Wednesday, March 31, 1999

Cincinnati fails to keep black doctors

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BY TIM BONFIELD
The Cincinnati Enquirer

Dr. Tonya Echols, a native Cincinnatian, is a fifth-year resident at University Hospital in radiation oncology. (Michael E. Keating photo) | ZOOM |

        More than 10 percent of medical students at the University of Cincinnati are African-Americans, a figure that exceeds national averages. But just 2 percent of practicing physicians in Cincinnati are black, a figure that falls below national averages.

        The disparity reveals that many black doctors who train here are leaving town to start private practices — an exodus of talent and diversity that some medical leaders say is a communitywide concern.

        “There needs to be a communitywide effort to increase the numbers of African-American doctors trained here and staying here,” said Dr. Camille Graham, president of the Cincinnati Medical Association, a trade group for black doctors. “Cincinnati is losing talented people who are trained here with our tax dollars.”

BLACK DOCTORS IN TRISTATE

According to the Cincinnati Medical Association, 89 African-American physicians are practicing in the Tristate. That's about 2 percent of the estimated 4,500 practicing physicians in Greater Cincinnati. They are represented as follows:   • Internal medicine: 14   • Obstetrics/gynecology: 13   • Pediatrics: 11   • Family practice: 10   • Psychiatry: 5   • Ophthalmology: 4   • Anesthesiology: 3   • Orthopedic surgery: 3   • Podiatry: 3   • Cardiology: 2   • Dermatology: 2   • General surgery: 2   • Neurology: 2   • Radiology: 2   • Cardiothoracic surgery: 1   • Ear, nose and throat: 1   • Endocrinology: 1   • Gynecology/oncology: 1   • Neurosurgery: 1   • Pediatric infectious diseases: 1   • Pediatric surgery: 1   • Plastic surgery: 1   • Child psychiatry: 1   • Urology: 1   • Vascular surgery: 1   • HMO medical director: 1   • HMO research: 1   Source: Cincinnati Medical Association and Enquirer research

        Black doctors leave town for many reasons: professional opportunity, family connections, even feelings that Cincinnati is a boring place for young professionals.

        Some black doctors feel stifled by Cincinnati's conservative image and racial controversies, such as Marge Schott's racial comments and the KKK cross on Fountain Square.

        “Let's put it this way. Cincinnati does have some work to do as far as diversity issues go,” said Dr. Rodgers Wilson, 40, an assistant professor of psychiatry at UC, who is leaving this fall for Chicago.

        Mostly, he's going because family and close friends live in Chicago, but after more than three years in Cincinnati, Dr. Wilson said, he still finds it hard to live here.

        “The university environment is good here, but outside the university environment, it's very hard to integrate,” he said.

        Dr. Wilson moved here from Ann Arbor, Mich., a college town that he described as much more liberal and ethnically diverse than Cincinnati. Many African-American professionals prefer cities with a highly diverse population, including Hispanics and Asians, not just whites and blacks, Dr. Wilson said.

        “Residents do feel there's a big social void for them here. I hear single black women who say there's no chance they'll get married here,” said Dr. Nita Walker, adviser to Residents of Color.

        Dr. Tonya Echols is a Cincinnatian completing her fifth and final year of residency training in radiation oncology. She also is a co-founder of Residents of Color, formed in June.

        The group identified 47 black residents and fellows at University, Christ, Children's, Good Samaritan and St. Elizabeth hospitals.

        “Before this year, nobody knew how many black residents there were,” Dr. Echols said.

        Dr. Echols said Cincinnati tends to attract black doctors from smaller towns and those already married, but it is less attractive to singles and those from bigger cities.

        Some of these social concerns about deciding where to live are common to any young professional, black or white. Even so, African-Americans have a different list of highly desirable cities than do whites, some black doctors say.

        That difference reflects perceptions among African-Americans about whether a community clearly welcomes black professionals or simply tolerates them.

        On the racial-image front, even black doctors who want to stay here say Cincinnati needs improvement.

        Black doctors say Cincinnati's image has been tainted by Mrs. Schott's local popularity despite racial remarks that helped trigger a push by Major League Baseball to make her sell the Reds.

        In addition to the Schott factor are the Christmas KKK crosses on Fountain Square, as well as comments from former Bengal Dan Wilkinson that Cincinnati is a racist town.

        Then there was the controversy caused by Anthem Blue Cross and Blue Shield's decision to drop Cincinnati's only two black orthopedic surgeons from the network serving its largest health plans. Anthem since has promised to add more black doctors to its managed-care health networks.

        Ù “In other cities, stuff like the cross on Fountain Square would never be tolerated,” Dr. Echols said. “And the situation with Anthem would never happen in Atlanta or Detroit.”

        It boils down to this: If a successful young black doctor can choose between “conservative” Cincinnati and the well-established black professional circles and excitement of Atlanta or Washington D.C., why stay here?

        Black enrollment in medical schools never has reflected the proportion of African-Americans in the U.S. population. In fact, new enrollment would have to nearly double to meet a goal of 3,000 first-year students by the year 2000 that was set by the American Association of Medical Colleges.

        Even if African-American enrollment in medical school doubled overnight, it would still take years for the population of practicing U.S. physicians to reflect the percentage of African-Americans in America. Nationally, black people make up 7.9 percent of medical school enrollments, and 3 percent of physicians in private practice.

        The original reasons for low enrollment date back decades, to when black people were excluded from most medical colleges.

        The trend continues for more complex reasons, ranging from the quality of public education to varying attitudes about desirable careers and continuing debates about affirmative action.

        Regardless of cause, the shortage of black doctors is a public health problem, some doctors say. Much like women who prefer a female gynecologist, many African-Americans would prefer to see a black doctor, Drs. Walker and Graham said.

        Many black people, especially the elderly, harbor a distrust of the white-dominated medical system that once relegated black patients to segregated hospital wings and second-rate care.

        Many black people still don't get full access to the best medical care, according to public health studies. For instance, a study of 720 physicians published in the New England Journal of Medicine in February found that, with all symptoms being equal, doctors were 60 percent as likely to order cardiac catheterization for women and blacks as for men and whites.

        The lack of black doctors perpetuates the distrust, Dr. Echols said.

        Repeated studies show that many African-American patients wait longer than whites to seek medical care, making their illnesses harder and more expensive to treat.

        Some of that trend is economic.

        Low-income people of all races are less likely to have medical insurance and are less likely to seek the routine physicals and screening tests that can catch disease in early stages.

        Some of the trend is about trust, Dr. Echols said. “I see the people who just won't go to a doctor. I see tons of patients who waited until they had humongous cancers before they came in.”

        Dissatisfaction with Cincinnati is not universal among black doctors.

        “I don't see Cincinnati as a malignant area. For the size of Cincinnati, I've found ways to have fun,” said Dr. Cheryl Buck, who will become chief resident at Children's Hospital Medi cal Center this year and was another co-founder of Residents of Color.

        Dr. Buck, from Rochester, N.Y., said she has not decided whether to stay in Cincinnati, but her concerns are primarily professional.

        “I'm very impressed with the pediatrics program here. And I have relatives here. But it's more about where I feel most challenged,” Dr. Buck said.

        The shortage of black doctors in Cincinnati is an old trend but still a fresh issue.

        Just this year, Anthem stirred controversy when the company dropped two black orthopedic surgeons from its physician networks panel. Anthem then aggravated the situation by saying it would be accused of racism if it tracked how many minority doctors were in its networks, a position black doctors sharply criticized.

        The episode led to the creation of a community task force and promises from Anthem to pay closer attention to diversity. It also revealed deeper concerns about diversity throughout the Cincinnati medical community.

        Some say the task force itself was a step forward.

        In addition, the Cincinnati Medical Association and UC are sponsoring more networking events for black medical students to meet local black doctors. Cincinnati City Councilwoman Minette Cooper has proposed that the city refuse to contract with health plans that cannot demonstrate a diverse physician panel.

        Last month in responding to the controversy over its networks, Dr. Neeraj Kanwal, medical director at Anthem, said:

        “The need to recruit and retain more African-American physicians is crucial to Greater Cincinnati. One of the ways we can encourage physicians is through including them in managed-care networks. But that is only part of the solution. Our challenge is to really address the full issue.”

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