It’s no secret that medicine has a diversity problem. In the United States, more than 60 percent of all working physicians are men; about 56 percent are white. Black, Hispanic, and Native American providers are all severely underrepresented in the nation’s medical workforce.
These racial disparities are especially stark in mental healthcare and obstetrics and gynecology (OB-GYN) — two essential fields for many women in their 30s, 40s, and 50s. More people of color are earning psychology degrees, but the vast majority of all U.S. psychologists are white. Psychiatry is even more homogeneous: Of the 41,000 active providers in this field, only 2 percent are Black. OB-GYN has a higher proportion of Black providers (about 11 percent), but it’s still low from an equity standpoint.
Although about 13 percent of Americans are Black, “less than 5 percent of all U.S. doctors are Black,” notes obstetrician-gynecologist Dr. Tamandra Morgan, a breast surgery fellow at UCSF. “If we’re taking care of patients who make up the American population, then at minimum, there should be an equal representation of Black and Hispanic providers,” she tells Flow.
Dr. Morgan is the co-founder of The Black OB-GYN Project, an anti-racism resource for patients and providers in reproductive healthcare. “One of our most frequently asked questions is, ‘Where can I find a Black OB-GYN in my neighborhood?’” she says. To her, this indicates a clear “need and desire” for more providers of color, also known as racially concordant providers. Unfortunately, medicine’s overwhelming homogeneity can hinder women of color from finding their best-fit therapist, psychiatrist, and/or OB-GYN. The demand for racially concordant providers is often too high, especially in more remote areas.
It’s an intricate structural issue complicated further by persistent racial gaps in women’s health outcomes, particularly in OB-GYN. America’s Black maternal mortality crisis is just one example of phenomena that prompt women of color to seek out racially concordant care.
To better understand this complex topic, Flow spoke with multiple providers who are working to address racial inequities in their fields. Here’s what they had to say about why these gaps in representation occur, how they may affect patients, and what structural changes need to happen to make women’s healthcare more inclusive.
Why are these racial disparities among providers so pronounced, anyway?
It’s important to remember that systemic racism affects all people of color in America, including healthcare providers. Whether you’re studying to become a licensed clinical professional counselor or OB-GYN, education and training can be very expensive. The same structural barriers that contribute to racial disparities in household income and higher education also preclude people of color from entering the medical field.
Mental healthcare is often a particularly unattractive field to people of color, says Dr. LaNail R. Plummer, licensed clinical professional counselor and CEO and founder of Onyx Therapy Group. In the U.S., Black and Hispanic women earn less than their white peers. “People have this idea that mental healthcare providers don’t make any money,” which isn’t always true, she tells Flow. “And so, if I’m already positioned to not make a lot of money, why would I go into a field in which I’ll make even less money?”
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What’s more, Western medicine has a fraught history of exploiting marginalized people, particularly Black women. Dr. Morgan cites Dr. J. Marion Sims, the so-called “father of gynecology,” as a prime example. Sims did make advancements in the field…but only by “experimenting” on enslaved Black women. Until recently, there was little to no acknowledgement of this in the medical community.
These legacies of harm can affect how marginalized providers and patients alike navigate healthcare. “We have to consider this historical context, and family legacies of people from these communities and their interactions with the healthcare system,” adds Dr. Morgan. “We can’t just say, ‘Oh, this is something that happened a long time ago, and it shouldn’t have any impact today.’ It’s very palpable.”
For many patients of color, racially concordant care feels more inviting.
A recent CDC study found that women of color experience disproportionately high rates of mistreatment during pregnancy and delivery care. Given these historical and contemporary contexts, it’s easy to grasp why women of color may prefer to see a racially concordant provider.
“The way Black and Brown people perceive mental health is very different than white people,” notes Dr. Plummer. Stigmas surrounding therapy are prevalent in these communities, albeit less so in recent years. But these negative perceptions, coupled with distrust of the medical establishment, can deter women of color from seeking the services they need. And if they finally do pursue therapy, having to “educate [a provider] about their identity and their culture,” which happens all too often, presents yet another barrier. “If I’m the therapist, but my client is guiding and teaching me, then that client doesn’t get to sit in the purity of being a client,” she adds.
This psychic burden of having to constantly educate others can take a major toll on women of color over the course of their lives. It’s the basis of weathering, a term coined by public health scholar Arline Geronimus to explain how the everyday effects of systemic oppression gradually wear down on marginalized people, causing their health to deteriorate.
Fortunately, many providers of color have a vested interest in addressing disparities in healthcare. (Under Dr. Plummer’s leadership, Onyx Therapy Group employs 31 Black women, 30 of whom are counselors.) Since they belong to the communities they serve, they tend to be more sensitive to specific issues that disproportionately affect their patients. For Black women at midlife, that could be uterine fibroids or polycystic ovarian syndrome (PCOS).
They may also have a better understanding of the unique symptom profiles that occur in women in color. Case in point: After years of fruitless doctors’ visits to address her “extreme pelvic pain,” actress Tia Mowry was finally diagnosed with endometriosis by a Black gynecologist, who immediately recognized and validated her “textbook” case.
Racially concordant care may also help address disparate health outcomes.
Diversifying women’s healthcare providers won’t solve systemic racism. However, research suggests that it may help close racial gaps in patient health outcomes. A recent JAMA study found that increasing the number of Black physicians working in primary care was associated with a decrease in Black patients’ mortality and a reduction in race-based mortality disparities.
In other words, seeking out a racially concordant provider isn’t just a matter of personal preference; it can potentially be life-saving. “It can really improve patient outcomes,” says Dr. Morgan. “The research is there.”
This evidence also underscores the importance of patient-provider trust and communication. For Black patients, certain colloquialisms or subtexts might be lost on non-Black providers. “If you trust your provider and can communicate with your provider,” Dr. Morgan explains, “then you’re more likely to actually adhere to the advice that you’re given because you think, I can trust this person; they have my best interest at heart.”
How can we increase the number of providers of color in women’s healthcare?
Whether you approach it from the perspective of equity or patient health outcomes, diversifying women’s healthcare is a pressing matter. Since this is an issue across our nation’s healthcare system, its solution will require systemic changes.
“There need to be more pipeline programs,” notes Dr. Morgan. This may include increasing educational opportunities — for instance, “identifying Black high school students who are interested in medical school and being able to address some of those barriers” — or bolstering financial support for people of color as they navigate clinical training.
Beyond that, all medical providers regardless of race should be trained in basic cultural competency. This may help address retention issues, which can arise in situations where a provider of color feels othered or under-resourced in the workplace. “People need to start creating definitions of what diversity looks like for them and what inclusion looks like for them,” adds Dr. Plummer. “If [a provider of color] works for you but doesn’t have a voice, are they actually being included?”
How to find a racially concordant provider
Depending on your location, finding a racially concordant provider might be challenging. Luckily, there are plenty of helpful online resources. Websites like Therapy for Black Girls, Latinx Therapy, and Asians for Mental Health offer searchable directories of virtual and in-person mental health professionals organized by location. Dr. Morgan also suggests Health In Her HUE. This online platform has a robust provider directory with filters for location, specialty, and insurance.
