Letters to the Editor
I thank the authors for their comments on my article. Research to identify predictive factors and best practices to create physicians likely to work in medically underserved areas is important and urgent. These new findings are a valuable contribution to that literature.
The importance of patient–provider congruency goes beyond superficial phenotypic similarities. The importance we attach to culture and cultural differences is reflected in the current efforts to instill cultural competence in our medical graduates and in accreditation standards. The U.S. Department of Health and Human Services Office of Minority Health in 2015 recognized the meaningful cultural differences between African immigrants/refugees and the African American population with the establishment of the National African Immigrant Project and the African Data Workgroup. The programs were established in response to the cultural and linguistic diversity of African immigrant populations, and differences between these immigrant populations and native-born African American populations.1 Similar statements can be made about cultural diversity of Caribbean diaspora members and their importance to health care. African American cultural norms, attitudes, and beliefs about health and health care clearly differ in meaningful ways from those present in Port-au-Prince, Haiti; Kingston, Jamaica; or Nairobi, Kenya, whether acquired experientially or through intergenerational transfer.
While both African Americans and foreign-born black physicians disproportionately practice in medically underserved areas, this represents a general characteristic of foreign-born physicians and is not specific to foreign-born black physicians.2 Differences in motivation among African Americans (“giving back”) are likely also present. In line with the principles of holistic review, we should acknowledge our applicants’ complete selves and the ways they can enrich a class cohort. This means recognizing the important peculiar context of the African American cultural experience. Equally, it acknowledges the unique insight into the immigrant experience other black physicians possess. Rather than an exclusionary framework, I argue that valuing racial/ethnic experiences beyond the box checked on demographics questionnaires will yield a more just and inclusive medical profession.
Reginald F. Baugh, MD
Assistant dean of admissions and professor of surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio; email@example.com.
2. Ahmed AA, Hwang WT, Thomas CR Jr, Deville C Jr. International medical graduates in the US physician workforce and graduate medical education: Current and historical trends. J Grad Med Educ. 2018;10:214–218.