image, which is a vital factor in his ability to practice confidently and well. Health and medical care are as essential to the Negro's joining the mainstream of American life as are education and job opportunities. Indeed health may be more fundamental, and Negroes are sicker than whites from womb to tomb--their infant-mortality rate is double that of whites. A child can learn little, even in a vastly improved school system, if he is suffering --as are many Negroes in both North and South--from borderline malnutri tion, iron deficiency and anemia, as well as assorted infectious and parasitic diseases.

The nation needs hundreds of health centers in both rural and urban slums.

And it will take Negro doctors, in whom patients must develop confidence, to give this care the full dimensions of social as well as medical achievement.

Today relatively few ambitious young Negroes are seeking careers in medicine. They have seen that it is a long, hard and costly road,, with the almost certain assurance of frustration and dis crimination at the end. Only now has the medical fraternity at large begun a substantial effort to remove the basis for that fatalistic preconception.

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