PRESIDENT'S COLUMN AFRICAN-AMERICAN WOMEN IN THE MEDICAL PROFESSION Alma R. George, MD President, National Medical Association Detroit, Michigan
INTRODUCTION African-American women have been represented in the US labor force since the founding of this country and have constituted a larger proportion of the African-American labor force than all women represented in the total labor force.' All women have had greater representation in the professions since 1910.' However, while all women have constituted only 38% to 41% of the total number of professionals since 1940, more than half of all African-American professionals since that time have been women.1 Although the representation in the medical profession of women in general, and of African-American women in particular, has grown over the years, it has not been at the same pace as women's participation in all professions. It was not until after 1970 that the number of active women in the medical profession drastically increased. The percentage of all women in the medical profession increased from 7.1% in 1970 to 15.3% in 1986.2 It has been estimated by the department of manpower and demographic studies of the American Medical Association (AMA) that by 1996, 40% of new medical school graduates will be women, and by the year 2010, women will represent 29.4% of all active physicians.2 Very few records have been kept on AfricanAmerican physicians throughout the years. Although African Americans make up 12% of the US population, as late as 1989 only 12% of the physicians in practice were African Americans.3 Data on African-American Dr George is Director, Primary Care Initiative, Surgical Services, St Joseph's Clinic, Samaritan Health Center, Detroit, Michigan. Requests for reprints should be addressed to Dr Alma R. George, National Medical Association, 1012 Tenth St, NW, Washington, DC 20001. 954
women physicians is even more remote. The existence of 65 African-American women physicians was documented in 1920. In 1970, the number increased to 1051, and by 1980, the number of African-American women physicians had increased to 3153.4 Although AfricanAmerican women physicians have always represented a small percentage of the total number of physicians practicing in this country, their history and contributions to the medical profession must not be overlooked.
HISTORY AND EARLY CONTRIBUTIONS OF AFRICAN-AMERICAN WOMEN IN THE MEDICAL PROFESSION In order to discuss the current status of AfricanAmerican women physicians, their history and early contributions to the profession throughout the years must be reviewed. African-American women's participation in the medical profession can be traced back to ancient Africa. Their African ancestors practiced their knowledge and skills in pharmacology and surgery in Memphis, Benin, and Kano, and their knowledge and skills were transferred with them when they were forced into slavery in this country.4 Many African-American women served as lay midwives and nurses throughout the South during the Civil War.4 One year before the 13th amendment was adopted to end slavery, Dr Rebecca Lee received her medical degree from New England Female Medical College in Boston, thus becoming the first documented African-American woman physician in the United States.4 Three years later in 1867, Dr Rebecca J. Cole received her medical degree from Woman's Medical College of Pennsylvania, Philadelphia.4 In a few sources, Dr Susan Smith McKinney Steward is listed as the first African-American woman physician JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
PRESIDENT'S COLUMN
in the United States. However, she was the third African-American woman physician in the United States, but the first in New York state when she graduated in 1870 from the New York Medical College and Hospital for Women.4 Dr Steward furthered her medical education by completing a postgraduate course at Long Island Medical College Hospital in 1888, an almost impossible accomplishment for AfricanAmerican physicians during this period.4 Dr Steward was the only woman in the school at this time, and her acceptance was due to the quality and impact of her contributions to the medical profession prior to her admittance. Dr Steward cofounded the Women's Hospital and Dispensary at Myrtle and Grand Avenues in Brooklyn in 1881.4 Drs Lee, Cole, and Steward overcame many obstacles to become physicians in a society that was hostile to African Americans and not yet open to women. It must be noted that each went to medical schools operating specifically for women since women were viewed as too frail to enter the profession and were not considered equal to men. Their accomplishments and contributions must be viewed in light of the fact that most African Americans could not get an education at all during the 1800s, neither women nor African Americans were enfranchised, and few white men were entering the medical profession. African-American women physicians continued to make their presence known in the medical profession in the early 1900s. Dr May E. Chinn became the first African-American graduate of the New York University Bellevue Medical Center, and in 1926, she became the first African-American woman physician to intern at Harlem Hospital, a predominantly white institution at that time.4 Dr Chinn's interest was in cancer research, and her strong belief was that her patients were victims of society as well as the diseases that affected them. This led her to obtain a masters degree in public health from Columbia University.4 Although the doors to hospitals never opened to Dr Chinn, she did accept an invitation to join the staff of the Strang Clinic, working in cancer research at the clinic for 26 years, her name never appearing on the clinic's roster.4 Dr Sena E Edwards received the Presidential Freedom Medal in 1964 for her humanitarian pursuits as a physician.4 Dr Edwards practiced in Jersey City, New Jersey for more than 30 years, serving inner-city residents and working on the staff of Margaret Hague Maternity Hospital. Upon leaving her post at the hospital, Dr Edwards had established a reputation for outstanding obstetrical work, including the implementation of innovative practices such as the use of minimal JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
or no anesthesia during deliveries.4 Dr Edwards served as an associate professor of obstetrics and gynecology at her alma mater, Howard University Medical School, and at age 60 resigned to establish Our Lady of Guadalupe Clinic, a 25-bed hospital and health center in Hereford, Texas that eventually grew to serve a population of 5000 migrant workers.4 These women are but a sampling of AfricanAmerican women pioneers in the medical profession and their contributions. It is important that their accomplishments get recorded along with the accomplishments of their white counterparts and male physicians alike. It can be a great motivational tool for young African-American women with goals of entering the medical profession and an encouragement to all physicians facing barriers when entering their specific areas of practice.
THE CURRENT STATUS OF AFRICANAMERICAN WOMEN IN THE MEDICAL
PROFESSION Concern over the insufficient number of physicians serving in minority areas, especially in the inner cities, prompted the government to sponsor programs to increase the number of minorities and women entering medical schools. Although African-American medical school enrollments increased during the 1960s and 1970s, since that time, the overall percentages of African Americans enrolling in medical schools has either leveled off or decreased, while the percentages for nonminorities is on the rise. However, it must be noted that during this same period, the percentage of African-American women medical students has increased. A 1983 national survey collecting data on the career plans of resident physicians indicated that the increase of women and minority physicians during the 1970s facilitated the government's goals for better specialty and geographic distribution of physicians. However, when the results of the 1983 survey were compared to earlier studies, it showed that white women and minority men are closing the gap on white men, representing the mainstream, in the areas of specialty distribution, while minority women continue to practice in the more traditional female patterns of the 1960s.5 In reviewing the specialty areas of the overall population of women physicians entering the profession since 1982, 15.6% chose to enter into general internal medicine, 15.1% chose pediatrics, 11.7% chose general or family practice, 10.8% chose obstetrics and gynecology, and 10% chose internal medicine subspe955
PRESIDENT'S COLUMN
cialties.2 The areas least likely to be chosen by women physicians were pathology (2.2%), general surgery (2.5%), emergency medicine (3.1%), ophthalmology (3.7%), and surgical subspecialties (3.7%).2 As the presence of women physicians was less likely in the surgical areas, their numbers were also limited in academic medicine.2 When compared with the total women's physician population, a larger percentage of minority women physicians chose to practice pediatrics (23.8%) and obstetrics/gynecology (16.7%) than their nonminority women colleagues, while only 4.8% chose surgery.5 When reviewing the primary care specialties alone, the disparity between minority women and other physician groups is even more evident. Whereas 70% of minority women planned to practice primary care medicine, 35% of white men, 47% of white women, and 45% of minority men planned to do so.5 Three reasons have been presented as to why a higher percentage of women physicians in general, and African-American women physicians in particular, choose to enter pediatrics and obstetrics/gynecology practices as opposed to surgery, emergency medicine, ophthalmology, or pathology. First, being that pediatrics and obstetrics/gynecology involve the treatment of children and women, they may be viewed as more compatible with the stereotypic role of women in society, and by doing so, women physicians can better meet the demands of gynecology patients preferring to be treated by a woman physician.5 Second, as women strive to satisfy their dual roles of professionals and wives/mothers, choosing a specialty area with a shorter residence period and more flexible work hours such as pediatrics may be well-suited to the demands of the woman physician.5 Finally, the lack of role models and perceived prejudicial barriers may deter some women from entering some specialties such as surgery.5 Sixty-two percent (62%) of women physicians were not board certified as of 1982 compared with 43% of their male colleagues.5 One must take into consideration that these figures include residents and young physicians in practice working to complete the board certification process; therefore, assuming that most board-certified physicians are 35 or older, approximately two thirds of women physicians in practice are board certified compared with three fourths of their male colleagues.6 The percentage of board-certified African-American physicians could not be extracted from this data because they were not broken down by racial or ethnic background. The survey also showed some differences in the 956
geographic locations where physicians planned to practice. Ninety percent of minority residents planned to practice in urban areas compared with 77% of nonminority residents.5 These percentages for minority physicians uphold the speculation that minority physicians are more likely to practice in their own communities, serving the medically underserved. While the trend for minority physicians is to serve in the inner cities, a large proportion of nonminority women plan to practice in rural areas, thus reducing the insufficient number of physicians serving these areas as well.5 On the whole, women physicians differ from their male counterparts in practice patterns as well. Women physicians tend to work fewer hours per week, see fewer patients, and earn less money than their male counterparts. They also tend to favor group practice or working in hospitals for a salary over solo practices.2 Statistics also show that minority preferences for salaried, hospital-based positions is even stronger than that of the overall women physician population.5 This preference may be due to anticipated patient or peer discrimination in solo practices, as well as minority physicians' perceptions of barriers to entry into group practices dominated by nonminority physicians.5 In reviewing the various available statistics on physicians in the United States, one may come to several conclusions regarding the current status of African-American women physicians. First, while progress has been made since the 1970s, one may conclude that African-American women are moving at a much slower pace in closing the gap between themselves and white male physicians, while minority men and nonminority women are almost on the verge of closing the gap. Second, the African-American community must not let the increase in African-American women's enrollment in medical schools come at the expense of the African-American male's enrollment and the overall minority admission percentages, which have either leveled off or dropped in many schools over the last decade.4 In the 1983-84 academic year, 44.9% of African-American medical students were women compared with 29.4% among nonminority students.4 This trend continues through the 1990-91 academic year, when 3.6% of the 6.5% African Americans enrolled in US medical schools were women compared with 2.9% males.7 It is imperative that the numbers and percentages of African-American male and female medical students are increased simultaneously to eradicate the insufficient number of physicians serving in the African-American community. Finally, the AfricanAmerican community must prepare itself for greater JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
PRESIDENT'S COLUMN
scarcity of African-American physicians in specialty areas that have been consistently male dominated, such as surgery, as women are represented in higher percentages among African-American physicians. As African-American women physicians continue to break down the barriers in their areas of practice, they are beginning to break down the barriers in professional medical associations as well.
THE ROLE OF AFRICAN-AMERICAN WOMEN IN PROFESSIONAL MEDICAL ASSOCIATIONS Leadership positions in professional medical associations have traditionally been held by male physicians. However, as more women enter the profession, they too are seeking leadership roles in professional medical associations. Although such positions in the AMA and the National Medical Association (NMA) are still dominated by men, in the last decade, women in general, and African-American women in particular, have begun to alter that trend. The NMA was founded in 1895; however, it was not until 1985, 90 years later, that the first woman was elected to serve as the organization's president, Dr Edith Irby Jones.4 Since then, the NMA has had two other women presidents, Dr Vivian Pinn-Wiggins (1989) and the current president, Dr Alma Rose George (1991). In addition, several women have served on the NMXs Board of Trustees, including at least two on the Executive Committee of the Board of Trustees.4 There are no statistics on the African-American woman physician's role in leadership positions in the AMA. African-American women physicians are not only looking to the traditional medical associations to serve in leadership positions. They have formed their own associations to exchange information and to address issues of unique concern to African-American women physicians. The Susan Smith McKinney Steward Medical Society was the first major African-American women's medical association, founded by Dr Muriel Petioni in the mid- 1970s with members located in New York, New Jersey, and Connecticut.4 The Society was approved as an NMA chapter in 1984.4 Other AfricanAmerican women medical associations have been founded in several major cities. In addition to these women medical associations, the NMA addresses the special concerns of its women physicians through its
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
Council on Concerns of Women Physicians.4 As the percentage of African-American women continues to escalate within the medical profession and more African-American women physicians seek to break down the traditional leadership roles of their male counterparts, it is hoped that African-American women will continue their leadership roles in the NMA and extend the trend to breaking down the barriers in the AMA as well.
CONCLUSION African-American women have made great strides in the medical profession since 1864 when Dr Rebecca Lee became the first African-American woman in the United States to receive a medical degree. They have done so despite the double jeopardy of racism and sexism. Although their percentages and numbers have increased, there is concern that African-American women physicians still choose to practice in the traditional female specialty areas of the 1960s, and their increase may be at the expense of their male counterparts. African-American women have demonstrated their ability to lead professional medical associations, yet as of 1991, only three African-American women physicians have led the NMA, while the AMA has yet to have an African-American woman president. As we enter the 1990s, African-American women must be afforded more opportunities to realize their full potential, which they have demonstrated over many decades as practitioners, academicians, researchers, and admin-
istrators.4 Literature Cited 1. Kilson M. Black women in the professions, 1890-1970. Monthly Labor Review 1977;1 00:38-41. 2. Friedman E. Changing the ranks of medicine-women MDs. Medical World News. April 1988:57-68. 3. Lloyd SM, Miller RL. Black student enrollment in US medical school. JAMA. 1989;261:272-274. 4. Goodwin NJ. The black woman physician. NY State J Med. 1985;85:145-147. 5. Adams EK, Bazzoli GJ. Career plans for women and minority physicians: implications for health manpower policy. JAMA. 1986;241:17-20. 6. AMA Women in Medicine. In the Marketplace: Work Pattems, Practice Characteristics and Incomes of Women Physicians. Chicago, III: American Medical Association; 1987:1. 7. Jonas HS, Etzel SI, Barzansky B. Education programs in US medical schools. JAMA. 1991;266:913-920.
957
INTRODUCTION African-American women have been represented in the US labor force since the founding of this country and have constituted a larger proportion of the African-American labor force than all women represented in the total labor force.' All women have had greater representation in the professions since 1910.' However, while all women have constituted only 38% to 41% of the total number of professionals since 1940, more than half of all African-American professionals since that time have been women.1 Although the representation in the medical profession of women in general, and of African-American women in particular, has grown over the years, it has not been at the same pace as women's participation in all professions. It was not until after 1970 that the number of active women in the medical profession drastically increased. The percentage of all women in the medical profession increased from 7.1% in 1970 to 15.3% in 1986.2 It has been estimated by the department of manpower and demographic studies of the American Medical Association (AMA) that by 1996, 40% of new medical school graduates will be women, and by the year 2010, women will represent 29.4% of all active physicians.2 Very few records have been kept on AfricanAmerican physicians throughout the years. Although African Americans make up 12% of the US population, as late as 1989 only 12% of the physicians in practice were African Americans.3 Data on African-American Dr George is Director, Primary Care Initiative, Surgical Services, St Joseph's Clinic, Samaritan Health Center, Detroit, Michigan. Requests for reprints should be addressed to Dr Alma R. George, National Medical Association, 1012 Tenth St, NW, Washington, DC 20001. 954
women physicians is even more remote. The existence of 65 African-American women physicians was documented in 1920. In 1970, the number increased to 1051, and by 1980, the number of African-American women physicians had increased to 3153.4 Although AfricanAmerican women physicians have always represented a small percentage of the total number of physicians practicing in this country, their history and contributions to the medical profession must not be overlooked.
HISTORY AND EARLY CONTRIBUTIONS OF AFRICAN-AMERICAN WOMEN IN THE MEDICAL PROFESSION In order to discuss the current status of AfricanAmerican women physicians, their history and early contributions to the profession throughout the years must be reviewed. African-American women's participation in the medical profession can be traced back to ancient Africa. Their African ancestors practiced their knowledge and skills in pharmacology and surgery in Memphis, Benin, and Kano, and their knowledge and skills were transferred with them when they were forced into slavery in this country.4 Many African-American women served as lay midwives and nurses throughout the South during the Civil War.4 One year before the 13th amendment was adopted to end slavery, Dr Rebecca Lee received her medical degree from New England Female Medical College in Boston, thus becoming the first documented African-American woman physician in the United States.4 Three years later in 1867, Dr Rebecca J. Cole received her medical degree from Woman's Medical College of Pennsylvania, Philadelphia.4 In a few sources, Dr Susan Smith McKinney Steward is listed as the first African-American woman physician JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
PRESIDENT'S COLUMN
in the United States. However, she was the third African-American woman physician in the United States, but the first in New York state when she graduated in 1870 from the New York Medical College and Hospital for Women.4 Dr Steward furthered her medical education by completing a postgraduate course at Long Island Medical College Hospital in 1888, an almost impossible accomplishment for AfricanAmerican physicians during this period.4 Dr Steward was the only woman in the school at this time, and her acceptance was due to the quality and impact of her contributions to the medical profession prior to her admittance. Dr Steward cofounded the Women's Hospital and Dispensary at Myrtle and Grand Avenues in Brooklyn in 1881.4 Drs Lee, Cole, and Steward overcame many obstacles to become physicians in a society that was hostile to African Americans and not yet open to women. It must be noted that each went to medical schools operating specifically for women since women were viewed as too frail to enter the profession and were not considered equal to men. Their accomplishments and contributions must be viewed in light of the fact that most African Americans could not get an education at all during the 1800s, neither women nor African Americans were enfranchised, and few white men were entering the medical profession. African-American women physicians continued to make their presence known in the medical profession in the early 1900s. Dr May E. Chinn became the first African-American graduate of the New York University Bellevue Medical Center, and in 1926, she became the first African-American woman physician to intern at Harlem Hospital, a predominantly white institution at that time.4 Dr Chinn's interest was in cancer research, and her strong belief was that her patients were victims of society as well as the diseases that affected them. This led her to obtain a masters degree in public health from Columbia University.4 Although the doors to hospitals never opened to Dr Chinn, she did accept an invitation to join the staff of the Strang Clinic, working in cancer research at the clinic for 26 years, her name never appearing on the clinic's roster.4 Dr Sena E Edwards received the Presidential Freedom Medal in 1964 for her humanitarian pursuits as a physician.4 Dr Edwards practiced in Jersey City, New Jersey for more than 30 years, serving inner-city residents and working on the staff of Margaret Hague Maternity Hospital. Upon leaving her post at the hospital, Dr Edwards had established a reputation for outstanding obstetrical work, including the implementation of innovative practices such as the use of minimal JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
or no anesthesia during deliveries.4 Dr Edwards served as an associate professor of obstetrics and gynecology at her alma mater, Howard University Medical School, and at age 60 resigned to establish Our Lady of Guadalupe Clinic, a 25-bed hospital and health center in Hereford, Texas that eventually grew to serve a population of 5000 migrant workers.4 These women are but a sampling of AfricanAmerican women pioneers in the medical profession and their contributions. It is important that their accomplishments get recorded along with the accomplishments of their white counterparts and male physicians alike. It can be a great motivational tool for young African-American women with goals of entering the medical profession and an encouragement to all physicians facing barriers when entering their specific areas of practice.
THE CURRENT STATUS OF AFRICANAMERICAN WOMEN IN THE MEDICAL
PROFESSION Concern over the insufficient number of physicians serving in minority areas, especially in the inner cities, prompted the government to sponsor programs to increase the number of minorities and women entering medical schools. Although African-American medical school enrollments increased during the 1960s and 1970s, since that time, the overall percentages of African Americans enrolling in medical schools has either leveled off or decreased, while the percentages for nonminorities is on the rise. However, it must be noted that during this same period, the percentage of African-American women medical students has increased. A 1983 national survey collecting data on the career plans of resident physicians indicated that the increase of women and minority physicians during the 1970s facilitated the government's goals for better specialty and geographic distribution of physicians. However, when the results of the 1983 survey were compared to earlier studies, it showed that white women and minority men are closing the gap on white men, representing the mainstream, in the areas of specialty distribution, while minority women continue to practice in the more traditional female patterns of the 1960s.5 In reviewing the specialty areas of the overall population of women physicians entering the profession since 1982, 15.6% chose to enter into general internal medicine, 15.1% chose pediatrics, 11.7% chose general or family practice, 10.8% chose obstetrics and gynecology, and 10% chose internal medicine subspe955
PRESIDENT'S COLUMN
cialties.2 The areas least likely to be chosen by women physicians were pathology (2.2%), general surgery (2.5%), emergency medicine (3.1%), ophthalmology (3.7%), and surgical subspecialties (3.7%).2 As the presence of women physicians was less likely in the surgical areas, their numbers were also limited in academic medicine.2 When compared with the total women's physician population, a larger percentage of minority women physicians chose to practice pediatrics (23.8%) and obstetrics/gynecology (16.7%) than their nonminority women colleagues, while only 4.8% chose surgery.5 When reviewing the primary care specialties alone, the disparity between minority women and other physician groups is even more evident. Whereas 70% of minority women planned to practice primary care medicine, 35% of white men, 47% of white women, and 45% of minority men planned to do so.5 Three reasons have been presented as to why a higher percentage of women physicians in general, and African-American women physicians in particular, choose to enter pediatrics and obstetrics/gynecology practices as opposed to surgery, emergency medicine, ophthalmology, or pathology. First, being that pediatrics and obstetrics/gynecology involve the treatment of children and women, they may be viewed as more compatible with the stereotypic role of women in society, and by doing so, women physicians can better meet the demands of gynecology patients preferring to be treated by a woman physician.5 Second, as women strive to satisfy their dual roles of professionals and wives/mothers, choosing a specialty area with a shorter residence period and more flexible work hours such as pediatrics may be well-suited to the demands of the woman physician.5 Finally, the lack of role models and perceived prejudicial barriers may deter some women from entering some specialties such as surgery.5 Sixty-two percent (62%) of women physicians were not board certified as of 1982 compared with 43% of their male colleagues.5 One must take into consideration that these figures include residents and young physicians in practice working to complete the board certification process; therefore, assuming that most board-certified physicians are 35 or older, approximately two thirds of women physicians in practice are board certified compared with three fourths of their male colleagues.6 The percentage of board-certified African-American physicians could not be extracted from this data because they were not broken down by racial or ethnic background. The survey also showed some differences in the 956
geographic locations where physicians planned to practice. Ninety percent of minority residents planned to practice in urban areas compared with 77% of nonminority residents.5 These percentages for minority physicians uphold the speculation that minority physicians are more likely to practice in their own communities, serving the medically underserved. While the trend for minority physicians is to serve in the inner cities, a large proportion of nonminority women plan to practice in rural areas, thus reducing the insufficient number of physicians serving these areas as well.5 On the whole, women physicians differ from their male counterparts in practice patterns as well. Women physicians tend to work fewer hours per week, see fewer patients, and earn less money than their male counterparts. They also tend to favor group practice or working in hospitals for a salary over solo practices.2 Statistics also show that minority preferences for salaried, hospital-based positions is even stronger than that of the overall women physician population.5 This preference may be due to anticipated patient or peer discrimination in solo practices, as well as minority physicians' perceptions of barriers to entry into group practices dominated by nonminority physicians.5 In reviewing the various available statistics on physicians in the United States, one may come to several conclusions regarding the current status of African-American women physicians. First, while progress has been made since the 1970s, one may conclude that African-American women are moving at a much slower pace in closing the gap between themselves and white male physicians, while minority men and nonminority women are almost on the verge of closing the gap. Second, the African-American community must not let the increase in African-American women's enrollment in medical schools come at the expense of the African-American male's enrollment and the overall minority admission percentages, which have either leveled off or dropped in many schools over the last decade.4 In the 1983-84 academic year, 44.9% of African-American medical students were women compared with 29.4% among nonminority students.4 This trend continues through the 1990-91 academic year, when 3.6% of the 6.5% African Americans enrolled in US medical schools were women compared with 2.9% males.7 It is imperative that the numbers and percentages of African-American male and female medical students are increased simultaneously to eradicate the insufficient number of physicians serving in the African-American community. Finally, the AfricanAmerican community must prepare itself for greater JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
PRESIDENT'S COLUMN
scarcity of African-American physicians in specialty areas that have been consistently male dominated, such as surgery, as women are represented in higher percentages among African-American physicians. As African-American women physicians continue to break down the barriers in their areas of practice, they are beginning to break down the barriers in professional medical associations as well.
THE ROLE OF AFRICAN-AMERICAN WOMEN IN PROFESSIONAL MEDICAL ASSOCIATIONS Leadership positions in professional medical associations have traditionally been held by male physicians. However, as more women enter the profession, they too are seeking leadership roles in professional medical associations. Although such positions in the AMA and the National Medical Association (NMA) are still dominated by men, in the last decade, women in general, and African-American women in particular, have begun to alter that trend. The NMA was founded in 1895; however, it was not until 1985, 90 years later, that the first woman was elected to serve as the organization's president, Dr Edith Irby Jones.4 Since then, the NMA has had two other women presidents, Dr Vivian Pinn-Wiggins (1989) and the current president, Dr Alma Rose George (1991). In addition, several women have served on the NMXs Board of Trustees, including at least two on the Executive Committee of the Board of Trustees.4 There are no statistics on the African-American woman physician's role in leadership positions in the AMA. African-American women physicians are not only looking to the traditional medical associations to serve in leadership positions. They have formed their own associations to exchange information and to address issues of unique concern to African-American women physicians. The Susan Smith McKinney Steward Medical Society was the first major African-American women's medical association, founded by Dr Muriel Petioni in the mid- 1970s with members located in New York, New Jersey, and Connecticut.4 The Society was approved as an NMA chapter in 1984.4 Other AfricanAmerican women medical associations have been founded in several major cities. In addition to these women medical associations, the NMA addresses the special concerns of its women physicians through its
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 11
Council on Concerns of Women Physicians.4 As the percentage of African-American women continues to escalate within the medical profession and more African-American women physicians seek to break down the traditional leadership roles of their male counterparts, it is hoped that African-American women will continue their leadership roles in the NMA and extend the trend to breaking down the barriers in the AMA as well.
CONCLUSION African-American women have made great strides in the medical profession since 1864 when Dr Rebecca Lee became the first African-American woman in the United States to receive a medical degree. They have done so despite the double jeopardy of racism and sexism. Although their percentages and numbers have increased, there is concern that African-American women physicians still choose to practice in the traditional female specialty areas of the 1960s, and their increase may be at the expense of their male counterparts. African-American women have demonstrated their ability to lead professional medical associations, yet as of 1991, only three African-American women physicians have led the NMA, while the AMA has yet to have an African-American woman president. As we enter the 1990s, African-American women must be afforded more opportunities to realize their full potential, which they have demonstrated over many decades as practitioners, academicians, researchers, and admin-
istrators.4 Literature Cited 1. Kilson M. Black women in the professions, 1890-1970. Monthly Labor Review 1977;1 00:38-41. 2. Friedman E. Changing the ranks of medicine-women MDs. Medical World News. April 1988:57-68. 3. Lloyd SM, Miller RL. Black student enrollment in US medical school. JAMA. 1989;261:272-274. 4. Goodwin NJ. The black woman physician. NY State J Med. 1985;85:145-147. 5. Adams EK, Bazzoli GJ. Career plans for women and minority physicians: implications for health manpower policy. JAMA. 1986;241:17-20. 6. AMA Women in Medicine. In the Marketplace: Work Pattems, Practice Characteristics and Incomes of Women Physicians. Chicago, III: American Medical Association; 1987:1. 7. Jonas HS, Etzel SI, Barzansky B. Education programs in US medical schools. JAMA. 1991;266:913-920.
957
