Affirmative Action in Medicine

Improving Health Care for Everyone

James L. Curtis, M.D.

Publication Year: 2003

Affirmative action programs have significantly changed American medicine for the better, not only in medical school admissions and access to postgraduate training but also in bringing a higher quality of health care to all people. James L. Curtis approaches this important transition from historical, statistical, and personal perspectives. He tells how over the course of his medical education and career as a psychiatrist and professor--often as the first or only African American in his cohort--the status of minorities in the medical professions grew from a tiny percentage to a far more equitable representation of the American population. Advancing arguments from his earlier book, Blacks, Medical Schools, and Society, Curtis evaluates the outcomes of affirmative action efforts over the past thirty years. He describes formidable barriers to minority access to medical-education opportunities and the resulting problems faced by minority patients in receiving medical treatment. His progress report includes a review of two thousand minority students admitted to U.S. medical schools in 1969, following them through graduation and their careers, comparing them with the careers of two thousand of their nonminority peers. These samples provide an important look at medical schools that, while heralding dramatic progress in physician education and training opportunity, indicates much room for further improvement. A basic hurdle continues to face African Americans and other minorities who are still confined to segregated neighborhoods and inferior school systems that stifle full scholastic development. Curtis urges us as a nation to develop all our human resources through an expansion of affirmative action programs, thus improving health care for everyone. James L. Curtis is Clinical Professor Emeritus of Psychiatry, Columbia University College of Physicians and Surgeons.

Published by: University of Michigan Press

Contents
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Book Details

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pp. v-

List of Tables

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pp. vii-x

Preface

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pp. xi-xvi

In Blacks, Medical Schools, and Society, published more than three decades ago, I heralded the beginning of affirmative action to increase the enrollment of Blacks in American medical schools. Then in 1980 I wrote a book-length progress report evaluating the outcomes of affirmative action in the first decade of this nationwide initiative. That review outlined the still-formidable racial barriers separating Black people...

Acknowledgments

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pp. xvii-xviii

Introduction

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pp. 1-9

This book is about affirmative action in undergraduate and postgraduate medical education, a significant part of my life’s work. Affirmative action in medicine is defined comprehensively, covering not only the equitable opportunity to be admitted to the best medical schools and postgraduate training programs, but also the equitable provision of health care. Major emphasis is placed here on the serious differentials in health status...

PART I

I. Affirmative Action in U.S. Medical Schools

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pp. 13-34

Affirmative action is a deliberate race-conscious recruitment goal designed to equalize access within a set time frame to the high-status jobs and professions such as medicine, from which Blacks have been unfairly excluded for many generations. The concept is based on the premise that relief from illegal racial discrimination is not enough to remove the burden of second-class citizenship from Blacks and other underrepresented...

II. Affirmative Action at Cornell

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pp. 35-57

Since 1969, the Cornell University Medical College (now the Weill Medical College of Cornell University) has conducted a special summer program for minority students following their junior year, as one of its major institutional efforts to increase the enrollment of highly qualified minority students. The summer program has had a significant impact on every aspect of the minority program at Cornell...

III. Civil Rights in Health Care

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pp. 58-76

After the southern slaves were set free by the Emancipation Proclamation, their health status and health care declined sharply. This paradox becomes easy to understand if we recall that slaves were valuable property because the fruit of all their labor and all of their children were assets of the master. The state of medical knowledge in the antebellum South was of course on a low order. Large plantations commonly employed a White physician and usually had a hospital...

PART II

IV. Geographical Distribution of Minority Residents

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pp. 79-102

In the preceding chapter I described the process by means of which Black Americans gained access to hospitals as patients and also as professional staff, beginning first in racially segregated settings such as the veterans’ administration hospital in Tuskegee, Alabama, and the Harlem Hospital Center. Both of these developments came in the aftermath of World War I as a result of demands of the Black community...

V. Comparing Specialty Choices

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pp. 103-117

It was a major hope and expectation that the increased enrollment of minority students in U.S. medical schools would to some extent correct both the geographic and specialty maldistribution of physician manpower in this country. Specifically, federal health manpower, legislation, Public Law 94-484, provided financial aid incentives for newly graduated physicians to pursue careers in primary care medical specialties...

VI. Affirmative Action in Graduate Medical Education

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pp. 118-146

Even more than undergraduate medical education, graduate medical education programs determine the future form and function of the national physician workforce. In recent decades, graduate medical education (GME) has come to rival and surpass the undergraduate system in complexity and size. While in 1940, just under six hundred hospitals offered a total of about five thousand residency training positions, in 1976...

PART III

VII. Thirty-Year Progress Report: Geographic Location of Practice and Medical Specialty Distribution

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pp. 149-178

This chapter presents thirty-year follow-up data on the medical careers of approximately 90 percent of the minority and nonminority medical students in the baseline data study group. Students were admitted to medical schools in the four-year period beginning in 1969 and graduated in the years 1973 through 1977...

VIII. The Future of Affirmative Action in Medicine

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pp. 179-211

The past thirty years have witnessed a remarkable improvement in medical educational opportunity for Black Americans. In this final chapter I outline the nature of these changes, then review the substantial legal and political assault that has been launched against this progress, and summarize the rationale for continuing the effort. Special reference will be made to the implications for Black Americans because the history of our nation, in its early economic beginning...

Epilogue

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pp. 212-216

In the more than fifty years since my graduation from the University of Michigan Medical School in 1946, as the only African American among the 145 graduates, I have been both an eyewitness to and an active player in the changing role of Blacks in American medicine. When I graduated, I was advised that I could choose my internship and subsequent postgraduate appointments...

References

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pp. 217-228

Index

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pp. 229-237

E-ISBN-13: 9780472025022
E-ISBN-10: 0472025023
Print-ISBN-13: 9780472112982
Print-ISBN-10: 0472112988

Page Count: 256
Illustrations: 45 tables
Publication Year: 2003