Black Man in a White Coat (3 page)

Why had Duke accepted me, and offered a full scholarship as enticement? As I played through the scenarios, affirmative action appeared to me the only answer. Seemingly dialed into my thoughts, the professor then turned to racial numbers:

“We have fourteen underrepresented minorities out of our total of one hundred students,” she said, as she smiled broadly. “That makes this our most diverse class ever.”

In academic circles, underrepresented minorities include blacks, Hispanics, and Native Americans; Asians are excluded from this tally because they enroll at colleges and medical school in very high proportion compared to their numbers in the U.S. population. In our class, all but one of these fourteen underrepresented minority students was black. Hispanic students tended to choose medical schools in a few large cities (New York) or states with large Hispanic populations (Texas, Florida, and California). At the time, North Carolina, and the city of Durham, had few Hispanic residents. Native Americans simply make up a very small percentage of the underrepresented minority pool, so they have little impact on the total distribution.

I scanned the room. About half the black faces clustered in a center area near the front, with the rest scattered, as I was, throughout the lecture hall. I had met most of them months earlier, during a weekend that Duke held for admitted black applicants. At the event, black medical students, resident doctors, and faculty all descended upon us to offer assurance that we would not be racially isolated at Duke. Along with the opportunity to meet and greet prominent people at the school, current black students had organized informal gatherings that featured common African-American themes: barbecue at the local park, pickup basketball games, and a venture to a trendy nightclub. They did everything to show that they wanted us badly.

Duke was not alone in its efforts to recruit black medical students. Johns Hopkins filled our recruitment weekend with similar engagements, and it had a few aces that Duke lacked. Levi Watkins Jr., a black cardiac surgeon who implanted the first automatic defibrillator in a human, led the festivities. Our experience culminated with brunch at the estate of Ben Carson, the famed neurosurgeon then known best for separating conjoined twins. Even then, his story of triumph over childhood hardship had spawned a career unto itself with lucrative speaking engagements and bestselling books. In our eyes, he was the Michael Jordan or Denzel Washington of black doctors. Seated in his elegant living room amongst black medical faculty, residents, and current Johns Hopkins medical students, we heard the implicit message loud and clear: As admitted applicants, we'd been invited to join an exclusive community. Friends of mine attended similar events at Harvard, Yale, and the University of Pennsylvania.

This preferential treatment from these elite schools stemmed from their perception of us as “the best black,” a term coined by Yale Law professor and novelist Stephen L. Carter. In the post–civil rights era, college and professional schools still sought to enroll the best white students as they always had, but they also began a new, urgent mission: to bring the top black students into their halls. According to Carter, this aim resulted in a distinct set of standards where academically successful blacks were not judged against whites (or Asians), but rather against one another. “There are black folks out there. Go and find the best of them,” Carter wrote, describing the mentality that he saw as pervasive across several areas of society. This approach to admissions explains why I received a full scholarship to Duke and was offered early acceptance to Johns Hopkins during my junior year of college.

Yet even with these aggressive efforts, the numbers of black students and doctors are low overall. Blacks constitute about 13 percent of the general U.S. population but a much smaller proportion of the physician world. In the mid-1990s, blacks accounted for about 7 percent of medical students; that percentage holds steady today. That figure includes three predominately black medical schools (Howard in Washington, D.C., Meharry in Nashville, and Morehouse in Atlanta) that currently comprise about 20 percent of the black medical student population. Some schools have just a few black students. What might those numbers look like without affirmative action? Perhaps the past holds some answers.

Before the social and political upheaval of the 1960s, black doctors were a rarity—comprising less than 2 percent of all U.S. physicians. The vast majority of these doctors were educated at Howard and Meharry (Morehouse was not established until 1975) with the expectation that they would provide medical care to segregated black communities. Of the prestigious white schools that did admit blacks, none could be called progressive in that era. Johns Hopkins graduated its first black medical students in 1967. The University of Chicago had just one black student in its Class of 1968. Harvard enrolled just two black students that same year. Yet Duke, from its founding in 1930, has dealt with a racial climate in many ways more intense than its peer schools.

Among elite medical schools—those regarded among the top ten in terms of selectivity, national reputation, and placement of graduates in prestigious clinical residency programs—Duke alone is located in the South. Like most southern hospitals and medical schools, it was fully segregated through the early 1960s until a constellation of events occurred. In 1964, the U.S. Supreme Court upheld a lower court ruling in a North Carolina case that struck down the separate-but-equal doctrine in hospitals. The subsequent Civil Rights Act of 1964 and enactment of Medicare in 1965 gave the federal government the leverage to force the hand of southern hospitals into integrating their facilities.

At the time of these radical developments, you could count the number of black medical students and physicians at Duke literally on one hand. “During the late 1960s, they basically enrolled just one black student every year,” one black doctor from that era told me.

On the undergraduate campus, black students were not admitted to Duke until 1963, and their numbers were only slightly higher than at the medical school. According to those who lived it, overt prejudice in those early years on campus was rampant. It was represented by senior university officials' membership in a prominent local country club that excluded blacks. It also took the form of campus cross burnings and other racist acts. This combined racism—equal parts blatant and symbolic—fomented black student unrest that culminated in the 1969 nonviolent protest and occupation of the school's Allen Building, an episode largely credited with paving the way for Duke's entry into the modern multicultural era.

Yet the stain of Duke's racial legacy persists. In the late 1980s, well-known Harvard professor Henry Louis Gates Jr. was briefly a professor at Duke. He didn't stay long, feeling unwelcome, and later publicly referred to Duke as “the plantation.” More recently, in 2006, Duke's racial problems resurfaced when three members of the near all-white men's lacrosse team were arrested and charged with the alleged rape of a local black exotic dancer. The case dissolved after the charges were shown to be false, but the race, gender, and class elements revived campus and community tensions while fueling decades-old stereotypes.

So while the days of cross burnings and swastikas are a distant memory, Duke still grapples with its legacy of racial discrimination. During my medical school interview at Harvard, I ate lunch with Kevin, a senior from Princeton who was the only other black person in the group of thirty or so applicants. We were considering all the same schools save for Duke. I told him how much I had enjoyed my interview at Duke and how beautiful the campus was.

“It's a great school,” he conceded, “and it would be great to live in a place where it is seventy degrees in November.” He then looked around to make sure that no one else was listening. “But you know how they don't have a good track record with people like us.” I must have heard some variant of this comment a dozen times during that interview season. It was clear that many black students viewed Duke through a racially tinged lens.

A few years earlier, in an effort to combat this perception, the medical school decided to offer full-tuition scholarships to the handful of underrepresented minorities (primarily black) it saw as most desirable. Anyone who has known a medical student or recent graduate recognizes this award as the lottery ticket it is. With rare exceptions, the only way that future doctors can get someone else to pay for their education is to serve in the military or on some rural outpost for a handful of years after graduation and training. But Duke's offer came with no strings attached. At its essence, the scholarship was a form of recruiting reparations, a practical way to entice blacks students who might otherwise be scared away by stories from Duke's past.

And it worked. For me, the scholarship was the decisive factor in choosing Duke over Johns Hopkins, which offered more prestige, a slightly better track record of training and hiring black doctors, and proximity to my family. It also bumped Duke ahead of three Ivy League schools on my list. I later learned that the free ride propelled the other five recipients to Duke for similar reasons. Back then, the scholarship was valued at $100,000 over four years, but factoring in interest rates for an equivalent loan over many years, it was more like $175,000, or even more. A lot of money for a group of people like us who'd never had much.

So there it was: Not only was I admitted to Duke, when in a color-blind world I might not have been, but I had arrived with a full-tuition scholarship in hand. Depending on your perspective, affirmative action had done its job, giving a working-class black kid the chance for an elite education, or affirmative action had reared its ugly head, taking a slot from someone else more deserving while possibly setting me up for failure.

*   *   *

In our initial week on campus, we accumulated all the trappings of first-year medical students: parking passes, ID badges, and bulky textbooks. Classes started the following Monday. As I nestled into a spot in the middle of the lecture hall, nearly a week after I'd learned how I stacked up against my classmates, I saw three unfamiliar faces seated together a few rows in front of me. Two were black. Were it not for this, I probably would have overlooked them, assuming they were classmates whom I had not met or had simply forgotten in the chaos of shaking so many sweaty palms during our orientation. However, the numbers of black students in my first-year class was small enough that I already had a mental catalog of their names and faces. These two—one man, one woman—were new to our select company.

During a short break between lectures, I leaned over to Greg, a native southerner who'd gone to college at the University of Florida. “Who are they?” I asked.

“I don't know for sure,” he said, “but I have an idea. Let's ask Angela. I bet she knows.”

We turned around and looked up at Angela, another black classmate, who sat a few rows behind us. She was from New York and had gone to Yale as an undergraduate, where she'd been an English major. The gregarious type, she already had her finger on the pulse of medical student gossip. Later that day, as the three of us walked along a semi-enclosed path to the medical school bookstore, we asked her about the unfamiliar faces.

“They have to repeat first-year,” she whispered.

“Why?” I asked.

“I guess because they didn't pass last year. What other reason is there?”

“That doesn't look good,” Greg said.

“You're right about that,” Angela said.

I agreed. Despite our varied backgrounds, we knew the stakes: Affirmative action may have done us a favor in admissions, but it certainly hurt us whenever a black student struggled.

“So who's the third person?” I asked, referring to the white person in that group.

“Her father is a tenured professor here,” Angela replied.

“That sucks for her,” Greg said.

As Daniel Golden detailed in his 2006 book
The Price of Admission
, elite schools are widely known to give clear admission preferences to the children of alumni and faculty. In contrast to race-based affirmative action, the beneficiaries in these instances are overwhelmingly white, a testament to the reality that these institutions were almost exclusively white during the pre–civil rights era.

“I think if it came to having to repeat a whole year, I would just quit,” Angela said.

“That would make things look even worse,” Greg said.

Over the next several weeks, I learned that minority-student struggles were indeed a real problem. A college friend at another elite medical school told me that three black students from the previous year had failed and were in her class, and that another had flunked out altogether. Other friends at different medical schools told similar stories. From what we saw and heard, white and Asian students were far less likely to suffer academically to this degree.

Our stories fit within a broader picture. The University of California, Davis (UC-Davis) medical school, ground zero for the famous 1978 U.S. Supreme Court
Bakke
decision that supported using race as a tool in admissions while striking down numerical quotas, conducted a twenty-year study of admitted students from 1968 to 1987. Those admitted under special consideration, meaning that traditional admissions criteria were not used in reviewing their applications, were far more likely to be black. Although they ultimately graduated at similar rates as the regular student body, medical school proved to be a struggle; they earned lower grades and were more likely to fail their general medical licensing exams compared to students accepted under general admissions criteria.

Defenders of affirmation action say that these studies of medical school classroom-based performance do not predict one's success as a physician; they argue that practicing medicine requires far different skills than answering multiple-choice questions. And perhaps they are right. No one can define a good doctor in the precise ways that tests identify good medical students. As Robert Ebert, the dean of Harvard Medical School from 1965 to 1973, who oversaw the school's implementation of affirmative action, asserted: “the purpose of medical education is not to pass the National Boards with the highest scores, but to send out physicians who answer the needs of our society for excellent care and quality research. A good doctor has nothing to do with how well he or she did on a test.”