Limitation of Opportunities for a Black Physician in Massachusetts

Ronald W. Dunlap, MD, FACC

I have been asked to provide some insight as a Black physician practicing in Massachusetts. I switched from biomedical engineering to medicine after observing the disparities in the treatment of a devastating illness in my sister, a nurse, in Newark, New Jersey . My medical school experience at Tufts University was at the very start of a limited number of attempts to diversify medical schools. I will skip over that era, and my time in technology, given that it would require more time to describe the complexity of the situation and that journey.

I will say that my focus in medicine was to train and practice in a community serving a diverse and underserved population. This led me to consider both Boston City Hospital, now Boston Medical Center, and Cambridge City Hospital. One of my colleagues from Mississippi spent one year at Boston City Hospital before he transferred to Meharry Medical College in Nashville, Tennessee. He cited the racism and attitude of the staff toward Afro-Americans in the mid-1970s. I opted out of Boston City Hospital, which was being re-organized at the time, and interned at Cambridge City Hospital. Fast forwarding 30 years and that same Boston institution became the leader in the care of the underserved and a leader in promoting diversity.

For Black physicians wanting to serve a diverse population, the options for medical practice were limited by the academic- and hospital-based systems that provided care for Black citizens. This situation was unique as the care of this Black demographic in other cities was somewhat proportional to the Black physicians in private practice. This structural deficit was partially rectified by the deployment of Federal Qualified Health Centers in Massachusetts which offered positions for black physicians.

The wealth gap between Black and white individuals in Boston limited the opportunity for Black practices in Boston.

I chose to remain in Boston because my ties to technology, business and my post-graduate training were all in this region. Advancement in academics was inhibited by the lack of mentors for Black physicians at that point, particularly in research. A conflict between salaried positions and surviving on grants made it even more challenging. Debt service inhibited both public service and career choices as it does today.

During my cardiology training at the Brigham Women’s Hospital in Boston, then affiliated with the West Roxbury Veterans Affairs facility in West Roxbury, and for many years afterward as an attending cardiologist with a Harvard University appointment, I moonlighted in community hospitals in critical care and emergency medicine. This was common for many working in academic medicine at that time. A major reason for that exposure, other than income, was to see how the residents of suburban communities responded to a Black physician. Private practice was not a viable option at the time. The veterans were accepting of care from a Black physician. The number of minority patients grew as they made up an increasing number of the forces involved with the Vietnam War and the Gulf conflicts. An interesting phenomenon during racial turmoil in South Boston at that time was that it didn’t seem to stop patients from that area from generally accepting me as their physician.

One common occurrence in community hospitals was that white patients in higher-income suburbs frequently questioned my education and training, seeking to determine if I were qualified. This process was described by Chester Pierce, a noted psychiatrist at Massachusetts General Hospital,as “microaggression.”In most cases, they were satisfied after I discussed their malady and the treatment plan. There was a minority of patients who were not happy or willing to be treated by a Black doctor. Thus, most of the patients were accepting of me as a treating physician and some called my home to see if they could arrange an appointment.

I had several experiences with microaggression during emergencies. I was on a United Airlines flight which was halfway between Hawaii and the mainland U.S. when an 18-month-old had a severe allergic reaction to peanuts. I responded to the call for a physician and was not allowed to treat the patient until I produced my license and a business card showing I was an attending cardiologist at a Harvard-affiliated hospital. This resulted in a delay of the treatment of the patient, which required me to dilute the adult Epinephrine vial to a pediatric dosage, which I knew from my Emergency Department experience.

On the other hand, the most striking phenomenon was that physician practices that I covered had full confidence in me but never spoke to me about joining their practices. When I decided to consider transitioning to private practice, I found that white physicians were concerned about the impact of a Black physician joining their practice – assuming their patients would object, which was not the case. When I explored practices in Washington, DC and other urban areas, I found that Black physicians practicing in mixed communities were also concerned about the practice marketing after adding a black partner .

I had two resumes. One noted my membership in the National Medical Association and the Association of Black Cardiologists, the other simply showed my education and training. My name didn’t give any indication of my race. The worst experience I had was showing up for an interview and finding the practice manager shocked that they had invited a Black doctor to come in. They rapidly dispensed with me. After that I confined my search to areas where I was a known quantity.

I finally accepted a hybrid position in a practice on the South Shore in 1992, which allowed me to spend one day a week teaching at Beth Israel Deaconess Medical Center for 15 years. I also spent a few years at Boston University Hospital on a per-diem basis. I switched practices in 1994 and was recruited to join two Irish cardiologists at South Shore Hospital. Brigham sent cardiac fellows to South Shore Hospital for a few years and, during that time, our exposure to the fellows allowed us to recruit a diverse group of highly talented young physicians from Brigham, Beth Israel and Boston Medical Center. We became a diverse practice with eight cardiologists with a racially, ethnically and gender-diverse perspective.

During that time, spanning 25 years, I became acquainted with Dr. Alice Coombs who was very involved in health care disparities at the National Medical Association, American Medical Association and the Massachusetts Medical Society. She got me involved in organized medicine with a focus on health care disparities. Ultimately, she became the first Black physician to serve as president of the MMS. She recruited me, and others, from South Shore Hospital to the MMS. Although I had not intended to, I literally followed in her footsteps also serving as MMS president and became involved in the MMS and AMA’s Commission to End Health Care Disparities and other state-based initiatives.

In 2013, we collaborated on a statewide study of patient access to physicians for Massachusetts Medicaid patients which showed marked access problems in communities with large Medicaid underserved populations. The Medicaid population size in a given area is driven by the wealth and income gap related to race between white and black individuals in Massachusetts. The MMS gave us a platform to pursue disparities and other issues involved with the role of physicians in governance in medicine. Unfortunately, those disparities have been magnified and increased during the COVID-19 pandemic. +

Ronald W. Dunlap, MD, FACC Past President, MMS MA Health Policy Commission Advisory Council Past chair and advisor to MMS Committee on Diversity Board Advisor for DEI at Coverys Companies AMA Minority Affairs Section New England Medical Association, NMA Instructor in Medicine, Harvard Medical School