Black Patients Need Black Doctors

The best case for affirmative action

Black patients, males in particular, do better with Black doctors. This is unambiguously a thing that happens. It is the strongest argument for affirmative action in medical schools, and given the likely channels through which this effect is working, it is unlikely to be coming at the expense of patients of other races.

We must be clear about why this is happening. It would be all too easy to claim, as many have, that this is evidence of racism on the part of doctors. If anything, it is evidence of racism on the part of Black males toward non-Black doctors. The substantial effects on mortality appear to be through increased communication from patient to doctor, and through increased adherence to a course of treatment. Studies which claim to find an effect of doctor-patient race concordance on populations who cannot communicate, like the survival rate of newborns, do not find the same effects once you add basic controls to account for non-random assignment of patients to babies (Borjas and Verbruggen, 2024).

With this in mind, affirmative action in medical admissions can be justified. And given the need for a pipeline, affirmative action for pre-med majors would also be justified. This is not to say that we should do it, but it is the most credible argument for diversity mattering that I know of.

First, some background. Black patients have a lower trust in the medical profession. I am skeptical of the tendency to link this all to the Tuskegee Experiment, as many people incautiously do, building off of the study by Alsan and Wanamaker; I think the bulk of it is better explained by covariates such as intelligence and not by historical trauma. Nevertheless, this gap in medical trust is real and substantial. Black patients are also less likely to use primary care physicians, and more likely to use emergency department services.