Moving beyond Black and White

Opening my 1965 Columbia College of Physicians and Surgeons yearbook reminds me that I had no African-American classmates. In the group pictures of the 3 classes following mine, I spy 1 person of color. Not 1 of the many faculty members pictured is African American.

Today, 14% of Columbia's medical students are from underrepresented minorities (Hutcherson HY. Columbia College of Physicians and Surgeons. Personal communication; 2003), as are 11% of students nationwide (1). Among the roughly 240 000 doctors in general medical and family practice, about 7% are minorities (2, 3). About 64 000 primary care nurse practitioners team with doctors in primary care practice (4), and while no data document explicitly the numer of minority nurse practitioners, fewer than 10% of all registered nurses are minorities (5). Despite some change since 1965, these numbers match poorly with the more than 1 in 4 American adults who are minorities: 59 million of 209 million (6).

I interned on Columbia's service at Bellevue Hospital and was headed for chief residency there. However, Columbia University's plans to build a gym on the edge of Harlem led to community rancor, followed by riots, and New York's mayor asked Columbia to do penance by bringing new resources to Harlem Hospital Center. So, in 1968 I ended up at Harlem—a white, Jewish doctor working with 55 housestaff, each brand new to the medical service. Half were white; half were African American. One of the biggest problems that year was that our primarily African-American patients often complained when assigned an African-American doctor.

Thirty-five years later, I doubt I'd encounter many patients with such attitudes. An article in this issue (7) offers …