Affirmative action improved public health — and carried a high personal cost for Black physicians

I should be irate and despondent about the Supreme Court’s scrapping of affirmative action in admissions. It’s several steps backward.

And yet, I have mixed emotions about the practice, informed by my own experiences with affirmative action.

By increasing the number of Black doctors, affirmative action has also been instrumental in reducing health inequity for disadvantaged communities throughout this country. Black men accept more preventive care, including diabetes and cholesterol screenings that can help improve cardiovascular health, when treated by Black doctors. Black people residing in areas with more Black primary care physicians live longer. Black newborns are more likely to survive when cared for by Black doctors. Study after study demonstrates that America depends on its Black doctors.

But affirmative action policies also expose Black doctors-in-training to more racism, the effects of which both debase the intent of the practice and undermine the oath to do no harm. Ultimately, the cost is high for both doctors and patients alike.

When I received my acceptance to Harvard College in 2006, some of my classmates gossiped that I had gotten in only because I was Black. I was a top student, no doubt, but the hurtful gossip is probably, at least partially, true. I likely benefited from affirmative action policies, and perhaps I shouldn’t have.

While higher education treats Black Americans as a monolith, affirmative action practices were meant to bend the arc of the moral universe toward justice by, in some small way, mitigating the loss of social, political, and economic opportunities stolen from the descendants of enslaved Africans by the legalized systematic oppression of American institutions for generations.

But I am the daughter of a dual-physician household and an immigrant to this country, not a descendant of enslaved Africans whose ancestors have been systematically oppressed by American institutions for generations. In my lifetime as a Black American, I’ve certainly experienced racism and discrimination due to the color of my skin. I have not, however, inherited the transgenerational trauma of enslavement.

In medical school, my misgivings about diversity initiatives crystallized. I survived my medical education, but I did not emerge from that process as a physician unscathed.

In an interview last year with the Stanford Graduate School of Business’s “View From the Top” podcast, alumna Dara Tresseder, chief marketing officer of Autodesk, likened diversity initiatives to transplant medicine, arguing that it takes sustained and conscientious effort to maintain inclusive environments:

“When you add a diverse person to an organization, guess what happens? It’s like a transplant. You add an organ that the body wants to reject. It’s just the truth. Because it’s a lot easier when we’re all the same. It’s easier when we all think the same things. It’s harder when we have different perspectives and points of view. It takes work. Are we willing to do the work?”

I’ve been thinking about that metaphor for a long time. I can’t shake the violent surgical imagery and unrelenting struggle that it conjures.

Medical school was an extraordinarily challenging experience for me. The content was difficult, which was to be expected, but the culture at the University of Virginia — the anachronistic clinging to Thomas Jefferson’s enslaver ideals — was crushing. As a student, I reached out to various Black female physicians within the UVA hospital system, from attendings to residents, for advice, guidance, and community. Each was eager to offer mentorship, but each also let me know they were charting their own exit from the university. The message was clear: Transplants don’t survive here. Research bears this out, as do others’ experiences.

Medicine is not the only place where transplants struggle. After Nikole Hannah-Jones, the award-winning journalist behind the New York Times’ 1619 Project, was denied tenure at the University of North Carolina at Chapel Hill, she eventually made Howard University, an HBCU, her academic home.

“At some point when you have proven yourself and fought your way into institutions that were not built for you, when you’ve proven you can compete and excel at the highest level, you have to decide that you are done forcing yourself in,” she said in explaining her decision.

That fight for validation comes with a cost: weathering.

Weathering is the erosion of physical and mental health due to the chronic stress of racism and discrimination. The high-effort coping required to survive places like the University of Virginia, University of North Carolina, and Harvard kills.

Ron Howell was a member of Yale’s class of 1970. At his 40th college reunion, he was dismayed by the fact that Black students like him made up 3% of the class yet made up 10% of the deceased alumni. “Are the black men who went to Yale and similar institutions — who represented the first significant presence of African-Americans on Ivy League campuses — now experiencing inequality in death, as their forebears did in life?” he wrote in Yale’s alumni magazine in 2011.

The weathering in medicine and medical education is significant. I’ve written extensively about my experiences, and I wouldn’t wish them on anyone else. Now that I’m a board certified psychiatrist, I spend my days helping my patients reduce mental health symptoms, improve their well-being, and achieve peace. When I view my journey to physicianhood, to being a healer, through this lens, it is painful. I find it difficult to reconcile the need for Black doctors and increased diversity in medicine with the sacrifices each transplanted individual must make in order to bend the moral arc. Doctors are patients, too.

I hold four diplomas from Ivy League institutions, and perhaps it is from that position of privilege that I can decide, as a Black woman, that I no longer want to participate in anything that is detrimental to my own health and well-being. I’m not suggesting we wind the clock back to the Supreme Court’s Plessy v. Ferguson days of segregation and “separate but equal.” But I do think it’s important to take the words of Audre Lorde to heart: “The master’s tools will never dismantle the master’s house.” Race-based affirmative action was ultimately a flimsy invitation to the master’s house.

For marginalized communities, that means building new houses, not just for us but for everyone. I am leaning into physician-entrepreneurship, where I can develop inclusive spaces rather than trying to transplant people of color into existing spaces with white supremacist ideals hard-coded into the organizational DNA.

For example, I started a reproductive psychiatry private practice. As a business owner and physician, I am explicit about these values and welcome all patients seeking wellness in the face of oppressive systems. As an early career physician, I’m also exploring opportunities to contribute to health tech startups that not only center the needs of women, but also prioritize the needs of Black women through mission-driven work and internal business practices.

But I’m a realist. With the fierce competition to train in medicine, we cannot extricate ourselves from all toxic learning and work environments. We must endure them to gain the skills and resources that allow us to pour back into our own communities.

Making this process less painful — less damaging — starts with destigmatizing mental health and having more open conversations about when resilience can be helpful and when it can be harmful. It means setting up support networks to soften the edges of these hard experiences. And it can mean reimagining education and work, by incorporating more remote or virtual opportunities that spare us the day-to-day microaggressions of being a minority in medicine. For example, despite having my name and title embroidered on my scrubs and my badge that identifies me as the doctor, the paramedics in the hospital will routinely look past me and address the white or male nonphysician clinicians in the room. In contrast, in my private practice, patients log into the video visit and know they are seeing Dr. O.

Since the birth of this nation, one thing has been clear: Minorities in this country cannot solely depend on our fairweather court system to be a steadfast and enthusiastic champion of our freedom and empowerment. We can, however, depend on each other. Due to a mitigation in racial stress, a 2021 study reported that Black students that attend HBCUs have better health outcomes than Black students like me who attended predominantly white institutions. Black students who attended HBCUs had a 35% reduction in the odds of having three or more risk factors for cardiovascular disease like high blood pressure, high cholesterol, and high blood sugar.

The burden of cardiovascular disease — conditions like heart disease and stroke — widens the gap in life expectancy between Black and white Americans. Community is the key for our physical and mental health. Community is the key to justice.

I have a deep gratitude for the Black physicians who have embraced me throughout my education and training. Despite their own challenges, these wounded healers have taken their own affirmative action, an intentional cocooning, to help me weather the storm.

But they can’t calm or stop the storm. On its own, affirmative action is a Sophie’s choice, just another way minorities are burdened in ways that our white colleagues are not.