The Chicago Reporter

About 10 years ago, Dr. Constance Shabazz interviewed for a position with a Georgia hospital. The administrator there was more than blunt: "You have two strikes against you," Shabazz said he told her. "You're black and you're a female."

Having just completed her residency at St. Joseph's Hospital in Chicago, she should be willing to accept any type of work, he said.

Shabazz said she half-expected that sort of treatment in the middle of Georgia, but upon returning to her native Chicago she discovered a similar problem: Most of the doctors in the metropolitan area are white males.

In fact, seven out of 10 physicians in the region are white, far exceeding the percentage of whites in the general population, according to The Chicago Reporter's analysis of race data for 13,548 doctors. And Asian doctors outnumber both black and Latino physicians by nearly 5-to-1, the analysis shows.

"Even though these numbers don't reflect the population, the problem is worse than what the numbers show," said Percy Russell, professor emeritus of biology at the University of California-San Diego, and associate dean emeritus of its medical school.

More alarming, he said, is that few whites practice in poor and minority communities, where doctors are needed most.

Nearly twice as many doctors–"9,021–"practice in the suburbs as in Chicago, the analysis shows. And nearly 60 percent of the black doctors in the region work in the city, while two-thirds of white doctors are based in the suburbs.

The Reporter obtained statistics for 23,536 doctors in the region and analyzed the 13,548 for whom race data is available.

The information comes from Medical Marketing Service Inc., a firm that markets physician data compiled by the American Medical Association for its Physician Masterfile, the most comprehensive and accurate source of statistics on U.S. doctors, according to the AMA.

The Masterfile is a compilation of the AMA's annual census of physicians and data collected through medical school graduation records.

In 1991, the AMA created the Minority Affairs Consortium to work toward boosting the number of minority physicians by increasing medical school enrollments. The group has 1,100 members across the country, said William McDade, a 38-year-old black anesthesiologist at the University of Chicago Hospital, 5841 S. Maryland Ave. McDade, a South Side native, also serves as president of the Cook County Physician's Association, a black physicians group.

One of the consortium's first acts was to urge the AMA to begin tracking physicians by race. In 1996, blacks made up only 3 percent of the 470,220 doctors for whom race data were available nationally, according to the AMA. Whites make up 79 percent of physicians, while Asians and Latinos are 10 percent and 5 percent, respectively.

"I think these [Chicago] figures only reflect America," said Dr. Lonnie Bristow, who served as the AMA's first black president from 1995 to 1996. "They only show we have a long way to go. They reflect patterns that are several hundred years old."

Comfort Zone
Having a black, female doctor is just right for South Shore resident Kimberly Webb, 36, a saleswoman at the Marshall Field's department store in the Loop. "I prefer a black female gynecologist because black women have needs that white women don't have. I don't feel that I'm being judged when they're examining the most private parts of my body.

"There's a certain comfort zone that you have with black doctors," she said. "There's no paranoia. The doctors are talking to me, not at me. They talk to me as a friend."

But in Chicago, black and Latino doctors can be hard to find. Blacks are about 40 percent of the city's population, according to census estimates by Claritas Inc., a market research firm. But African Americans make up only 7 percent of the city's physicians, the Reporter's analysis shows. Latinos, who make up nearly one-fourth of the city's population, are only 5 percent of the physician population.

Whites, on the other hand, make up 33 percent of the population but 69 percent of the doctors. And Asians far exceed their 4 percent of the Chicago population, with 15 percent of the doctors.

In the suburbs, blacks and Latinos make up an even smaller percentage of the physician pool. Asians comprise 21 percent of the doctors.

On average in California, black physicians cared for nearly six times as many black patients as did other physicians, and Hispanic doctors treated three times as many Latino patients, according to a study published in the May 1996 New England Journal of Medicine.

Researchers analyzed data on physicians' practice locations and the racial and ethnic makeup and socioeconomic status of communities during 1990. Minority areas were four times as likely to have a doctor shortage, regardless of income.

Many white people do not feel comfortable living next to, doing business with or even associating with blacks and other minorities, said Dr. Randall C. Morgan Jr., immediate past president of the National Medical Association, a trade group that represents black doctors.

"This is the most disturbing fact as we head into the next millennium: White physicians haven't tried to be comfortable with people of color," said Morgan, an orthopedic surgeon who practices in Gary, Ind.

"Doctors are concerned that a number of Illinois regions, both urban and rural, are medically underserved," said Dr. Richard A. Geline, president of the Illinois State Medical Society.

The society supports timely reimbursement from government programs and a student loan program that helps finance the education of doctors who agree to practice for a specified time in an underserved area, said Geline, an orthopedic surgeon who practices in north suburban Skokie.

Dr. Hugo Muriel, who served as Chicago health commissioner from 1979 to 1983, is now chairman of the board of the Hispanic Physicians Network, which he created four years ago to target Latino patients. Doctors own the health care group that, among other things, seeks to provide a better working environment for Latino doctors and run a non-profit foundation that supports research on Hispanic health issues.

"Who is going to treat these [underserved

 

people? Not minority physicians. There's not enough of us."–"Javier Sanchez, a third-year resident, Ravenswood Hospital Family Practice Program. (Photo by Olga Yolanda Lopez.)]

"We're going to fight together to restore our rights as physicians," said the Bolivian-born physician, who works with the St. Augustine College health program, and once worked with the Urban Health Program at the University of Illinois at Chicago's College of Medicine.

Among the physicians analyzed by the Reporter, Chicago averages nearly 17 doctors per 10,000 people. That average dips less than two doctors per 10,000 in 16 community areas, where the combined population is 69.5 percent black and 21.8 percent Latino.

Of the 57 doctors practicing in these neighborhoods, there are 33 whites, 15 Asians, four Latinos, three blacks and two physicians of other races.

"Who is going to treat these [underserved] people? Not minority physicians. There's not enough of us," said Javier Sanchez, 31, a third-year resident in the Ravenswood Hospital Family Practice Program.

At least 20 of Sanchez' patients drive an hour or more to his clinic "simply because I speak Spanish," he said.

Puerto Rican native Carmen Mendez, 63, is a longtime patient of Dr. Francisco Chuy. The Humboldt Park housewife and 40-year resident speaks only Spanish.

"I understand my doctor and can communicate with him more effectively," Mendez said through her daughter, Anna Santiago, a receptionist at Erie Family Center, 1901 W. Superior St. "I just love my doctor."

Sanchez, who attended UCLA for his undergraduate work and the University of Iowa Medical School, is one of two Latinos in the Ravenswood program, which accepts about five residents per year. About one-fourth of all the patients–"and half the patients Sanchez sees–"are Latino. After his residency, he would like to continue practicing in an urban setting.

"Patients want someone who not only looks like them, but speaks their language," he said.

Gender Gap
If you're a Latino woman, however, your Hispanic doctor is most likely to be a man, the analysis shows.

Latino males make up 81.1 percent of the Hispanic physicians in the region. Overall, male doctors in the Chicago area outnumber women physicians by nearly 3-to-1.

Many Latino doctors, most of them men, come from other countries where "it's more accepted for men than women to be in the medical professions," said Dr. Teresa Ramos, an attending physician specializing in internal medicine at Chicago's Illinois Masonic Medical Center, 836 W. Wellington Ave.

By contrast, only 58.6 percent of African American physicians in the region are men.

Those numbers reflect the shortage of black males in medical schools, said Dr. Niva Lubin, a former president of the Cook County Physicians' Association, a black doctors' group. The 41-year-old internist has been practicing for 11 years.

"Unfortunately, in this country, there are just as many black males in the criminal justice system, if you can call it that, as there are in higher education," said Lubin, who practices in the predominantly black Chatham neighborhood on the city's South Side, where she was born and raised.

The solution is a simple one, though difficult to achieve, Sanchez said. "We need to graduate more minority students. As a culture, as a country, we need to make a commitment to increase the number of minorities in medical school."

Sanchez, who is a member of the advisory committee to the National Hispanic Medical Association, said the organization is asking the federal government for money to develop a mentoring program for underserved communities.

Many Hispanics are the first in their families to graduate from college or attend medical school. They don't have the support system, financially or psychologically, to help them get through college, Sanchez said. "You need someone who's looking out for you."

Encouraging minorities to enter medicine must start early, in grammar and middle school, said Dr. Nathaniel H. Murdock, the current president of the National Medical Association. Murdock, a black obstetrician, said he has been speaking in schools in the St. Louis area for 20 years, and has encouraged his members to do the same in their communities.

Dr. Herbert W. Nickens, vice president for community and minority programs for the Association of American Medical Colleges, said that unless there is a big reversal in the trend, the AAMC's, "Project 3000 by 2000," won't succeed. The program aims to increase the number of matriculating minority medical students to 3,000 by the year 2000. In 1997 there were 1,770.

About 4,500 minority applicants vied for 16,000 medical school slots in 1997, Nickens said. Three thousand is close to the number needed to mirror the general population, he said.

Ideally, the environment will change by partnering schools with academic medical centers, he said. "You tell kids: This is what you can become if you do the right things."

Student Support
About 24 percent–"132–"of the black doctors practicing in the Chicago area graduated from the UIC College of Medicine, the Reporter's analysis shows.

UIC has produced more minority doctors practicing in the region than any other Illinois medical school. In addition to the black physicians, 72 Latino and 54 Asian graduates are working in the Chicago area.

Yet minority students in UIC's Urban Health Program filed a complaint with the Civil Rights Division of the U.S. Department of Education in September 1997, charging they were not receiving adequate faculty and staff support. In January, the students took their case to the Illinois Black Caucus. The caucus is expected to release a report on the student complaints in early August, said Cindy Heapner, a spokeswoman for state Sen. Emil Jones (D-Chicago), who is Senate minority leader.

UIC gives students access to counseling services, including debt counseling and tutoring, said Jobe Payne, interim senior administrative officer for the program, who added that he could not comment on the complaint. The services are open to everyone, not just underrepresented groups, he said.

"We're making a strong effort to attract, retain and graduate minorities," said Payne, who helped create the Urban Health Program in 1979. The school works hard to bring minorities into the medical school, keep them there and help them find jobs in the city, he said.

But that support is "all in theory, but not in reality," said Ramos of Illinois Masonic, who graduated from UIC's Urban Health Program in 1988 and now serves as a mentor to students there.

The same problems alleged in the complaint existed then, she said. If a person was in danger of flunking out, "it was usually a person of color."

Ramos, who serves on the National Hispanic Medical Association board of directors, said many of those students "were simply told to study harder."

On average, blacks and Latinos make up 25 percent to 27 percent of those entering the medical school, but 20 percent of the graduates, said Danny Chun, the school's interim director of public affairs. Whites are 50 percent to 55 percent of the incoming students and 60 percent of the graduates. Asians, who are not considered a minority in the program, are 25 percent of both the incoming and graduating classes.

Graduation and retention rates are not always accurate because some students take extra time to graduate, Chun said. Some minority students may take a year off or take exams over, and graduate in five years, not four.

"Medical school is the toughest school you will ever go through," Chun said. "Our standards have to be tough because doctors have people's lives in their hands."

Abolishing affirmative action for colleges and medical schools will only exacerbate the problem, said Bristow, the former AMA president.

"Every time we take three steps forward, these attacks are two steps backward," he said. "The [numbers] outline why affirmative action is still needed."

Community Health
Constance Shabazz, now 46, began medical school at age 30 at Southern Illinois University in Carbondale, and she has worked in the community health field since 1971. "I go back awhile. I know what it's like for people not to have access to health care. I get the greatest satisfaction working with someone who can't go somewhere else."

Born and raised in Chatham, Shabazz, an internist, has been medical director for Aunt Martha's, a youth services center focusing on adolescent care based in south suburban Matteson, since July of 1997.

"We're doing basic community medicine," Shabazz said, filling the void of the insurance gap. The clinic's mission is to provide services to a diverse patient base. "Many white doctors aren't willing to practice in minority communities because the patients are not only poorer, but often are sicker."

Because of the lack of access to health care, Shabazz said poor patients may split medication. They may take one pill once a day, rather than one pill three times a day, to save money.

Aunt Martha's offers its patients information about public aid as well as housing, education and rape counseling. Services that are, "in my mind, very crucial to practicing a holistic type of medicine," Shabazz said. She added that the "experience is positive" since she's been at Aunt Martha's.

"I'm no longer a black female physician," she said. "I'm the doctor here."

Contributing: Danielle Gordon, Natalie Pardo and Nicolette McDavid. Rui Kaneya, Karen Shields, Cedric L. Stines and Kat Zeman helped research this article.

Links:
National Medical Association
www.nmanet.org

National Hispanic Medical Association
home.earthlink.net/~nhma/index.html

American Association of Medical Colleges
www.aamc.org