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Dedicating a Career to Diversity and Disparities

— NMA president Edith Mitchell, MD, laments racial gaps in medicine

MedpageToday

Growing up in the segregated South in the early 1950s, , knew from the age of three that she wanted to become a doctor.

Now more than 60 years later, as president of the , representing more than 30,000 African-American physicians, she is still concerned about the lack of diversity in medical school training as well as disparities in healthcare.

Mitchell is clinical professor of medicine and medical oncology at , in Philadelphia, where she is also program leader in gastrointestinal oncology, and associate director for diversity affairs.

She is among the small number of female African-American women medical oncologists and thinks she may be the first medical oncologist to lead the NMA.

She told MedPage Today that few African-Americans pursue careers in medical oncology, as most gravitate toward radiation oncology and then surgical oncology, and many more treat cancer patients as general surgeons.

"I believe that we should increase the pipeline of individuals with minority backgrounds going into medicine and not just medical school but other professions as well since it's important to make sure the numbers reflect our community," Mitchell said.

African-Americans represent 13% of the population, but only 3% of physicians, she noted, and the latter percentage has not increased for half a century. She pointed to estimates that, by 2030, Caucasians will no longer be in the majority in the U.S.

Mitchell said the NMA has been trying to increase that pipeline for years, providing a substantial effort working to develop ideas and educational programs with the NAACP and other organizations. She is also a proponent of engaging African-American physicians with minority medical students who may not know another African-American medical professor.

She said that the traditionally black medical colleges -- in Atlanta, in Washington DC, and in Nashville, Tenn., and to a lesser extent, the in Los Angeles -- have still been producing the majority of African-American physicians in this country.

"For most of the majority [i.e., predominantly white] medical schools, including Jefferson, there has not been a large growth of minority medical students in those schools, and I think that until the majority medical schools participate in the training of minority students, the percentage isn't going to change so much," she said.

Mitchell cited the lack of scholarship funding, and the lack of interest among minority students to apply to institutions that are not among the traditionally black ones, as factors contributing to the current situation.

She said more African-American students are from backgrounds in the lowest socio-economic areas, and therefore have greater need for financial aid and cannot afford to go to majority schools such as Jefferson.

"Traditionally black schools really make an effort to offer some financial assistance, it's woven into their being," she added.

"I think that medical schools have to develop multifactorial programs that perpetuate the success of individuals from minority backgrounds, and that until the majority of medical schools admit and graduate larger numbers of minority students we won't see the percentage of [black] physicians change significantly because the traditionally black schools still graduate the greatest numbers of minorities."

Mitchell noted there were very significant disparities in outcomes related to race, citing colon cancer as an example, and said that it was important that all physicians understand the barriers that contribute to healthcare disparities and incorporate that understanding into their clinical practice.

Mitchell's personal story of experiencing diversity is similar to the situation she'd like to see for more minority students.

She was raised on a farm in rural Tennessee, with six siblings and several generations of family members nearby, and fondly remembered the African-American doctor who paid house calls to her great-grandfather.

"When I told my great-grandfather that I wanted to be a doctor, he patted me on the head and said, 'Baby, you can be anything you want.'"

She said that Tennessee was totally segregated until she finished high school, and it wasn't until Medicare was passed in 1965 that hospitals had to abandon "white" and "colored" entrances and sections.

Mitchell received her bachelor's of science degree in biochemistry from Tennessee State University, got married, and entered medical school a few years later after she and her Air Force officer husband had settled in. They have two grown children.

She chose in Richmond and was the only African-American women and only one of two black students in her class.

Explaining she had always been very comfortable in diverse groups, she admitted she hadn't even considered applying to traditionally black medical schools.

At first she thought she'd become a cardiac surgeon, but during her second year, she "fell in love with the microscope and viewing cancer cells and what accounted for the differences in how each cancer looked."

Her experience in the clinic also helped steer her toward oncology where she was impressed by the relationships that oncologists could establish with their patients, and unimpressed by how certain other health staff treated cancer patients.

She did her residency training at Meharry Medical College, where she volunteered in the hematology clinic, and then a medical oncology fellowship at Georgetown.

Mitchell praised her mentors over the years, including ; ; ; and , from Georgetown's Lombardi Cancer Center, among others.

Meanwhile, to help with expenses, she joined the U.S. Air Force while in medical school, later serving in the Air Force Reserve and Air National Guard, and retired as a brigadier general, the first woman physician to attain that rank.

In 2012 she received the American Society of Clinical Oncology's Humanitarian Award "for going above and beyond the call of duty in providing outstanding patient care," with special citations for her helping patients in medically underserved areas, demonstrating the importance of community service and outreach, and participating in flood-relief supportive patient advocacy, and vaccination clinics.