Dr. Valerie Emuakhgbon stands with a group of residents huddled around a desk at University of Louisville Hospital. The small group of physicians is discussing a burn victim in the intensive care unit.
Emuakhgbon, the chief resident in the department of surgery, listens intently as the other doctors suggest next steps for treating the patient. She tells the lead doctor working with the group how she would treat the patient moving forward.
The group agrees on a course of treatment and fills the patient’s room. Emuakhgbon checks in with one of the nurses. Soon, she asks a nurse to put an arterial line into a neurosurgeon patient.
Emuakhgbon, 28, moved to Dallas from Nigeria when she was a child. She came to Louisville for medical school in 2011. She said becoming a doctor has long been her plan.
“I knew I always wanted to help people, and I probably decided freshman year of high school after doing some dissections, and I just kind of fell in love with it instantly,” she said.
As a black physician in the United States, Emuakhagbon is a rarity.
A 2012 report by the Association of American Medical Colleges found that only 7.3 percent of all first-time applicants to medical schools were African-American. More than 54 percent were white.
''In the minority community, I think seeing outside of your world is important. Knowing that there’s a bigger world, and there are other things outside of what is normal for you … and just being OK with being uncomfortable.'' Valerie Emuakhgbon
The imbalance is far greater in Kentucky, where more than 70 percent of doctors are white, according to the state Board of Medical Licensure. And at U of L’s medical school, fewer than one in 10 students enrolled is a person of color.
The reasons more minorities aren’t pursuing careers in medicine are complex. Dr. Faye Jones, assistant vice president of the U of L Health Sciences Center’s Office of Diversity and Inclusion, said the high cost and student loan burden, as well as the lack of exposure and opportunities, are among them.
But she said there can also be racial bias in admissions. Although race isn’t an indicator of someone’s qualifications, it might figure into the consideration anyway.
“We have to not look at people on the surface and judge who’s qualified, who’s not. There are so many things that will make somebody qualified,” Jones said.
The center has recently started offering workshops on unconscious bias to help students and faculty identify their own biases — in their interactions with patients and colleagues — and develop a plan to overcome them.
Jones said a person’s life experiences and abilities are good indicators of whether they can successfully complete medical school and go on to have careers in medicine.
Emuakhagbon agrees. She cited her own experience — parents who always stressed the importance of education, spending time overseas visiting family — as key in broadening her view of the world and her potential to thrive.
“In the minority community, I think seeing outside of your world is important,” Emuakhagbon said. “Knowing that there’s a bigger world, and there are other things outside of what is normal for you … and just being OK with being uncomfortable.”
But the lack of diversity among doctors contributes to problems for patients, who may not receive care that’s sensitive to their race and culture.
Dr. Nadine Gracia, director of the Office for Minority Health at the U.S. Department of Health and Human Services, said having a diverse group of doctors who are respectful and responsive to their patients’ needs can improve health outcomes.
“Unfortunately there can be some significant consequences, like a misdiagnosis where there is poor communication that results in a delay in diagnosis,” she said. “To ensure that we’re providing high-quality care, it’s important that that care is culturally and linguistically appropriate.”
Research by the Institute of Medicine found “strong but circumstantial evidence for the role of bias, stereotyping and prejudice” in perpetuating racial health disparities. The study showed black Americans receive less effective care than whites for almost every disease studied. Minority populations also receive fewer recommended treatments for conditions such as AIDS, cancer and heart disease. And those disparities still existed after controlling for socioeconomic and insurance status.
A University of California, San Francisco study found black and Hispanic patients visiting the emergency room are less likely than whites to receive opioid drugs to relieve severe pain. About 31 percent of whites received drugs such as codeine and oxycodone, but only 23 percent of blacks and 24 percent of Hispanics received the same treatment.
“No one goes in, at least most of the time, no ones goes in and says, ‘OK, I’m going to treat this patient badly because of race,’” Jones said. “But we all have unconscious bias, and we need to make sure that we’re aware that everybody has bias and realize that can affect your decision-making.”
The best way to reduce instances of bias in care is to foster a more diverse medical community, Jones said. Providing more resources and role models for minority students is a start.
Sick & Tired is a four-part web and radio series examining health disparities among racial minorities in Kentucky. It's part of the Next Louisville: Community Health project, a partnership between WFPL News, the Foundation for a Healthy Kentucky and the Community Foundation of Louisville.
U of L’s Office of Diversity and Inclusion offers pipeline programs to attract young minority students to careers in medicine. The Summer Medical and Dental Education Program was designed by the Robert Wood Johnson Foundation to increase the number of qualified medical school applicants from minority groups that were underrepresented in medicine. The six-week program, hosted by U of L, offers students academic enrichment, career development and financial planning.
Emuakhagbon said mentors, like Jones, have been an important support system for her. Now, she’s trying to do her part to encourage people who may be considering a career in medicine.
“I try to set an example for people who are interested in it,” she said. “I welcome phone calls, emails and text messages from younger people who are looking to get into the profession, just to offer them advice,” she said.
In the meantime, she’s hoping to soon take the next step in her own medical career: a fellowship in colorectal surgery.