Race and Medicine

Race and Medicine

Issue: February 2021
Source: Healio interview
Disclosures: Hobley reports no relevant financial disclosures.
February 25, 2021
6 min read
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For many black physicians, they may be ‘just one decision away’

Issue: February 2021
Source: Healio interview
Disclosures: Hobley reports no relevant financial disclosures.
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When I was 8 years old, I told my mother that I wanted to be a nurse just like her when I grew up. As quickly as I said that, she replied, “Son, that’s great but why don’t you become a doctor?”

I said, “OK,” and I pushed ahead toward my newly declared goal. During my life, I faced many challenges and losses. Beginning with the loss of my sweet mother to a motor vehicle accident, there were many challenges ahead that could’ve nudged me off course. That special moment shared by my mother and I is when my dreams were cemented in my desire to bring healing to people as I had watched her do. This inspired me to make a decision that would never be put aside.

James Hobley, MD, MHES, FACG, FACP
James Hobley

We moved from California to Louisiana in the early 1980s. My new state possessed a culture that was very different than the one I had known; however, I grew up in a mostly Caucasian neighborhood in both California and Louisiana. I did experience some forms of discrimination throughout my life.

I recall that at times, life was challenging solely because of my pigmentation. My parents always taught me that my faith in God, hard work, determination and a solid code of ethics would help overcome any adversity. In my case, they were proven correct in their teaching.

Learning About the Pipeline

I was in middle school when I first heard about a program designed to expose kids to a career in the medical field. There was a more intense program during the high school years, where you were essentially dually enrolled. One half of your day was spent in your normal high school curriculum, the other half in the Medical Careers Magnet program.

The curriculum was distinctly based in the now-coined STEM tract with the addition of medical careers courses each year as you progressed. Summertime was full of opportunities to have usually a 6- to 8-week experience within the medical field. This overall experience builds confidence, knowledge and comfort for a young person interested in a career in medicine.

I graduated high school in Louisiana and matriculated to Tulane University of Louisiana. During my time at Tulane, I began to understand more about what it took to get to the next level. This involves mentors and people in the advisory positions that help a student navigate through all the rigors of a pre-medical track.

I was very fortunate to discover a program that truly changed my life. A friend alerted me of a program that was conducted on the campus of Tulane University. This program attracted minority students from across the country. Major universities sent their deans of admission to this program to recruit students. The students who participated in the program were from the top-notch universities from across this country.

During that summer, I immersed myself into a pre-medical curriculum, research and an MCAT preparation course that set the stage from my matriculation to medical school. It was also during this program that I discovered how critical it is to have people in positions of power believe in you.

My father told me, “All we needed was one (decision).” I never understood that more than during the summer of that program.

Encouragement and the Right Questions

During my time of undergraduate education, I struggled to find a pre-medical adviser who could connect with me in a way to truly launch me into the next level. This did not deter me, however, because I kept in touch with a lot of my colleagues who were a year or two ahead of me. I followed their pathway and that led me to the aforementioned summer program.

It was during that summer program that I had the fortunate destiny of meeting someone who forever changed my life. One of the deans from Pennsylvania State University, Alfonse Leuree duPree, MD, visited our program and took interest in me. He simply asked me what I wanted to do with my life. I told him I wanted to change the lives of the unfortunate and make an impact on humanity.

That, coupled with my GPA and MCAT scores, lead to an interview at the Pennsylvania State University College of Medicine. Fortunately, I was considered for an early decision and was admitted in December of my senior year. As I mentioned before, my life was changed forever with that one decision.

Mentorship Matters

It was during my medical student tenure that I realized the importance of mentorship.

Most of my mentors while in medical school did not look like me. That fact never deterred any of them from pouring into my life their absolute best. I was a willing and active participant of their mentorship and that allowed critical enrichment in my development.

My internal medicine program director, Richard Simons, MD, was the first to show true belief in me. Through his firm and steadfast training, I had the great honor to become the first African American chief resident of the internal medicine program at Penn State University.

During my time as a resident, I continued to develop my medical acumen as well as my academic leadership potential. I was introduced to my next mentor, Thomas McGarrity, MD, who happened to be a gastroenterologist.

He asked me a simple question: “Why are there so many African Americans dying of colon cancer?” That was a bit of a shock to me at the time because we had learned that heart disease, kidney disease, diabetes and lung cancer were some of the most significant causes of mortality for African Americans. Colon cancer was never discussed as one of those major causes.

After some discussion and contemplation of my career pathway, I applied to and was accepted to become an NIH fellow for the research in colorectal cancer disparities in African Americans.

Representation Translates to Access

I returned to Louisiana after finishing my training. I immediately began to work on some of the initiatives that I started at Penn State as it relates to health care disparities in colon cancer.

Louisiana was fertile ground for this type of work because I believe that true disparity occurs due to lack of access to quality health care. That lack may be due to socioeconomic, geographic, educational or, unfortunately, racial reasons. Louisiana has a largely rural population, large minority population and some socioeconomic challenges that negatively affect its residents. We have seen some of the larger rates of colorectal cancer in Louisiana, especially among the minority population.

I have taken part in the Louisiana Colorectal Cancer round table now for many years. Currently, there are plans in the works to implement measures to improve access to colon cancer screening to the lower income residents of the state. Like the importance of a pipeline for academic success, a pipeline for access to quality medical care is essential to achieve success in erasing barriers.

I have been asked: “Why are there not more Black gastroenterologists?” The answer is in the pipeline.

If I look at the fellowship programs across the country, there are not a great deal of African Americans in fellowships. Then if you back up and look at residency, those numbers are low for internal medicine. If you look back at medical school, those numbers are also low. If you look at colleges, those numbers are still low. Even high school, some studies have reported as many as 60% of Black males drop out of high school. In the 21st century?

This shows that the pipeline toward medicine is damaged. I believe that one way to repair that pipeline is through mentorship and inclusion. That involves being invited to become part of a scholar’s program at a university or becoming part of a summer program specific for mentoring young people in careers in medicine and science. To have inclusion, you must improve access; the same word – access – comes into play with improved medical care.

It’s important for young children growing up to see other people who look like them involved in medical careers, so they may be encouraged to do the same thing. If you look at all the African Americans playing sports, that’s why a large portion of young Black children get inspiration and encouragement from the community to pursue sports. They don’t see a plethora of judges, lawyers, doctors or engineers. There are the Ben Carsons, Clarence Thomases, Condoleezza Rices and Barack Obamas of the world. However, individuals of this level of achievement are in such low numbers or it seems so unattainable to Black children that they may not decide to pursue it.

I am convinced that seeing more people of color or seeing more women doing these things would give the youth a glimpse of that possibility.

When you see more people of color doing things on a higher level; when you see more people of color in Congress and other elected positions; when you see more people of color in medicine, it allows you to visualize yourself in those positions.

The decision to mentor a young person of color is an opportunity to positively impact a life forever. That impacted life can go on to replicate the same and then we can actualize a more diverse and inclusive world that we can all share in together. Decide today to be that agent of change.

Because every next Black physician is just one decision away, make your decision: help repair the damaged pipeline; mentor the spark in the next generation; improve access to equitable medical care.