AMA apologizes for past inequality against black doctors

The American Medical Association officially apologized in July for its history of excluding black physicians from membership, for listing black doctors as "colored" in its national physician directory for decades, and for failing to speak against federal funding of segregated hospitals and in favor of civil rights legislation.

"The AMA failed, across the span of a century, to live up to the high standards that define the noble profession of medicine," said AMA Immediate Past President Ron Davis, MD, in a commentary published in the July 16 Journal of the American Medical Association.

The apology came in response to an AMA-appointed expert panel's report on the historical racial divide in organized medicine, "African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide," also published in JAMA.

Former AMA President John C. Nelson, MD, MPH, personally apologized in 2005 for the Association's history of excluding black physicians, but the latest apology is an official statement of the AMA Board of Trustees.

Dr. Davis said the AMA is committed to increasing the number of minority physicians and improving its relationship with minority doctors. The AMA's Minority Affairs Consortium developed the Doctors Back to School program, which has sent physician volunteers to talk with more than 13,000 students from underrepresented groups about careers in medicine. Also, the AMA each year awards $10,000 scholarships to minority scholars -- more than $100,000 was awarded this year.

In a statement, National Medical Assn. President Nelson L. Adams, MD, commended the AMA for taking a "courageous step and coming to grips with a litany of discriminatory practices that have had a devastating effect on the health of African-Americans."

Dr. Adams urged the AMA to join the NMA in an effort to recruit more blacks into medicine, reduce racial health disparities and mandate cultural competency training as part of medical education and licensure. In 2004, the two organizations formed the Commission to End Health Care Disparities.

Randall W. Maxey, MD, PhD, the inaugural co-chair of the commission and a former NMA president, said the AMA's apology "opens the door to forward-looking cooperation" between the AMA and the NMA. Dr. Maxey, president of the Alliance of Minority Medical Assns., called for an annual summit meeting of high-level leaders of the AMA and the NMA. Dr. Davis called the proposal a "great idea."

Anne C. Beal, MD, MPH, called the AMA's apology "an important first step." The matter is not "ancient history," because if it were, "we wouldn't be dealing with racial disparities in health care and health care outcomes. This is still something we're working with and dealing with today," said Dr. Beal, assistant vice president for the Program on Quality of Care for Underserved Populations at the Commonwealth Fund in New York City.

Lonnie Bristow, MD, who became the AMA's first black president in 1995, said the apology "shows a mature perspective, and by comparison to the other institutions in our nation, including our government, the AMA is leading the way."

"That's what the AMA has always done," he said. "But it has also been a mirror reflecting American society."

The AMA's history of allowing discrimination goes back to its very beginnings, according to the panel's report. The Association's acknowledged founder, Nathan Smith Davis, MD, was crucial to the 1870 effort to exclude the integrated National Medical Society from admission to the AMA.

Four years later, the AMA adopted policy that effectively allowed each state to decide whether to let black physicians become members. Nearly all southern state medical societies barred black doctors from joining.

It wasn't until 1968 that the AMA threatened to expel organizations with racially exclusionary policies.

Robert Baker, PhD, lead author of the panel's report, said he was impressed that the AMA appointed an independent panel to examine its history and took the report seriously.

"They had no way of knowing what we would find and how we would parse it," said Baker, a bioethicist who served as a visiting scholar at the AMA in 2005. "There are very few institutions in American society willing to be that transparent and open about the past."