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Throughout history, Black physicians have been bound by a dual obligation: to pursue excellence and success in their profession, and to leverage their professional stature to improve the condition of their communities. This paradigm of race-conscious professionalism has affected greatly the experience of Black physicians, and shaped their formulation of professional identity. This paper explores the relationship between professional life and racial activism in the Black physician community from the pre-Civil War era until the present. The nature of this negotiation has shifted according to the professional and social dynamics of the era. Before the Civil War, Black physician-activists were forced to relinquish their professional duties in order to engage in activism. In later years, activism emerged as a valuable endeavor in the Black medical community, which offered greater opportunities for activism within the profession. The implications of these findings for contemporary physicians are discussed.