Future Black Doctors Are Getting Blocked

Iknew that I wanted to attend Brown University when I was a sophomore in high school. Our college counseling office had a database of schools that could be searched by keyword. I clicked on “Biology” and “Pre-medicine.” The list generated was alphabetical. Brown was first. The internet was just taking hold, and so I had to find the web address and type it directly into a browser window on a boxy Macintosh in our computer lab. There was a picture of an elegant brick building centered on a grassy green. The few, text-heavy pages talked about an “open” curriculum. There were no course requirements outside of your “concentration,” so you were free to explore as you wished. All classes could be taken without letter grades. It seemed perfect. I never looked back.
When I started at Brown several years later, I was finally a pre-medical student. Or, at least I hoped to be one. And so it felt natural to schedule a meeting with the Dean who was, at the time, in charge of guiding all undergraduates who wished to attend medical school. So, in the first semester of my first year, I made my way to his office for our appointment.
The Dean was nice enough. I don’t want to imply that his tone or his manner was unpleasant. But there also weren’t any pleasantries. He asked about how I was doing in my introductory general chemistry course, and I told him that I had done poorly on the first exam. That I’d received a C. I can’t say that I was used to receiving such grades, but I didn’t really think much of it either. I was in the harder engineering section of the course, not the easier section that was designed for premeds. And I had chosen Brown partly because I imagined that the pass/fail ethos would de-emphasize grades and re-emphasize learning. Apparently, I had imagined wrong.
It’s hard to have particular regrets about the life that is mine. And real harm was done. I was sent on a decade-long detour simply because I hadn’t been perfect.
“Colorado,” I said.
“The University of Colorado,” he said. “That wouldn’t be bad.” I could not detect any irony.
He did not know that I had previously been accepted to Brown’s eight-year Program in Liberal Medical Education (PLME), the combined undergraduate and MD program. I had declined to matriculate because it felt like too big a commitment to a city I’d only visited once. Essentially, I had already been offered admission to medical school. But like a physician that is either too busy or distracted or is simply practicing past the point when he should have retired, he didn’t bother to collect or consider the full details of my story. He had been doing this for a long time and he had his heuristics. His cognitive shortcuts. My humanity had no chance of cutting through.
He didn’t suggest tutoring or attending office hours. He did not suggest a follow-up meeting. Or anyone who might mentor me. In retrospect, I wonder if I should have done something differently. But, as an eighteen-year-old Black woman, still a child, really, why should it have been my duty to argue my competence? My worth. In any case, I was too shocked to do so. I nodded. I probably thanked him. I left. We have been told what happens when a dream is deferred. How about when it dies? When it is killed?
There are two distinct truths about my undergraduate experience at Brown. They exist in parallel, not in series. The first truth is that it was a lovely beginning to a life of the mind. College Hill is still a place I hold dear. I have been to reunions. The only piece of collegiate gear that I own from any alma mater is a vintage t-shirt with a bear in a mortar board holding a champagne coupe in one hand and a diploma in the other that simply says “Brown ‘82,” which is the year of my birth, not my graduation. I wear it often. The other truth is that I was frankly, unequivocally, and yet insidiously deterred from becoming a doctor. I wasn’t guided forward on my journey with support or mentorship. I was pushed out before I’d really even started. I was blocked.
When I tell this story to my Black (or otherwise minoritized) mentees, it’s often a lightbulb moment that illuminates a dozen experiences they have had and might not have been able to characterize. Or have characterized perfectly, but have not been able to say out loud. Yes, you are being held to a different and likely unachievable standard. No, it isn’t just happening to you. Unfortunately, you will likely never be able to prove it. And, if you do try to prove it, it will almost certainly be you who is deemed the problem. The specter of “professionalism” will be invoked if you try to challenge the narrative. You did “fail,” after all, so what standing do you have to complain? And why are you so angry? I did get a C on that examination. And George Floyd did attempt to use a counterfeit bill.
I want Black mistakes and Black failures…The evidence of being alive in the world and thus, fallible.
When I left the Dean’s office, I thought that I was done with medicine. I knew that the Dean hadn’t assessed my capacity. What he had done was shown me the nearly impassable road ahead, should I try to enter the system. I now understood how much time, energy, and heartbreak would be required. I wanted to help people. I didn’t want to trade my humanity. I fled for the field of public health and rarely looked back. It was nearly seven years later, after graduating, working, and starting a Masters of Public Health program, that I stumbled upon physician mentors who urged me to reconsider medicine. They, mostly women and mostly Black, were willing to invest in my promise. To defend against the Deans of the world. What’s past is prologue. It’s hard to have particular regrets about the life that is mine. And real harm was done. I was sent on a decade-long detour simply because I hadn’t been perfect.
So what I want is a whole rethinking of Black exceptionalism and Black achievement. Of having to prove over and over again that we, Black students and Black doctors and Black people, are deserving. I want Black mistakes and Black failures. I want to be able to be late for a morning lecture without it impugning my character. I want to have a typo in an email without it meaning that someone will judge me as unable to succeed. I want a C or even a failure on my transcript to be looked at like the “hiccup” it is. The evidence of being alive in the world and thus, fallible. I want the simple grace of being human to be afforded to me as I see it afforded to my colleagues. Let us live, figuratively. And literally.
I am able to tell this story because I love Brown, as much as anyone can or should love an institution. Which is to say, I love what it proposes to stand for. I love many of the people and ideas that have gathered under its name. And I am able to tell this story because it happened twenty years ago. Because I am now finished with medical school, nearly at the end of residency, and I have a job as an attending physician. Because I no longer need anything from Brown. And because, at this moment in history, perhaps Brown needs something from me: the truth of one alumnus that maybe, if anyone looks harder, the truth of many alumni. The reality is that every academic environment has current and former students who would tell the same story. The details would differ. But the impact would be the same. And I tell this story because I have always believed that Brown is like the sun under cloud cover on its collegiate crest: almost ready to breakthrough. Almost ready to really shine.
We need more transparency. Deans and mentors and department chairs need to document more systematically who is supported — and how — at every level of advancement. And these systems must be open to outside scrutiny. To have one gatekeeper, one Dean, that determines worthiness is unfortunately still quite common. Even if the gatekeeping is distributed among multiple parties, the outcome can be identical if subjective judgments are not audited.
We can make these systems better, now. We do not need to wait another twenty years for more stories to be told. We rely on the “leaky pipeline” theory to explain why there are not more Black doctors, particularly in compensated and recognized leadership roles. A leaky pipeline is the classic use of passive voice to the obscure agency. Instead, let us consider that, whether purposefully or inadvertently, leaders in medicine are actively blocking the pipeline in many cases. Now that we have clarified our language, we know where to focus our attention. Not just on those who are being blocked, but especially on those who are doing the blocking.