Before the Civil War, and for many decades after, Black Americans who wanted to get a medical degree faced severe discrimination, and often had to travel abroad for their education. After the Civil War, multiple Black medical schools were founded between 1868 and 1904, dramatically increasing the number of Black medical graduates.
Educational institutions like the University Medical School, Meharry Medical College, Leonard Medical School, and numerous others were established across the United States, but the American Medical Association (AMA) made it hard for Black physicians to survive by excluding most of them from its membership and official directories.
By 1906, the AMA’s Physician Professional Data, for example, listed only 1.8% of all physicians in the United States as African American. This 1906 directory made sure to label those doctors it did find as “Col” — for “Colored” — to point them out, according to Benjamin Chrisinger, an assistant professor in Tufts University’s Department of Community Health.
“This practice was strongly opposed by Black medical leaders of the time,” Chrisinger wrote in explaining his research, “It contributed to the further exclusion of Black physicians from medical training, practice, and professional communities. Today, these archival records offer us a look into the earliest racial inequalities in post-Reconstruction healthcare, and [stand as] a testament to the achievements and perseverance of Black physicians who overcame immense barriers to serve their communities.”
Chrisinger, who has digitized and analyzed data and historical records from the AMA’s 1906 directory, recently spoke with the AmNews about his work. His research, “Deep Roots of Racial Inequalities in US Healthcare: The 1906 American Medical Directory,” provides a stark look at the history of medical discrimination and helps explain why the gap between Black doctors and the Black population remains so wide today.
Starting in 1906, the AMA initiated the practice of labeling Black physicians in its directories — a practice that continued until 1938. “The National Medical Association opposed it from the start, so we know that this wasn’t something that Black doctors were volunteering, or information that they thought that they needed to volunteer,” Chrisinger said. “The AMA was forcing this kind of distinction.”
The directory was one of the AMA’s many efforts to establish itself as the authority on quality medical doctors. Chrisinger added that historian Vanessa Northington Gamble, of George Washington University, found correspondence between AMA secretaries, archive staff, and medical school presidents inquiring about the race of graduates.
“Our guess was also that maybe state and local secretaries of chapters might voluntarily provide this information or be asked by AMA central to help identify the race of doctors, perhaps through biographical cards filled out by people and placed in journals,” he said. “There’s no checkbox for it, so doctors weren’t asked to give that information directly, but somehow, the data was still being gathered.”
Using information from the directory, Chrisinger found that in 1906, there were 746 Black doctors in 16 states; 57% of all Black doctors at that time were educated at Howard or Meharry. He began his review of the AMA directories while researching health disparities and the structures that create them, after reading the AMA’s 2008 apology for its history of discriminatory practices against Black physicians. Chrisinger’s research looked at how the AMA labeled Black physicians between 1906 and 1938 while it was trying to “professionalize” and “standardize” medicine and assert more control over medical education.
“Some of the patterns that we found explain where Black doctors were or what the county-level characteristics were that might explain where Black doctors were setting up,” Chrisinger said.
Chrisinger’s research shows that Black doctors have historically served as more than just healthcare providers. They have been economic anchors in their communities, owning real estate, running local businesses, and offering informal loans to those excluded from traditional banking. Today’s continuing decline in the number of Black physicians, as both healers and wealth-builders, creates a dual threat to community stability. Chris Lee is founder of BlackEconomics.com.