Dr. Cedric Bright has been described colleagues as a resident-recruitment “secret weapon" because of his passion - and how difficult it is to turn him down. He has been involved in college admissions since his early career, helping recruit students during his residency at Brown University. Join us as Dr. Bright discusses his journey from Brown to Duke University, the Durham VA, and the Brody School of Medicine at East Carolina University, with podcast host Dr. Randall Morgan, President and CEO of the W. Montague Cobb Institute. Dr. Bright highlights the challenges and successes in recruiting and retaining Black medical students and faculty, the importance of cultural humility, and the transformative power of intentionality in medical education. Dr. Morgan and Dr. Bright also reflect on the legacy of W. Montague Cobb, comparing his stature in the 1960s to that of President Barrack Obama today.
Dr. Cedric Bright, is a general internal medicine physician. He is Senior Associate Dean for Admissions and Professor of Medicine at The Brody School of Medicine at East Carolina University.
He was previously Associate Clinical Professor of Internal Medicine and Community and Family Medicine at Duke University and a staff physician at the VA Medical Center in Durham. Dr. Bright also served on the North Carolina Medical Society Patient Safety Taskforce; chaired the board of directors at the Lincoln Community Health Center; has spoken about health disparities before the Congressional Black Caucus; was a medical ambassador to Ghana; and has served as a mentor for the Student National Medical Association.
Dr. Bright is a dedicated leader in delivering patient equity through broader access, and is a staunch proponent of healthcare reform. He is a published author, lecturer, and thought leader on current trends and best practices in healthcare, healthcare policy and management, medical education, health equity, and DEI issues.
Randall C. Morgan, Jr., MD, MBA, is the President and CEO of the W. Montague Cobb/NMA Health Institute based in Washington, D.C. In that role he leads a staff of scholars and research specialists who focus upon the elimination of Health Disparities. He is also an active orthopedic surgeon who has practiced in Sarasota and Bradenton, Florida since 2005. He serves as founder and President of University Park Orthopedics in that community. He is also Clinical Associate Professor of Orthopedic Surgery at Florida State School of Medicine and is also a Clinical Associate Professor in the Department of Community Medicine at the University of Connecticut. He is a graduate of Grinnell College with a B.A. in Chemistry. He received the M.D. degree from Howard University. He served as a resident in Orthopedic Surgery at Northwestern University and served a Pediatric Orthopedic Fellowship at Children’s Hospital in Cincinnati. He later received an MBA degree from the University of South Florida.
Dr. Morgan served as the 95th President of the National Medical Association during the years 1996 and 1997. He was the first board-certified orthopedic surgeon to hold that position. Dr. Morgan is a true pioneer in his profession and was among the first surgeons to perform total joint replacement surgery at Northwestern University. Dr. Morgan has practiced General Orthopedic Surgery and Pediatric Orthopedics in Evanston, Illinois, and as well in his hometown of Gary, Indiana, for more than 30 years prior to his relocation to Sarasota. With the assistance of his father, Mr. Randall C. Morgan, Sr., he founded the Orthopedic Centers of Northwest Indiana and served as its president from 1975 to 1999. At one time, this was the largest minority-owned orthopedic practice in the United States. He has written and published extensively throughout his career on Orthopedics, Social Responsibility, Health Equity and the Education Pipeline for Underrepresented young scholars. He is a Diplomat of the American Board of O
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Episode Transcript
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(00:01):
I was the first Black in that residency program's history.
By the time I left, we had six, because somebody dared to be first.
When I came to the VA, I was the first Black male internal medicine physician in that VA.
By the time I left, we had up to five or six.
(00:22):
Now, that being said, it can also be a very lonely position,
you know, when you're one of onlys. And so it's one of those things where you
have to have the right fortitude.
You have to have the right faith.
You have to have the right position to understand that, you know,
you're doing it for a mission.
I'm proud of that work because I know that I'm making generational change. age.
(00:46):
And what we saw, Randall, we saw we went from 524 in 2014 to by 2021,
we had 863 Black males matriculating to medical schools.
So the menino has moved.
Cultural Competence says, I read the book. I took the course.
(01:08):
I know everything about people who are different than me.
Cultural Ultramelody says, I read the book, I took the course,
and I know just enough to be dangerous.
So I need to surround myself with people who are different than me and then
get to understand their perspectives of health.
And then that will allow me to be
able to interact more effectively with patients that don't look like me.
(01:32):
Part of what we have to understand is how do we value people's lives, right?
And how much did they have to work to get to the same point of attainment as
those who have not had as many adverse childhood events, ACEs, or adverse life events?
(01:53):
Everyone is valuable. We can't afford to have anybody leave because they weren't able to afford it.
We can't have anybody fired. We can't have anybody discouraged.
We can't have all these kinds of negative things happen because our needs are too great.
Music.
(02:21):
Welcome to this episode of Cobb & Company, the podcast of the W.
Montague Cobb Health Institute.
The mission of the Institute is to conduct rigorous research and policy analysis
and to engage in dynamic collaborative partnerships and programs for the reduction
of persistent racial and ethnic disparities in health and racism in medicine.
(02:46):
Over the coming months, we will be welcoming numerous thought leaders in the
areas of health equity and increasing diversity in the health care workforce.
It is my great pleasure to welcome Dr. Cedric Bright to the podcast today.
Thank you for joining us on the podcast.
(03:06):
Thank you so much for having me, Randall. It's always a pleasure to be here.
Now, we're going to be talking about pipeline and pathway programs and best practices.
But first, I'm going to share a little background for our listeners.
Dr. Cedric Bright is a general internal medicine physician.
He is a senior associate dean for admissions and professor of medicine at the
(03:32):
Brody School of Medicine at East Carolina University.
He was previously Associate Clinical Professor of Internal Medicine and Community
and Family Medicine at Duke University and a staff physician at the VA Medical Center in Durham.
Dr. Bright also served on the North Carolina Medical Society Patient Safety Task Force,
(03:57):
chaired the Board of Directors at the Lincoln Community Health Center,
and has spoken about health and health disparities before the Congressional Black Caucus.
He was a medical ambassador to Ghana when he served as president of the National
Medical Association and has served as a mentor for the Student National Medical Association.
(04:19):
He is a dedicated leader in delivering patient equity through broader access
and is a staunch proponent of health care reform. form.
He is a published author, lecturer, and thought leader on current trends and
best practices in health care, health care policy and management,
(04:40):
medical education, health equity, and DEI issues.
Now, we have much to talk about. Let me start by asking you about your time,
not only at the the University of North Carolina,
but also at Duke University and at Eastern Carolina in the area of admissions.
(05:04):
We know that during your time, more than 14% of UNC's medical students identified
as Black, which is compared to a national average of around 7.3%.
In other words, UNC, as well as Duke and Eastern Carolina, have achieved a level
of representation which mirrors the general population.
(05:27):
What are some of the pipeline and pathways, best practices that have enabled this achievement?
Well, thanks for that question, Randall. And, you know, this actually,
I started all the way back when I was at Brown.
So I've been at four medical schools. I started off at Brown.
And one of the things that I did there was just be present.
And in being present, the students of color came to find a black attending and
(05:52):
decided that they would come and shadow me in the various clinics that I worked in.
Fast forward to leaving there and going to the Durham VA and Duke University,
once again, a Black attending, a Black male attending, not a lot of Black males in academic medicine.
We probably comprise less than 2% of faculty in academic medicine.
(06:15):
And preponderantly, most of those are located in predominantly Black medical
schools, such as Howard and Meharry, Charles Drew, and Morehouse.
And so, you know, it's kind of like being a unicorn in a way.
I've described myself in many ways as being a unicorn, a black male in academic medicine.
(06:35):
And the one thing that I found as I was going through my training,
Randall, was that, you know, I didn't have people that I could talk to about
the issues that were impacting me.
And so I ended up writing a paper, and my paper was entitled title,
Perceived Barriers and Bias in Medical Education by Race and by Gender.
And that was the one way that I found to be able to describe my experiences
(06:56):
as I was going through medical education.
That paper was published in the Journal of the National Medical Association in November of 1998.
And from that point forward, I decided, you know, if I didn't have it,
I want to try to be the a bridge for those that are coming behind me.
And so that's kind of the backdrop of why I wanted to go into the area of student
(07:19):
development and the aspect of enhancing students to help them become prepared
to give appropriate counseling to students in a timely manner.
Because I saw so many students that would come my direction who were broken
because they had a bad grade as a freshman, didn't have the best high school,
and therefore they struggled in college.
And immediately they They were told by health advisors, you can't go to medical
(07:43):
school. It's not going to happen.
And so I realized that that was a false narrative, and I wanted to change that narrative.
Fortuitously, in the state of North Carolina, we have a population of almost 23% of Blacks.
Part of success comes from what is the pool that you can pull from.
We have 11 HBCUs in the state of North Carolina to go up a great university
(08:06):
system in the state of North Carolina, the University of North Carolina system.
And it has been touted nationally as being one of the most progressive system schools in the nation.
And so we have a lot of a pool, we have a large pool to pull from.
And so fortunately, what I did was I made myself available.
You know, Randall, if you build
(08:27):
it, they will come, right? And so what I did is I built this process.
I engaged in working with a pipeline program called the MED program.
And fortuitously, we just celebrated our 50th year of the MED program.
Almost 3,700 students Students have gone through that program since 1974,
(08:48):
and over 1,800 of them have gone on to become physicians.
And those are mostly people of color. Now, here's the deal.
People say, well, why are y'all just doing that for people of color?
Well, medicine has traditionally been almost 80 to 90 percent white, but patients are not.
And the key is outcomes. And what we know is that when there's race congruence,
(09:12):
there's trust and there are better outcomes, there's better compliance,
there's better physician satisfaction, better patient satisfaction.
It's also an aspect of a rising tide, because if the people who have the worst
health outcomes start to have better health outcomes, it becomes a rising tide
and that lifts all boats.
(09:33):
So that is the argument for why we must have diversity.
Because not only is it adversity for the fact that we can have congruence,
but it also leads to cultural humility, Randall.
And cultural humility is different than cultural competence.
Cultural competence is I read the book, I took the course, I know everything
about people who are different than me.
(09:54):
Cultural humility says I read the book, I took the course, and I know just enough to be dangerous.
So I need to surround myself with people who are different than me and then
get to understand their perspectives of health and then that would allow me
to be able to interact more effectively with patients that don't look like me.
That works both ways, Randall.
(10:14):
That helps our black students learn how to relate to white patients and it allows
our white students to learn how to interact with black patients.
And so I think that's a win-win that sometimes we confuse and we downplay the
importance of it, but I think that's very important.
So I was fortunate enough that I had a good supply of people to pull from.
(10:35):
We were able to get the University of North Carolina to go from 14% to 25%.
I was able at ECU to go from 15% to 33%.
ECU, while I was there, went up to number nine in the nation as being one of
the most diverse medical schools out of 125 that reported to U.S. News and World Reports.
(10:57):
I'm proud of that work. I'm proud of that work because I know that I'm making generational change.
You know, admissions, Randall, it's two ways you can do admissions.
One way is transactional. I get to people with the highest numbers,
and I just bring all the highest numbers in because they're the highest numbers, right?
But oftentimes, many of those students don't have the communication skills.
(11:21):
They're very book smart, but they can't interact with people.
The goal of admissions is to be transformative.
We want to transform our nation's healthcare system by bringing in people that
have that cultural humility, that have learned how to be able to talk to all people.
If from Kipling's poem, if you can talk with kings, nor lose the common touch, right?
(11:45):
And so that's what we're looking for in admissions and why we want to be transformative
And also empowering, right?
Because many of our students, you know, come in and are first generation students.
That's transformational generational change in their families.
And that is just something that is what the American dream is about.
(12:05):
But if you have people that are only looking for the same people,
it becomes transcriptive and that's what you end up with.
So certainly as a unicorn and one with endless energy,
you have been able to create programs
literally in three or four different institutions just intuitively.
(12:27):
And so the question is, in terms of sustainability, how does it look for faculty
recruitment and development?
Because if you're there, what happens when you left Brown?
How much of a fall off was there in terms of student support and then to the
next institution and the next institution?
(12:48):
So how can we also affect a more difficult area, and that is to recruit and
retain faculty in the medical schools?
Great point, Randall. You know, this is just one of those things where—.
You have to be intentional, right? And so I can honestly say over the last 10
(13:10):
years, I have spent more time talking to medical students about you can't change
the face of medicine by being a student.
You change the face of medicine by becoming faculty.
Because then when you become faculty,
then you have the ability to logarithmically have influence, right?
(13:31):
When we're out practicing in our community and we see patients,
We see patients, one patient at a time, right?
But if we are in a medical school and we're working with medical students,
we're working with sometimes 100 to 200 students at a time, right?
And each time you influence a student, they become inspired by you.
(13:51):
They go and do that for somebody else, and then they do it for somebody else,
and it becomes like being a teacher.
It becomes logarithmic. You know, it's not 10, it becomes 10 fold of opportunities
that occur from just one interaction.
So I think that's one part of it. One part of it is that the second part of
it is, is we need to be faculty so that we can help other faculty.
(14:14):
Right. Because we need to do things like help people with their unconscious bias.
We need to know our own unconscious bias because everybody has it.
It's not something that is owned by white people or by black people.
We all have unconscious bias.
And so we must come to terms with that and learn how to be able to recognize
it and be able to utilize our ability to see it and then work with that cultural
(14:39):
humility in order to address people who are different than us.
And then the other part of it is, is that, you know, people gravitate to where
they see people who are like them, right?
And so when I came on as faculty, when I came to Brown for my residency program,
I was the first Black in that residency program's history.
(15:00):
By the time I left, we had six because somebody dared to be first.
When I came to the VA, I was the first Black male internal medicine physician
in that VA. By the time I left, we had up to five or six, okay?
When I came to UNC, I was the first black medical doctor to be an assistant
(15:23):
dean on the admissions committee, okay?
And representation matters.
And being in those places to represent, to help people dispel their unconscious
biases and dispel the myths that they have regarding what students should and
should not be, I think is so important.
And then, you know, developing these types of programs such as Bengap,
(15:46):
I wasn't a part of the actual starting of that, but it's the next generation
of academic physicians.
It's what Bengap is all about. And they are going about doing these types of
seminars to help young people who are medical students understand the importance of becoming faculty.
Now, that being said, it can also be a very lonely position,
you know, when you're one of onlys.
(16:07):
And so it's one of those things where you have to have the right fortitude,
you have to have the right faith, you have to have the right position to understand
that, you know, you're doing it for a mission.
And so it's a long season. And I think that those students that you impact are really the energy.
(16:29):
Yeah. That keep you going on the days when it's extremely frustrating,
extremely competitive.
And I know many, many faculty members are always concerned about their ability
to remain at an institution, remain successful, to obtain promotion.
(16:50):
And so I think that the students serve as a major catalyst for faculty and maybe
even administration in certain institutions.
I would agree with that. With that being said, as you look over your shoulder,
what do you see at the institutions that you've left in terms of their numbers,
(17:15):
in terms of their programs? Are they all still tracking?
The way they were when you were there, or better, hopefully not worse.
But what do you see? Well, Randall, I have to be cautious in how I talk about this.
Yeah, just in general. And so what I see in general is that,
you know, depending upon their intentionality is how the numbers will go.
(17:42):
Yeah, that's how I see it. But your point that you said earlier is so well spoken,
and that's the aspect of students. You know, students are the lifeblood of a school, right?
The school exists for students, not for faculty, not for staff.
If you have no students, you have no school.
And so we need to make sure that we're focusing on our students more so than
we're focusing on our own needs.
(18:04):
And that's what makes a successful school, because word of mouth will either
boost you or it will kill you.
And that's so important. And so, as we talk about this pipeline initiative,
it is important for us to think about all those aspects of this adventure.
(18:30):
That will create sustainability because if we have ebbs and flows of the number
of students that are in institutions,
it's not going to be as, certainly not gratifying, but it's also practically,
we're not going to be able to get to where we want to be in terms of the health of our nation.
(18:53):
So that's kind of why I was asking, not so much that I know that schools,
any institution, It's not going to be able to sustain a number at a point in time.
But how can we kind of plan for these sine wave type of changes for the greater good?
So at the end of the day, the arrow is pointing upward.
(19:15):
I think it's a combination of things.
You know, we can never train enough black doctors to take care of all black patients.
That's the first point. I read a stat where we would have to fill every medical
school class with only Black people for the next 25 years in order to get to physician equity.
That's not going to happen. OK. And so what we have to do is we need to make
(19:39):
sure that we are being intentional about the work that we do and understanding
that a diverse class improves educational outcomes and improves educational performances.
And so I think that's one of the things that we have to always put in our forefront.
The other part of it is also it helps to develop that culture of humility,
(19:59):
such that our colleagues will be able to take care of patients in race-incongruent settings.
I think that's very important. I think it's important and it works both ways.
And it works for all people.
And so finally, for my last point, how do we sustain it? Randall,
we have to have programs that are tailored in a way.
(20:19):
So for instance, how do we get here to begin with? Well, HCOP,
Health Careers Opportunity Funding from HRSA.
That started back in about 1972.
It started at Meharry Medical School. And it was a program that helped to give
funding to do a nine-week immersion into what medical sciences was in order
to try to take students who were coming from HBCUs and getting them prepared
(20:42):
to go to medical schools at any medical school, right?
The MED program that I talked about, that is an evidence of HCOP funding,
Health Careers Opportunities Programs, okay? So that's important.
We need programs like Robert Wood Johnson's program. It's Summer Health Education
and Medicine and Dental Program.
(21:03):
It's a summer program that they've been funding since 1999. 99.
And what you do when you look at the data, you will see that two thirds of the
students that go through those
programs ended up matriculating into a medical or dental school. Okay.
Then we have to have actions that occur in an organized medicine.
What type of organized medicine? Well, we talk about the AAMC and that's the
(21:25):
Association of American Medical Colleges and the work that they're doing in
this action collaborative, which is to look at how do we improve the lot of the least of us.
You know the paradigm about the canary in a coal mine, right?
And the canary saves the miners, right?
Well, it's like that in life. If we take care of the least of us,
(21:46):
the ones who are most impacted, we improved a lot for everybody else.
I talked about it previously as a rising tide.
And so, you know, at the AAMC with the National Medical Association,
we're working to do an action collaborative to look at why has this been the dearth of black males?
You know, In 1974, there were more black males that matriculated in the medical school than in 2014.
(22:10):
We started doing this work about 2015, 2016, with a group called Diverse Medicine,
Inc., which is with Dale Okorodudu, who developed this film Black Men in White Coat.
And this whole series of Black Men in White Coat, you can find it online and go look at those videos.
And that raised the Q factor about this aspect of Black men in medicine.
(22:33):
And what we saw, Randall, we saw we went from 524 in 2014 to by 2021,
we had 863 black males matriculating to medical schools.
So the needle has moved.
Now, how's that overall percentage? Well, when there's 25,000 spots in medical
(22:56):
school, we haven't really moved the needle that much, but the needle has moved.
And that's important. And then the last thing I'll talk about is,
you know, we have organized groups like the National Academy of Science,
the National Academy of Science, which has a roundtable on Black men and Black women in STEM.
And we have put together some articles as well as workshops to try to address
(23:20):
the issues of why we have the numbers that we do.
And the bottom line of it is, is that, you know, all of this intentional work
will have a positive impact.
How well it will be sustained will be because of people who get into positions,
positions of leadership, who this becomes part of their agenda for what they
want to do moving forward.
(23:41):
Understanding that we have a browning of America and we need to make sure that
we try to mitigate the cost of health disparities because health disparities
cost us $1.24 trillion a year.
Back in 1998, 1999, 2001, and 2002, if we don't change that,
it's going to eat up our GDP and we're going to be one of the poorest outcomes
(24:04):
of health with the most money spent.
Well, I think you're absolutely correct. And I remember when I was president
of the National Medical Association, as of course you have been as well,
in 1997, there was from AAMC.
Maybe not from AAMC, but certainly AAMC considered the statistics that were
(24:29):
stating that we would have overage physicians in the United States.
And so here we are 20 years later, and they're projecting 30,000 shortage of physicians.
And I remember that our response from the NMA was that we were tone deaf to
(24:49):
those statistics because our communities were so underserved.
There would be a long time before we had. We'd welcome the opportunity to have
more physicians than were necessary in any of the schools because our patients need them.
And as we could see, the way the demographics come about and where people live
(25:12):
and where they can access care,
even if you had the numbers, people still wouldn't get the care because so many
of them live in places where they don't have access.
So we certainly have to keep this pipeline and pathway going,
but also be innovative in terms of how we can improve these pockets that no
(25:35):
matter how many numbers we have, they still continue to be underserved. Great points.
Just to give you kind of an idea,
you know, in 1920, there were more black physicians per 100,000 people.
People than they were in 2020. And so we've seen a decline in our number of
(25:58):
proportionate physicians to doctor ratio.
And a part of that was back in then we had more Black medical schools because
that's when segregation was, Jim Crow and all of that.
So we couldn't go to predominantly white institutions.
And so that's where that all started. And there was an article that was written
by a colleague of mine, Dr.
Kendall Campbell, that estimated if those medical schools had stayed open,
(26:21):
we would have had over 35,000 to 40,000 extra Black physicians in this country to make a difference.
You know, the other part of this is, though, is how do they reimburse things, right, Randall?
So if you're closer to a ivory tower, which is a medical school,
you get higher reimbursement than if you go out into a rural community.
(26:42):
And then there's also the medical
isolation that occurs for people who practice in rural communities.
And so it's not that very desirable of people who are coming out of their residency
programs to go want to work in areas where they're going to feel like they're being isolated.
And so that's some of the things that we need to be able to work on.
How do we develop better support mechanisms and systems such that we make rural
(27:07):
medicine more attractive?
Because Because really and truly, that's where a lot of our disparities occur
in the inner city, you know, where folks are and not able to get access and in rural areas.
And many people in rural areas think we've forgotten about them.
But we as health centers really need to take that on.
And part of that issue is the funding and remuneration that we get for providing
(27:30):
care in those areas where preponderantly many of those people don't have health insurance.
That's why Medicaid expansion was so important and states that have expanded
Medicaid have had the ability to be able to.
Reap more funding to provide those services to those communities who are mostly underserved.
(27:54):
And I think North Carolina is one of the most recent, if not the most recent. Most recent.
Hallelujah. And so certainly I live in Florida now after a career in Indiana,
and there's stark differences in the care for people and those who have certain insurances.
They feel almost like lepers sometime in the state, unable to obtain health care, have no options.
(28:22):
And that's such, I just can only imagine how despondent a person would be understanding
that they have kind of hospital gown coverage.
It covers the front of you, but the whole back of you is out.
Right. Yeah. And they're very, very angry, very bitter individuals too.
So we have a long way to go in terms of solving this, and we're trying to do
(28:45):
our part in the National Medical Association.
AAMC, COB, National Academies, to make progress with this pipeline and pathway challenge.
Challenge, but I think the success is going to be the impact that we have across
several disciplines, as you've mentioned,
(29:06):
and being able to fund programs that not only when these young people finish their training,
they're able to make a living by sharing in communities that are underserved.
And they can only do that basically by being employed by some entity that finds
(29:27):
that it is important to spread out and cover that group of people.
None of our young people now are opening up a practice and putting a shingle.
That's the old NMA model, but that's gone now.
So it's so ironic that you mentioned that, Randall, because I was coming into
(29:48):
being and a president in 2011.
2012, 1998, almost 80% of our members in the NMA went private practice.
When I came in as president, that number had shrunk to only 10%.
And that was just the movement of physicians wanting to get out from being their
(30:08):
own business administrators to wanting to become purists.
And I just want to practice medicine. I don't want to have to worry about all
the overhead head and stuff like that.
So we gave away our rights of our own to people who became administrators over us.
And that's what the difference is right now. The other thing,
though, that I would suggest to you, Randall, besides as we're making these
(30:30):
new physicians coming out of medical school, we need to get them in front of
students in elementary school.
We need to get them in front of students in middle school and help develop programs
that inspire our young people beyond the inspiration that they're getting from
their teachers or the lack thereof, right?
And that's really, I think, very important that we role model that they can do it. My mentor, Mr.
(30:56):
Larry Keith, he used to say, if you can see it, you can dream it.
If you dream it, you can believe it. If you can believe it, you can achieve it.
Right. Well, that's absolutely, absolutely true.
And one of the things that I think still is true about those of us who have
(31:16):
been fortunate enough to become physicians and who are African-American or dentists
or PhDs is that there's a certain responsibility.
That we have to the community the responsibility of
the chosen few to do whatever we can to
help that next generation yeah and
(31:39):
influence them and certainly i remember going to back
to my home in gary and the first person
i ran into is my fourth grade teacher who asked me to work with her on a new
program she was in gifted education by that point called the prep program It
was a program that was geared on a professional resource education program.
(32:02):
So it was a program that was geared toward middle school and high school students
with Saturday programs where they would get a chance to meet professionals,
get a chance to visit the hospital.
And we had different areas. We had medicine, we had dentistry,
we had law, and we had engineering. nearing.
(32:24):
And so we had volunteers in the community that would have these students who
would have 15 or 20 in each discipline.
And so there's just a way, an organized way for communities to put their professionals
together with students.
And so many of the students have done exceptionally well.
So hopefully that type of thing continues in other communities because Because
(32:50):
our young people are really short on that kind of contact and that kind of inspiration, really.
Yeah, you're right on that. You know, it's so amazing to me how I meet students
and they will say to me, I've never seen a black doctor or I've never seen a woman doctor.
(33:11):
I've never seen a Hispanic doctor.
And we're here. We are here. It's almost like quoting Here's to Who.
We are here, we are here, we are here, right?
But if we're only sounding off in our own echo chambers and we're not reaching
out of the walls which constrain us and go into the arenas where people can
(33:34):
see us, it makes a difference.
We've got to get out of our walls.
We got to stop thinking of our job, because there's one thing that's a job, right, Randall?
A job is something from 9 to 5, I go home, I don't think about it. We're professionals.
That means we're on, you know, seven days a week, 365 a year.
(33:55):
I go to the grocery store, I'm trying to get me some salad dressing.
My patient walks up to me and says, hey, Dr. Bright, how you doing?
Good to see you. What's this on my arm, right? Right.
Just as what happens in the grocery store. That's why we got to go to the schools.
OK, because we need to help our young people to see that we exist and that they can do it.
(34:16):
That's very important. I agree with you there, Randall. Yes.
So as we kind of get toward the end here, I'm so appreciative of this discussion.
Discussion, but I would like maybe as you look at your career to this point,
which you still have a long way to go in your career, but I guess maybe it does
(34:38):
add up to around 30 years.
Amazingly so. There's been a lot of progress made in pipeline and pathway programs.
So, however, challenges, And we're here at the National Medical Association Convention.
We will be speaking tomorrow about the challenges related to the dissolution
(35:00):
of the affirmative action initiatives in many schools of higher education.
And is this the single largest blow to the progress that we've made to this time?
And what is going to be our workaround?
Because certainly we're not going to give up until we are successful.
(35:24):
Great question, Randall.
Well, my first answer is vote.
This is going to be an election of choice. And we can choose to move forward
or we can choose to go back.
I think it's important that our young people understand their vote is going to win this election.
(35:45):
If the people from the ages of
18 to 30 come out and vote and vote for progress, that's where we will go.
If they have apathy and decide not to vote and we have an election that goes
backwards, then that's what will happen.
This is a central point in our history as a nation.
(36:07):
And we can either determine that we want to choose division or we want to choose unity.
And I'm hoping that we will choose unity. The second point on that,
there is an excellent model.
I won't call it a workaround. What I will call it is, you know,
there's more than one way to skin a cat.
OK. And in this particular instance, I think the folks out of California.
(36:31):
University of California, Davis School of Medicine, Mark Henderson is their
dean of admissions out there.
He has developed this adversity index that looks at how much adversity has a
person come through to to get to the point, the starting line of medical school.
As you know, in life, not everybody is born at the same spot.
(36:52):
You know, life gives talent equally, but opportunities are not given equally.
Many people who have come to the starting line of medical school,
you know, they were born in the parking lot outside of the baseball field, right?
But we got people who are born inside the field on third base and they make
it to home that then now come to medical school.
(37:13):
And there's no way that you can have the same type of experiences when you have
that distance traveled versus somebody who was born out in the parking lot, right?
And so part of what we have to understand is how do we value people's lives, right?
And how much did they have to work to get to the same point of attainment as
(37:36):
those who have not had as many adverse childhood events, ACEs or adverse life events.
And so, but that also kind of sometimes backfires because sometimes how they
got there ends up being the anchor that pulls them back, right?
Because family issues are going to keep happening. Lack of money is going to
(37:56):
continue to keep happening.
Yes, you're getting scholarship dollars to be in medical school, right?
But if you're giving your scholarship dollars to your family so that they can
eat, over time it's going to get to a point where you have taken out more money than you can.
And they are still going to have those same issues. And they're going to demand
time of you that then pull you away from your academics.
(38:19):
So we have to have the resources within the schools to be able to help students
address life issues such as social workers, wellness counselors,
you know, mental health facilities, mental health workers.
All of those things are important to ensure that these generations that are
coming in with these types of backgrounds are able to thrive in medical school and not just survive.
(38:45):
Exactly. And hopefully, maybe, with the number of philanthropists that we have
now who are coming up with these mega gifts to medical schools so that they
will be tuition-free in the future,
that those will go to many of the schools that are minority-serving medical schools, primarily.
(39:08):
Yeah, that would be great. And so that at least that group of students will
have a much greater chance to do what they have to do.
We all realize the stresses we had in medical school just getting through medical school.
I can't even imagine trying to deal with a family support issue at the same time.
(39:32):
It's beyond me to even think about that. So, I mean, I realize I was fortunate.
I don't have to worry about me. Yeah, so is I.
But these young people now have lots of stresses that we did not have to encounter.
But hopefully we can continue to encourage that philanthropy.
(39:54):
Because that may really help us. I mean, every student that's successful,
as you mentioned, it's a geometric impact that they have on the community.
And so everyone is valuable. We can't afford to have anybody leave because they
weren't able to afford it.
We can't have anybody fired. We can't have anybody discouraged.
(40:17):
We can't have all these kinds of negative things happen Because our needs are
too great just to have health. I agree.
But at the same time, we have to make sure that we maintain our standards and
that we maintain the professionalism and that we maintain the ability to take
care of the most esoteric medical condition.
(40:40):
It's because that's why we're physicians.
Right. You know, we're supposed to be able to recognize the zebras from the horses.
And that makes a big difference in what we do.
And so I think that's important as well. So Dr.
Bright, as you know, because you served as a board member with the Cobb Institute,
that the Cobb Institute is now 20 years old.
(41:02):
And part of how we are celebrating this is to establish this podcast in honor of Dr. Cobb's legacy.
Can you recall some ways that medical anthropology or Dr.
Montague Cobb's approach or accomplishments have inspired you or influenced
your thinking about systems of health and health equity.
(41:25):
The only way that I can say that I'm influenced by Dr. Cobb is by being influenced
by you because you were a student under Dr. Cobb.
And so just as we have this exponential aspect of teaching and how what he taught
you, you have taught me, and what you've taught me, I'm going to teach somebody else.
I think that is the living legacy of Dr. Cobb.
(41:49):
Certainly, he was a stalwart in the National Medical Association at a time.
We were still segregated from the AMA and not able to participate in those types
of activities, where we still had to have our segregated hospitals.
And he became, in his role within the National Medical Association,
a very strong stalwart of the positions of our people.
(42:11):
And so therefore, you know, from that aspect, I understand today that many of
those issues of what she talked about then, we still champion about today.
When we talk about the amelioration of health disparities, when we talk about
the movement to health equity,
when we talk about the wealth gap, the economic wealth gap,
(42:34):
when we talk about the changing of our public school systems such that we don't
have the type of funding that used to go to our public school systems,
such that our students have the resources that they need. I think if Dr.
Monica Ucobb were alive live today, those will be many of the topics that I
think that he would be still expounding upon and championing because he would
(42:56):
understand, as he did back then,
that in order to become the best, we have to be able to put in the work and
we have to have the resources.
We create our own luck, Randall, right? Because luck is when the combination
of preparation meets opportunity.
And then that's what we all want in life. We want to be able to create our own
luck, But we have to have that ability.
(43:17):
But be prepared since that when opportunity knocks, we can answer.
Well, thank you. And I would say that this is the reason why we need to further
develop this podcast series around some of the philosophies and some of the activities of Dr.
(43:39):
Cobb, because everyone should know more about Dr. Cobb than they really do.
And it's incumbent it upon the National Medical Association that we continue to tell that history.
And Dr. Cobb was a historian.
And a lot of the articles that he wrote in the journals were historical articles
(44:01):
about physicians' generations before and their influence on society,
in addition to all the other things that he did.
So it kind of makes it, I think, imperative that everyone understands the depth and breadth of Dr.
Cobb. And there's lots that I don't know.
(44:25):
And so many things that he was involved in, he was involved in when we were
medical students and we didn't even know it.
Because we were in anatomy lab. But this was the other time,
you know, again, the responsibility of the chosen few, you know,
the NAACP, the hospital, the MHOTEP hospital.
(44:47):
Initiative, all the things, Medicare, Medicaid, all those things that he was
involved in because he was one of those kind of unicorns. That's what he was.
So it's important for us, in all honesty, when I meet medical students now,
I always ask them, Howard students, you know, tell me about Dr. Cobb.
(45:10):
It's like 50 years from now, asking black kids in elementary school,
tell me about Barack Obama.
If there's crickets, we have not successfully transmitted our history.
When you went to Howard, when you chose to go to Howard to medical school,
(45:32):
everybody always talked about these iconic faculty members.
That was part of the Howard experience. That's kind of part of what you were
signing up for. You couldn't get out of medical school unless you passed Dr.
Cobb's course and J.B. Johnson's cardiology course and so forth and so on.
(45:55):
It was very personalized.
But he was like the one that had that personality.
Bordering on arrogance. No question about it.
Looked as much white as he did black, but he was through and through black from
(46:18):
Dunbar High School in Washington, all the way to Amherst, along with Charles
Drew, Howard Medical School,
Case Western, where he became an anthropologist, the first black physical anthropologist,
and then back to Howard for 50, 60 years on faculty.
But his demeanor was always one of slight arrogance, but always kind.
(46:44):
He spoke of doctors and who were to be as doctors.
When you became a freshman medical student at Howard, you always referred to his doctor.
And sometimes it was your classmates me sitting next to you.
(47:05):
Dozing. And he just walked by and said, wake the doctor.
But everybody was doctor. You're never your first name or anything like that.
Yeah. He's planting the seed. You're going to succeed.
He's speaking life. Right. Yeah. And the importance of your success.
(47:26):
Right. I mean, you're here you've got
to succeed and it's up to us to
make sure that you succeed but then
the other part of it was the fact that he was really intellectually so incredible
that he could give a lecture on the gi track and draw the entire gi track in
(47:50):
the lecture the movie now have PowerPoint,
all that, he'd just come and start on the blackboard.
And then come into biology, I mean, to anatomy lab at one in the morning and
playing his violin and then quoting Greek mythology.
And I mean, I'm telling you, he was just incredible.
(48:11):
That's a renaissance man. Just absolutely. Yeah.
But these are things that our young people have to know. So why don't we have
a special journal of the NMA go for a reflection back on the writings of Dr. Cobb? Absolutely.
We have to do that. Yeah, that's something we should do.
Well, Dr. Bright, I want to thank you so much for spending time with us today.
(48:36):
This kicks off our conversations that we'll have with Cobb and Company at the
National Medical Association 2024 here in New York.
And hopefully the listeners will benefit from your wisdom, your experience and
we look forward to the next time.
Well, thank you. I really appreciate the opportunity to be on this podcast, Randall.
(48:59):
And it's always a joy to share time with you.
Music.
I was the first Black in that residency program's history.
By the time I left, we had six, because somebody dared to be first.
When I came to the VA, I was the first Black male internal medicine physician in that VA.
By the time I left, we had up to five or six.
(00:22):
Now, that being said, it can also be a very lonely position,
you know, when you're one of onlys. And so it's one of those things where you
have to have the right fortitude.
You have to have the right faith.
You have to have the right position to understand that, you know,
you're doing it for a mission.
I'm proud of that work because I know that I'm making generational change. age.
(00:46):
And what we saw, Randall, we saw we went from 524 in 2014 to by 2021,
we had 863 Black males matriculating to medical schools.
So the menino has moved.
Cultural Competence says, I read the book. I took the course.
(01:08):
I know everything about people who are different than me.
Cultural Ultramelody says, I read the book, I took the course,
and I know just enough to be dangerous.
So I need to surround myself with people who are different than me and then
get to understand their perspectives of health.
And then that will allow me to be
able to interact more effectively with patients that don't look like me.
(01:32):
Part of what we have to understand is how do we value people's lives, right?
And how much did they have to work to get to the same point of attainment as
those who have not had as many adverse childhood events, ACEs, or adverse life events?
(01:53):
Everyone is valuable. We can't afford to have anybody leave because they weren't able to afford it.
We can't have anybody fired. We can't have anybody discouraged.
We can't have all these kinds of negative things happen because our needs are too great.
Music.
(02:21):
Welcome to this episode of Cobb & Company, the podcast of the W.
Montague Cobb Health Institute.
The mission of the Institute is to conduct rigorous research and policy analysis
and to engage in dynamic collaborative partnerships and programs for the reduction
of persistent racial and ethnic disparities in health and racism in medicine.
(02:46):
Over the coming months, we will be welcoming numerous thought leaders in the
areas of health equity and increasing diversity in the health care workforce.
It is my great pleasure to welcome Dr. Cedric Bright to the podcast today.
Thank you for joining us on the podcast.
(03:06):
Thank you so much for having me, Randall. It's always a pleasure to be here.
Now, we're going to be talking about pipeline and pathway programs and best practices.
But first, I'm going to share a little background for our listeners.
Dr. Cedric Bright is a general internal medicine physician.
He is a senior associate dean for admissions and professor of medicine at the
(03:32):
Brody School of Medicine at East Carolina University.
He was previously Associate Clinical Professor of Internal Medicine and Community
and Family Medicine at Duke University and a staff physician at the VA Medical Center in Durham.
Dr. Bright also served on the North Carolina Medical Society Patient Safety Task Force,
(03:57):
chaired the Board of Directors at the Lincoln Community Health Center,
and has spoken about health and health disparities before the Congressional Black Caucus.
He was a medical ambassador to Ghana when he served as president of the National
Medical Association and has served as a mentor for the Student National Medical Association.
(04:19):
He is a dedicated leader in delivering patient equity through broader access
and is a staunch proponent of health care reform. form.
He is a published author, lecturer, and thought leader on current trends and
best practices in health care, health care policy and management,
(04:40):
medical education, health equity, and DEI issues.
Now, we have much to talk about. Let me start by asking you about your time,
not only at the the University of North Carolina,
but also at Duke University and at Eastern Carolina in the area of admissions.
(05:04):
We know that during your time, more than 14% of UNC's medical students identified
as Black, which is compared to a national average of around 7.3%.
In other words, UNC, as well as Duke and Eastern Carolina, have achieved a level
of representation which mirrors the general population.
(05:27):
What are some of the pipeline and pathways, best practices that have enabled this achievement?
Well, thanks for that question, Randall. And, you know, this actually,
I started all the way back when I was at Brown.
So I've been at four medical schools. I started off at Brown.
And one of the things that I did there was just be present.
And in being present, the students of color came to find a black attending and
(05:52):
decided that they would come and shadow me in the various clinics that I worked in.
Fast forward to leaving there and going to the Durham VA and Duke University,
once again, a Black attending, a Black male attending, not a lot of Black males in academic medicine.
We probably comprise less than 2% of faculty in academic medicine.
(06:15):
And preponderantly, most of those are located in predominantly Black medical
schools, such as Howard and Meharry, Charles Drew, and Morehouse.
And so, you know, it's kind of like being a unicorn in a way.
I've described myself in many ways as being a unicorn, a black male in academic medicine.
(06:35):
And the one thing that I found as I was going through my training,
Randall, was that, you know, I didn't have people that I could talk to about
the issues that were impacting me.
And so I ended up writing a paper, and my paper was entitled title,
Perceived Barriers and Bias in Medical Education by Race and by Gender.
And that was the one way that I found to be able to describe my experiences
(06:56):
as I was going through medical education.
That paper was published in the Journal of the National Medical Association in November of 1998.
And from that point forward, I decided, you know, if I didn't have it,
I want to try to be the a bridge for those that are coming behind me.
And so that's kind of the backdrop of why I wanted to go into the area of student
(07:19):
development and the aspect of enhancing students to help them become prepared
to give appropriate counseling to students in a timely manner.
Because I saw so many students that would come my direction who were broken
because they had a bad grade as a freshman, didn't have the best high school,
and therefore they struggled in college.
And immediately they They were told by health advisors, you can't go to medical
(07:43):
school. It's not going to happen.
And so I realized that that was a false narrative, and I wanted to change that narrative.
Fortuitously, in the state of North Carolina, we have a population of almost 23% of Blacks.
Part of success comes from what is the pool that you can pull from.
We have 11 HBCUs in the state of North Carolina to go up a great university
(08:06):
system in the state of North Carolina, the University of North Carolina system.
And it has been touted nationally as being one of the most progressive system schools in the nation.
And so we have a lot of a pool, we have a large pool to pull from.
And so fortunately, what I did was I made myself available.
You know, Randall, if you build
(08:27):
it, they will come, right? And so what I did is I built this process.
I engaged in working with a pipeline program called the MED program.
And fortuitously, we just celebrated our 50th year of the MED program.
Almost 3,700 students Students have gone through that program since 1974,
(08:48):
and over 1,800 of them have gone on to become physicians.
And those are mostly people of color. Now, here's the deal.
People say, well, why are y'all just doing that for people of color?
Well, medicine has traditionally been almost 80 to 90 percent white, but patients are not.
And the key is outcomes. And what we know is that when there's race congruence,
(09:12):
there's trust and there are better outcomes, there's better compliance,
there's better physician satisfaction, better patient satisfaction.
It's also an aspect of a rising tide, because if the people who have the worst
health outcomes start to have better health outcomes, it becomes a rising tide
and that lifts all boats.
(09:33):
So that is the argument for why we must have diversity.
Because not only is it adversity for the fact that we can have congruence,
but it also leads to cultural humility, Randall.
And cultural humility is different than cultural competence.
Cultural competence is I read the book, I took the course, I know everything
about people who are different than me.
(09:54):
Cultural humility says I read the book, I took the course, and I know just enough to be dangerous.
So I need to surround myself with people who are different than me and then
get to understand their perspectives of health and then that would allow me
to be able to interact more effectively with patients that don't look like me.
That works both ways, Randall.
(10:14):
That helps our black students learn how to relate to white patients and it allows
our white students to learn how to interact with black patients.
And so I think that's a win-win that sometimes we confuse and we downplay the
importance of it, but I think that's very important.
So I was fortunate enough that I had a good supply of people to pull from.
(10:35):
We were able to get the University of North Carolina to go from 14% to 25%.
I was able at ECU to go from 15% to 33%.
ECU, while I was there, went up to number nine in the nation as being one of
the most diverse medical schools out of 125 that reported to U.S. News and World Reports.
(10:57):
I'm proud of that work. I'm proud of that work because I know that I'm making generational change.
You know, admissions, Randall, it's two ways you can do admissions.
One way is transactional. I get to people with the highest numbers,
and I just bring all the highest numbers in because they're the highest numbers, right?
But oftentimes, many of those students don't have the communication skills.
(11:21):
They're very book smart, but they can't interact with people.
The goal of admissions is to be transformative.
We want to transform our nation's healthcare system by bringing in people that
have that cultural humility, that have learned how to be able to talk to all people.
If from Kipling's poem, if you can talk with kings, nor lose the common touch, right?
(11:45):
And so that's what we're looking for in admissions and why we want to be transformative
And also empowering, right?
Because many of our students, you know, come in and are first generation students.
That's transformational generational change in their families.
And that is just something that is what the American dream is about.
(12:05):
But if you have people that are only looking for the same people,
it becomes transcriptive and that's what you end up with.
So certainly as a unicorn and one with endless energy,
you have been able to create programs
literally in three or four different institutions just intuitively.
(12:27):
And so the question is, in terms of sustainability, how does it look for faculty
recruitment and development?
Because if you're there, what happens when you left Brown?
How much of a fall off was there in terms of student support and then to the
next institution and the next institution?
(12:48):
So how can we also affect a more difficult area, and that is to recruit and
retain faculty in the medical schools?
Great point, Randall. You know, this is just one of those things where—.
You have to be intentional, right? And so I can honestly say over the last 10
(13:10):
years, I have spent more time talking to medical students about you can't change
the face of medicine by being a student.
You change the face of medicine by becoming faculty.
Because then when you become faculty,
then you have the ability to logarithmically have influence, right?
(13:31):
When we're out practicing in our community and we see patients,
We see patients, one patient at a time, right?
But if we are in a medical school and we're working with medical students,
we're working with sometimes 100 to 200 students at a time, right?
And each time you influence a student, they become inspired by you.
(13:51):
They go and do that for somebody else, and then they do it for somebody else,
and it becomes like being a teacher.
It becomes logarithmic. You know, it's not 10, it becomes 10 fold of opportunities
that occur from just one interaction.
So I think that's one part of it. One part of it is that the second part of
it is, is we need to be faculty so that we can help other faculty.
(14:14):
Right. Because we need to do things like help people with their unconscious bias.
We need to know our own unconscious bias because everybody has it.
It's not something that is owned by white people or by black people.
We all have unconscious bias.
And so we must come to terms with that and learn how to be able to recognize
it and be able to utilize our ability to see it and then work with that cultural
(14:39):
humility in order to address people who are different than us.
And then the other part of it is, is that, you know, people gravitate to where
they see people who are like them, right?
And so when I came on as faculty, when I came to Brown for my residency program,
I was the first Black in that residency program's history.
(15:00):
By the time I left, we had six because somebody dared to be first.
When I came to the VA, I was the first Black male internal medicine physician
in that VA. By the time I left, we had up to five or six, okay?
When I came to UNC, I was the first black medical doctor to be an assistant
(15:23):
dean on the admissions committee, okay?
And representation matters.
And being in those places to represent, to help people dispel their unconscious
biases and dispel the myths that they have regarding what students should and
should not be, I think is so important.
And then, you know, developing these types of programs such as Bengap,
(15:46):
I wasn't a part of the actual starting of that, but it's the next generation
of academic physicians.
It's what Bengap is all about. And they are going about doing these types of
seminars to help young people who are medical students understand the importance of becoming faculty.
Now, that being said, it can also be a very lonely position,
you know, when you're one of onlys.
(16:07):
And so it's one of those things where you have to have the right fortitude,
you have to have the right faith, you have to have the right position to understand
that, you know, you're doing it for a mission.
And so it's a long season. And I think that those students that you impact are really the energy.
(16:29):
Yeah. That keep you going on the days when it's extremely frustrating,
extremely competitive.
And I know many, many faculty members are always concerned about their ability
to remain at an institution, remain successful, to obtain promotion.
(16:50):
And so I think that the students serve as a major catalyst for faculty and maybe
even administration in certain institutions.
I would agree with that. With that being said, as you look over your shoulder,
what do you see at the institutions that you've left in terms of their numbers,
(17:15):
in terms of their programs? Are they all still tracking?
The way they were when you were there, or better, hopefully not worse.
But what do you see? Well, Randall, I have to be cautious in how I talk about this.
Yeah, just in general. And so what I see in general is that,
you know, depending upon their intentionality is how the numbers will go.
(17:42):
Yeah, that's how I see it. But your point that you said earlier is so well spoken,
and that's the aspect of students. You know, students are the lifeblood of a school, right?
The school exists for students, not for faculty, not for staff.
If you have no students, you have no school.
And so we need to make sure that we're focusing on our students more so than
we're focusing on our own needs.
(18:04):
And that's what makes a successful school, because word of mouth will either
boost you or it will kill you.
And that's so important. And so, as we talk about this pipeline initiative,
it is important for us to think about all those aspects of this adventure.
(18:30):
That will create sustainability because if we have ebbs and flows of the number
of students that are in institutions,
it's not going to be as, certainly not gratifying, but it's also practically,
we're not going to be able to get to where we want to be in terms of the health of our nation.
(18:53):
So that's kind of why I was asking, not so much that I know that schools,
any institution, It's not going to be able to sustain a number at a point in time.
But how can we kind of plan for these sine wave type of changes for the greater good?
So at the end of the day, the arrow is pointing upward.
(19:15):
I think it's a combination of things.
You know, we can never train enough black doctors to take care of all black patients.
That's the first point. I read a stat where we would have to fill every medical
school class with only Black people for the next 25 years in order to get to physician equity.
That's not going to happen. OK. And so what we have to do is we need to make
(19:39):
sure that we are being intentional about the work that we do and understanding
that a diverse class improves educational outcomes and improves educational performances.
And so I think that's one of the things that we have to always put in our forefront.
The other part of it is also it helps to develop that culture of humility,
(19:59):
such that our colleagues will be able to take care of patients in race-incongruent settings.
I think that's very important. I think it's important and it works both ways.
And it works for all people.
And so finally, for my last point, how do we sustain it? Randall,
we have to have programs that are tailored in a way.
(20:19):
So for instance, how do we get here to begin with? Well, HCOP,
Health Careers Opportunity Funding from HRSA.
That started back in about 1972.
It started at Meharry Medical School. And it was a program that helped to give
funding to do a nine-week immersion into what medical sciences was in order
to try to take students who were coming from HBCUs and getting them prepared
(20:42):
to go to medical schools at any medical school, right?
The MED program that I talked about, that is an evidence of HCOP funding,
Health Careers Opportunities Programs, okay? So that's important.
We need programs like Robert Wood Johnson's program. It's Summer Health Education
and Medicine and Dental Program.
(21:03):
It's a summer program that they've been funding since 1999. 99.
And what you do when you look at the data, you will see that two thirds of the
students that go through those
programs ended up matriculating into a medical or dental school. Okay.
Then we have to have actions that occur in an organized medicine.
What type of organized medicine? Well, we talk about the AAMC and that's the
(21:25):
Association of American Medical Colleges and the work that they're doing in
this action collaborative, which is to look at how do we improve the lot of the least of us.
You know the paradigm about the canary in a coal mine, right?
And the canary saves the miners, right?
Well, it's like that in life. If we take care of the least of us,
(21:46):
the ones who are most impacted, we improved a lot for everybody else.
I talked about it previously as a rising tide.
And so, you know, at the AAMC with the National Medical Association,
we're working to do an action collaborative to look at why has this been the dearth of black males?
You know, In 1974, there were more black males that matriculated in the medical school than in 2014.
(22:10):
We started doing this work about 2015, 2016, with a group called Diverse Medicine,
Inc., which is with Dale Okorodudu, who developed this film Black Men in White Coat.
And this whole series of Black Men in White Coat, you can find it online and go look at those videos.
And that raised the Q factor about this aspect of Black men in medicine.
(22:33):
And what we saw, Randall, we saw we went from 524 in 2014 to by 2021,
we had 863 black males matriculating to medical schools.
So the needle has moved.
Now, how's that overall percentage? Well, when there's 25,000 spots in medical
(22:56):
school, we haven't really moved the needle that much, but the needle has moved.
And that's important. And then the last thing I'll talk about is,
you know, we have organized groups like the National Academy of Science,
the National Academy of Science, which has a roundtable on Black men and Black women in STEM.
And we have put together some articles as well as workshops to try to address
(23:20):
the issues of why we have the numbers that we do.
And the bottom line of it is, is that, you know, all of this intentional work
will have a positive impact.
How well it will be sustained will be because of people who get into positions,
positions of leadership, who this becomes part of their agenda for what they
want to do moving forward.
(23:41):
Understanding that we have a browning of America and we need to make sure that
we try to mitigate the cost of health disparities because health disparities
cost us $1.24 trillion a year.
Back in 1998, 1999, 2001, and 2002, if we don't change that,
it's going to eat up our GDP and we're going to be one of the poorest outcomes
(24:04):
of health with the most money spent.
Well, I think you're absolutely correct. And I remember when I was president
of the National Medical Association, as of course you have been as well,
in 1997, there was from AAMC.
Maybe not from AAMC, but certainly AAMC considered the statistics that were
(24:29):
stating that we would have overage physicians in the United States.
And so here we are 20 years later, and they're projecting 30,000 shortage of physicians.
And I remember that our response from the NMA was that we were tone deaf to
(24:49):
those statistics because our communities were so underserved.
There would be a long time before we had. We'd welcome the opportunity to have
more physicians than were necessary in any of the schools because our patients need them.
And as we could see, the way the demographics come about and where people live
(25:12):
and where they can access care,
even if you had the numbers, people still wouldn't get the care because so many
of them live in places where they don't have access.
So we certainly have to keep this pipeline and pathway going,
but also be innovative in terms of how we can improve these pockets that no
(25:35):
matter how many numbers we have, they still continue to be underserved. Great points.
Just to give you kind of an idea,
you know, in 1920, there were more black physicians per 100,000 people.
People than they were in 2020. And so we've seen a decline in our number of
(25:58):
proportionate physicians to doctor ratio.
And a part of that was back in then we had more Black medical schools because
that's when segregation was, Jim Crow and all of that.
So we couldn't go to predominantly white institutions.
And so that's where that all started. And there was an article that was written
by a colleague of mine, Dr.
Kendall Campbell, that estimated if those medical schools had stayed open,
(26:21):
we would have had over 35,000 to 40,000 extra Black physicians in this country to make a difference.
You know, the other part of this is, though, is how do they reimburse things, right, Randall?
So if you're closer to a ivory tower, which is a medical school,
you get higher reimbursement than if you go out into a rural community.
(26:42):
And then there's also the medical
isolation that occurs for people who practice in rural communities.
And so it's not that very desirable of people who are coming out of their residency
programs to go want to work in areas where they're going to feel like they're being isolated.
And so that's some of the things that we need to be able to work on.
How do we develop better support mechanisms and systems such that we make rural
(27:07):
medicine more attractive?
Because Because really and truly, that's where a lot of our disparities occur
in the inner city, you know, where folks are and not able to get access and in rural areas.
And many people in rural areas think we've forgotten about them.
But we as health centers really need to take that on.
And part of that issue is the funding and remuneration that we get for providing
(27:30):
care in those areas where preponderantly many of those people don't have health insurance.
That's why Medicaid expansion was so important and states that have expanded
Medicaid have had the ability to be able to.
Reap more funding to provide those services to those communities who are mostly underserved.
(27:54):
And I think North Carolina is one of the most recent, if not the most recent. Most recent.
Hallelujah. And so certainly I live in Florida now after a career in Indiana,
and there's stark differences in the care for people and those who have certain insurances.
They feel almost like lepers sometime in the state, unable to obtain health care, have no options.
(28:22):
And that's such, I just can only imagine how despondent a person would be understanding
that they have kind of hospital gown coverage.
It covers the front of you, but the whole back of you is out.
Right. Yeah. And they're very, very angry, very bitter individuals too.
So we have a long way to go in terms of solving this, and we're trying to do
(28:45):
our part in the National Medical Association.
AAMC, COB, National Academies, to make progress with this pipeline and pathway challenge.
Challenge, but I think the success is going to be the impact that we have across
several disciplines, as you've mentioned,
(29:06):
and being able to fund programs that not only when these young people finish their training,
they're able to make a living by sharing in communities that are underserved.
And they can only do that basically by being employed by some entity that finds
(29:27):
that it is important to spread out and cover that group of people.
None of our young people now are opening up a practice and putting a shingle.
That's the old NMA model, but that's gone now.
So it's so ironic that you mentioned that, Randall, because I was coming into
(29:48):
being and a president in 2011.
2012, 1998, almost 80% of our members in the NMA went private practice.
When I came in as president, that number had shrunk to only 10%.
And that was just the movement of physicians wanting to get out from being their
(30:08):
own business administrators to wanting to become purists.
And I just want to practice medicine. I don't want to have to worry about all
the overhead head and stuff like that.
So we gave away our rights of our own to people who became administrators over us.
And that's what the difference is right now. The other thing,
though, that I would suggest to you, Randall, besides as we're making these
(30:30):
new physicians coming out of medical school, we need to get them in front of
students in elementary school.
We need to get them in front of students in middle school and help develop programs
that inspire our young people beyond the inspiration that they're getting from
their teachers or the lack thereof, right?
And that's really, I think, very important that we role model that they can do it. My mentor, Mr.
(30:56):
Larry Keith, he used to say, if you can see it, you can dream it.
If you dream it, you can believe it. If you can believe it, you can achieve it.
Right. Well, that's absolutely, absolutely true.
And one of the things that I think still is true about those of us who have
(31:16):
been fortunate enough to become physicians and who are African-American or dentists
or PhDs is that there's a certain responsibility.
That we have to the community the responsibility of
the chosen few to do whatever we can to
help that next generation yeah and
(31:39):
influence them and certainly i remember going to back
to my home in gary and the first person
i ran into is my fourth grade teacher who asked me to work with her on a new
program she was in gifted education by that point called the prep program It
was a program that was geared on a professional resource education program.
(32:02):
So it was a program that was geared toward middle school and high school students
with Saturday programs where they would get a chance to meet professionals,
get a chance to visit the hospital.
And we had different areas. We had medicine, we had dentistry,
we had law, and we had engineering. nearing.
(32:24):
And so we had volunteers in the community that would have these students who
would have 15 or 20 in each discipline.
And so there's just a way, an organized way for communities to put their professionals
together with students.
And so many of the students have done exceptionally well.
So hopefully that type of thing continues in other communities because Because
(32:50):
our young people are really short on that kind of contact and that kind of inspiration, really.
Yeah, you're right on that. You know, it's so amazing to me how I meet students
and they will say to me, I've never seen a black doctor or I've never seen a woman doctor.
(33:11):
I've never seen a Hispanic doctor.
And we're here. We are here. It's almost like quoting Here's to Who.
We are here, we are here, we are here, right?
But if we're only sounding off in our own echo chambers and we're not reaching
out of the walls which constrain us and go into the arenas where people can
(33:34):
see us, it makes a difference.
We've got to get out of our walls.
We got to stop thinking of our job, because there's one thing that's a job, right, Randall?
A job is something from 9 to 5, I go home, I don't think about it. We're professionals.
That means we're on, you know, seven days a week, 365 a year.
(33:55):
I go to the grocery store, I'm trying to get me some salad dressing.
My patient walks up to me and says, hey, Dr. Bright, how you doing?
Good to see you. What's this on my arm, right? Right.
Just as what happens in the grocery store. That's why we got to go to the schools.
OK, because we need to help our young people to see that we exist and that they can do it.
(34:16):
That's very important. I agree with you there, Randall. Yes.
So as we kind of get toward the end here, I'm so appreciative of this discussion.
Discussion, but I would like maybe as you look at your career to this point,
which you still have a long way to go in your career, but I guess maybe it does
(34:38):
add up to around 30 years.
Amazingly so. There's been a lot of progress made in pipeline and pathway programs.
So, however, challenges, And we're here at the National Medical Association Convention.
We will be speaking tomorrow about the challenges related to the dissolution
(35:00):
of the affirmative action initiatives in many schools of higher education.
And is this the single largest blow to the progress that we've made to this time?
And what is going to be our workaround?
Because certainly we're not going to give up until we are successful.
(35:24):
Great question, Randall.
Well, my first answer is vote.
This is going to be an election of choice. And we can choose to move forward
or we can choose to go back.
I think it's important that our young people understand their vote is going to win this election.
(35:45):
If the people from the ages of
18 to 30 come out and vote and vote for progress, that's where we will go.
If they have apathy and decide not to vote and we have an election that goes
backwards, then that's what will happen.
This is a central point in our history as a nation.
(36:07):
And we can either determine that we want to choose division or we want to choose unity.
And I'm hoping that we will choose unity. The second point on that,
there is an excellent model.
I won't call it a workaround. What I will call it is, you know,
there's more than one way to skin a cat.
OK. And in this particular instance, I think the folks out of California.
(36:31):
University of California, Davis School of Medicine, Mark Henderson is their
dean of admissions out there.
He has developed this adversity index that looks at how much adversity has a
person come through to to get to the point, the starting line of medical school.
As you know, in life, not everybody is born at the same spot.
(36:52):
You know, life gives talent equally, but opportunities are not given equally.
Many people who have come to the starting line of medical school,
you know, they were born in the parking lot outside of the baseball field, right?
But we got people who are born inside the field on third base and they make
it to home that then now come to medical school.
(37:13):
And there's no way that you can have the same type of experiences when you have
that distance traveled versus somebody who was born out in the parking lot, right?
And so part of what we have to understand is how do we value people's lives, right?
And how much did they have to work to get to the same point of attainment as
(37:36):
those who have not had as many adverse childhood events, ACEs or adverse life events.
And so, but that also kind of sometimes backfires because sometimes how they
got there ends up being the anchor that pulls them back, right?
Because family issues are going to keep happening. Lack of money is going to
(37:56):
continue to keep happening.
Yes, you're getting scholarship dollars to be in medical school, right?
But if you're giving your scholarship dollars to your family so that they can
eat, over time it's going to get to a point where you have taken out more money than you can.
And they are still going to have those same issues. And they're going to demand
time of you that then pull you away from your academics.
(38:19):
So we have to have the resources within the schools to be able to help students
address life issues such as social workers, wellness counselors,
you know, mental health facilities, mental health workers.
All of those things are important to ensure that these generations that are
coming in with these types of backgrounds are able to thrive in medical school and not just survive.
(38:45):
Exactly. And hopefully, maybe, with the number of philanthropists that we have
now who are coming up with these mega gifts to medical schools so that they
will be tuition-free in the future,
that those will go to many of the schools that are minority-serving medical schools, primarily.
(39:08):
Yeah, that would be great. And so that at least that group of students will
have a much greater chance to do what they have to do.
We all realize the stresses we had in medical school just getting through medical school.
I can't even imagine trying to deal with a family support issue at the same time.
(39:32):
It's beyond me to even think about that. So, I mean, I realize I was fortunate.
I don't have to worry about me. Yeah, so is I.
But these young people now have lots of stresses that we did not have to encounter.
But hopefully we can continue to encourage that philanthropy.
(39:54):
Because that may really help us. I mean, every student that's successful,
as you mentioned, it's a geometric impact that they have on the community.
And so everyone is valuable. We can't afford to have anybody leave because they
weren't able to afford it.
We can't have anybody fired. We can't have anybody discouraged.
(40:17):
We can't have all these kinds of negative things happen Because our needs are
too great just to have health. I agree.
But at the same time, we have to make sure that we maintain our standards and
that we maintain the professionalism and that we maintain the ability to take
care of the most esoteric medical condition.
(40:40):
It's because that's why we're physicians.
Right. You know, we're supposed to be able to recognize the zebras from the horses.
And that makes a big difference in what we do.
And so I think that's important as well. So Dr.
Bright, as you know, because you served as a board member with the Cobb Institute,
that the Cobb Institute is now 20 years old.
(41:02):
And part of how we are celebrating this is to establish this podcast in honor of Dr. Cobb's legacy.
Can you recall some ways that medical anthropology or Dr.
Montague Cobb's approach or accomplishments have inspired you or influenced
your thinking about systems of health and health equity.
(41:25):
The only way that I can say that I'm influenced by Dr. Cobb is by being influenced
by you because you were a student under Dr. Cobb.
And so just as we have this exponential aspect of teaching and how what he taught
you, you have taught me, and what you've taught me, I'm going to teach somebody else.
I think that is the living legacy of Dr. Cobb.
(41:49):
Certainly, he was a stalwart in the National Medical Association at a time.
We were still segregated from the AMA and not able to participate in those types
of activities, where we still had to have our segregated hospitals.
And he became, in his role within the National Medical Association,
a very strong stalwart of the positions of our people.
(42:11):
And so therefore, you know, from that aspect, I understand today that many of
those issues of what she talked about then, we still champion about today.
When we talk about the amelioration of health disparities, when we talk about
the movement to health equity,
when we talk about the wealth gap, the economic wealth gap,
(42:34):
when we talk about the changing of our public school systems such that we don't
have the type of funding that used to go to our public school systems,
such that our students have the resources that they need. I think if Dr.
Monica Ucobb were alive live today, those will be many of the topics that I
think that he would be still expounding upon and championing because he would
(42:56):
understand, as he did back then,
that in order to become the best, we have to be able to put in the work and
we have to have the resources.
We create our own luck, Randall, right? Because luck is when the combination
of preparation meets opportunity.
And then that's what we all want in life. We want to be able to create our own
luck, But we have to have that ability.
(43:17):
But be prepared since that when opportunity knocks, we can answer.
Well, thank you. And I would say that this is the reason why we need to further
develop this podcast series around some of the philosophies and some of the activities of Dr.
(43:39):
Cobb, because everyone should know more about Dr. Cobb than they really do.
And it's incumbent it upon the National Medical Association that we continue to tell that history.
And Dr. Cobb was a historian.
And a lot of the articles that he wrote in the journals were historical articles
(44:01):
about physicians' generations before and their influence on society,
in addition to all the other things that he did.
So it kind of makes it, I think, imperative that everyone understands the depth and breadth of Dr.
Cobb. And there's lots that I don't know.
(44:25):
And so many things that he was involved in, he was involved in when we were
medical students and we didn't even know it.
Because we were in anatomy lab. But this was the other time,
you know, again, the responsibility of the chosen few, you know,
the NAACP, the hospital, the MHOTEP hospital.
(44:47):
Initiative, all the things, Medicare, Medicaid, all those things that he was
involved in because he was one of those kind of unicorns. That's what he was.
So it's important for us, in all honesty, when I meet medical students now,
I always ask them, Howard students, you know, tell me about Dr. Cobb.
(45:10):
It's like 50 years from now, asking black kids in elementary school,
tell me about Barack Obama.
If there's crickets, we have not successfully transmitted our history.
When you went to Howard, when you chose to go to Howard to medical school,
(45:32):
everybody always talked about these iconic faculty members.
That was part of the Howard experience. That's kind of part of what you were
signing up for. You couldn't get out of medical school unless you passed Dr.
Cobb's course and J.B. Johnson's cardiology course and so forth and so on.
(45:55):
It was very personalized.
But he was like the one that had that personality.
Bordering on arrogance. No question about it.
Looked as much white as he did black, but he was through and through black from
(46:18):
Dunbar High School in Washington, all the way to Amherst, along with Charles
Drew, Howard Medical School,
Case Western, where he became an anthropologist, the first black physical anthropologist,
and then back to Howard for 50, 60 years on faculty.
But his demeanor was always one of slight arrogance, but always kind.
(46:44):
He spoke of doctors and who were to be as doctors.
When you became a freshman medical student at Howard, you always referred to his doctor.
And sometimes it was your classmates me sitting next to you.
(47:05):
Dozing. And he just walked by and said, wake the doctor.
But everybody was doctor. You're never your first name or anything like that.
Yeah. He's planting the seed. You're going to succeed.
He's speaking life. Right. Yeah. And the importance of your success.
(47:26):
Right. I mean, you're here you've got
to succeed and it's up to us to
make sure that you succeed but then
the other part of it was the fact that he was really intellectually so incredible
that he could give a lecture on the gi track and draw the entire gi track in
(47:50):
the lecture the movie now have PowerPoint,
all that, he'd just come and start on the blackboard.
And then come into biology, I mean, to anatomy lab at one in the morning and
playing his violin and then quoting Greek mythology.
And I mean, I'm telling you, he was just incredible.
(48:11):
That's a renaissance man. Just absolutely. Yeah.
But these are things that our young people have to know. So why don't we have
a special journal of the NMA go for a reflection back on the writings of Dr. Cobb? Absolutely.
We have to do that. Yeah, that's something we should do.
Well, Dr. Bright, I want to thank you so much for spending time with us today.
(48:36):
This kicks off our conversations that we'll have with Cobb and Company at the
National Medical Association 2024 here in New York.
And hopefully the listeners will benefit from your wisdom, your experience and
we look forward to the next time.
Well, thank you. I really appreciate the opportunity to be on this podcast, Randall.
(48:59):
And it's always a joy to share time with you.
Music.
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