One of the underappreciated facts about the evil of racism in America is that it was a feature not only of the poor and uneducated but of the most elite educated professions. This was underscored this month by the apology issued by the American Medical Association to black physicians for a history of mistreatment, including the wholesale exclusion of black doctors from its ranks for nearly a century after the Civil War. The apology, published in the July 16 issue of the Journal of the American Medical Association, invokes the moral doctrine of practicing physicians — as depicted in the Hippocratic oath and the prayer of Maimonides, statements recited by new medical graduates — to heal their patients regardless of personal traits. Along with the association's own Code of Medical Ethics, these principles serve to compel physicians to treat each other and their patients without prejudice, the association's immediate past president, Dr. Ronald Davis, argued in the written apology. "In this regard the AMA failed, across the span of a century, to live up to the high standards that define the noble profession of medicine," he wrote.
The expression of regret is the culmination of rigorous introspection. In 2005, the group's Institute for Ethics invited a panel of experts to analyze the roots of racial division in medicine in the United States. They probed archival materials such as attendance rosters from Civil War-era AMA meetings and entries in the American Medical Directory, which included racial designations from 1906 to 1940 — black doctors were marked "col." after their names to indicate "colored." In an introduction to a report also published last week in JAMA, "African American Physicians and Organized Medicine, 1846-1968," members of the panel noted that by the end of the 19th century, physicians in the United States had formed two national associations, the National Medical Association and the American Medical Association. "This peculiar duplication reflected a profession segregated by race," they wrote. "The AMA was almost entirely white; the NMA predominantly black — founded in reaction to the exclusion of black physicians by many state and local medical societies and the AMA's refusal to recognize several racially integrated societies." Through the 1960s, the AMA did not take action against local affiliates that practiced racial exclusion. Though the Medical Society of the State of New York, which was integrated, tried in 1939, 1948, and 1949 to win changes at the national level, its efforts were rejected by the AMA.
The panel observed that some physicians opposed the exclusionary policies of the AMA, including a doctor from New York, Martha Mendell, who in 1952 noted that the exclusion of black doctors from local medical societies was an "international disgrace." In 1950, Peter Marshall Murray of New York became the first black doctor to serve in the association's House of Delegates. But in broader strokes, the leadership of the AMA sought to build a national association by tolerating racial exclusion. In recent years, "despite much progress, this legacy continues to adversely affect African Americans," panel members wrote. In 2006, blacks represented 12.3% of the country's total population but just 2.2% of physicians and medical students. That proportion is less than it was in 1910, when blacks represented 2.5% of physicians and medical students.
Citing a social responsibility and public health concerns, the AMA, which has 250,000 members, has sought in recent years to rectify the disparity. It funds pipeline programs for aspiring medical students, offers financial aid to underrepresented students, and supports programs to cultivate minority faculty members. Through its Commission to End Health Care Disparities, the AMA — along with the National Medical Association and the National Hispanic Medical Association — supports a "Doctors Back to School" program, which targets school-age children and college students from underrepresented groups and urges them to consider careers in medicine. In his commentary, Dr. Davis noted: "Acknowledging past wrongs lays a marker for understanding and tracking current and future actions." There are those who say that apologies can't change the past, and they have a point. The hope is that they will change the future.