Beyond Skin Deep: Promoting Diversity in Medical School

Barbara-Ross-Lee2021_200pwDr. Barbara Ross-Lee is a nationally recognized health policy expert, bringing a diverse perspective to academic medicine. She serves as an advisor for state and federal governments on primary care, medical education and healthcare issues.

She currently serves as chair of AACOM’s Racism and Injustice in Healthcare Education Adaptive Working Group, and president elect of the American Osteopathic Foundation. She was founding director of the American Osteopathic Association Health Policy Fellowship Program for 25 years, the founding director of Training in Policy Studies for postgraduate osteopathic trainees for 20 years and a director of the Institute for National Health Policy and Research. She is also a member of the executive committee of the National Osteopathic Medical Association and past president of the Board at AACOM and the Association of Academic Health Centers.

Dr. Ross-Lee is the first African American woman to serve as dean of any US medical school (DO or MD)—Ohio University Heritage College of Osteopathic Medicine from 1993 to 2001—and is the first osteopathic physician to participate in the Robert Wood Johnson Health Policy Fellowship. Dr. Ross-Lee also served as vice president for Health Sciences and Medical Affairs at the New York Institute of Technology. The Accreditation Council for Graduate Medical Education recently named its Diversity and Inclusion Award in honor of Dr. Barbara Ross-Lee, and Dr. Ross-Lee was selected to deliver the 2021 Gold Foundation's White Coat Ceremony keynote address for all medical students.

“She has proved to be an innovator and leader in the osteopathic profession, as well as in the field of American healthcare,” writes Darnita Anderson Hill, DO, in Blacks in Osteopathic Medicine: An Idea Whose Time Has Come. “She has demonstrated that being Black and being female are not stumbling blocks, rather building blocks that create an even stronger foundation for each task and accomplishment.”

A Living Inspiration

Dr. Barbara Ross-Lee was born in Detroit, Michigan, the oldest of six children. Growing up in an inner-city housing project and attending public school, Dr. Ross-Lee always displayed an aptitude and fondness for math and science. Despite never having seen an African American physician, she always dreamed of growing up and becoming a doctor, or perhaps a teacher because of her love of education (in the 1950s and '60s, teaching was a far more realistic professional goal for a Black woman).

In 1960, Dr. Ross-Lee began working toward her bachelor’s degree at Detroit's Wayne State University. She enrolled in the school’s pre-medical program, despite the fact that female physicians were few and far between at the time, and there were only a handful of American medical schools offering admission to minority students. Dr. Ross-Lee graduated with a Bachelor of Science degree in biology and chemistry in 1965, and temporarily abandoned her dream of practicing medicine to train as a teacher in the National Teachers Core.

It wasn’t until nearly five years later, in 1970, that Dr. Ross-Lee finally began her medical career. Fresh on the other side of the tumultuous 1960s civil rights movement, Dr. Ross-Lee saw an opportunity to pursue her lifelong dream—she applied to a new osteopathic medical college in Michigan (that subsequently became Michigan State University College of Osteopathic Medicine, or MSUCOM) and was accepted.

Although she was finally on the path to becoming a physician and achieving a lifelong goal, her challenges were far from over. In many ways, Dr. Ross-Lee was an exceptionally “non-traditional” medical student: in addition to being African American and female, she was going through a divorce and was about to be a single mother of two young children. Despite her many hurdles, Dr. Ross-Lee graduated with her Doctor of Osteopathic Medicine (DO) degree in 1973.

The Need for Change 

During the interview for this article, Dr. Ross-Lee was asked to speak about a few significant moments in her career. One such moment she shared was a memory from her years in private practice:

A 14-year-old African American girl living in an unfortunate socioeconomic state was experiencing some health and interpersonal issues. She came to see Dr. Ross-Lee for help. After some discussion, the girl was clearly frustrated and interjected the conversation with a very disturbing comment, “Dr. Ross-Lee, I ain’t nothin’, I ain’t going to be nothin’, and you can’t make me.”

Immediately, Dr. Ross-Lee decided that, while she wasn’t sure exactly how to help this young woman, one thing was certain: we as a society had failed her long ago.

Reflecting on the lessons she took away from that experience, Dr. Ross-Lee said, “This is the human context in which we have to practice medicine, and reminds me why practicing medicine and being an osteopathic physician is important—to make a real difference in the lives of all of our patients, including those who no longer have hope.” This exemplifies how powerfully social determinants impact the way in which physicians care for patients.

Studies1 have shown that minority patients prefer to see, and report higher levels of satisfaction from, physicians of the same race, particularly in medically underserved, impoverished rural and urban areas. These studies also indicate that this phenomenon is foundationally due to the perception that a physician of the same race and/or sex as the patient understands more deeply the patient’s background, issues, social realities, etc., and therefore translates into better care.

While improving one-on-one patient care is an important goal, expanding diversity in medical education and practice is crucial for a number of other reasons. When a pool of applicants expands to include larger numbers of individuals from different backgrounds, that applicant pool will undoubtedly produce more top-level students. When those students graduate and become physicians, their diverse experiences translate into unique ideas and perspectives that they will carry into the healthcare workforce. As the US healthcare system looks to evolve to meet the needs of the nation it serves, the ideas and perspectives of a diverse physician workforce will be critical to success.

Providing Opportunities

One key contributing factor to the limited number of minority students in medical education is access to opportunity—an element of the recruitment process that is often overlooked because of its complexity. Even Dr. Ross-Lee can trace her success in medicine back to the opportunity she was given to enter MSUCOM in the early 1970s. However, developing an adequate level of opportunity to truly expand the diversity of the medical school applicant pool means constructing a strategic and comprehensive system of education and support. A system that reaches out to students as early as elementary school to drum up interest in STEM programs, gains buy-in from the communities around these children to support interest in higher education and imbeds in children the belief that achievement and success are possible. “The goal of diversity should be to provide opportunities to people who otherwise would not gain access,” Dr. Ross-Lee remarked.

Getting There with Commitment and Value

Like the 14-year-old in Dr. Ross-Lee’s story—for many it is all about value and worth. If the osteopathic medical education (OME) system values these populations and, as a whole, makes diversity a real priority, the profession will be able to make a real difference. That means creating an environment throughout the OME continuum that is built with and supportive of diversity—with the understanding that diversity is critical to training the best possible physician workforce; using socioeconomic and cultural data to come up with innovative ways to effect change; and identifying leadership to shepherd the process. “To do this means making a real commitment. This is a long haul, maybe 20-30 years, but if we don’t start now we’ll never get there,” said Dr. Ross-Lee.

Lisa Cooper-Patrick, Joseph Gallo, Junius Gonzales, et al., “Race, Gender, and Partnership in the Patient-Physician Relationship,” Journal of the American Medical Association. 1999; 282(6):583-589.doi:10.1001/jama.282.6.583.

Association of American Medical Colleges, “America Needs a More Diverse Physician Workforce.” https://www.aamc.org/data-reports/workforce/report/diversity-facts-figures