DETROIT (AP) — Dr. Starling Tolliver knew she wanted to become a doctor. Yet, as a Black girl growing up in Akron, Ohio, it was a dream that felt out of reach.

She rarely saw doctors who looked like her. As a child, she experienced severe hair loss, and struggled to find a dermatologist who could help.

Tolliver made a pact with two childhood best friends to become doctors who would care for Black and underserved communities like their own. Now 30, she is in her final year of dermatology residency at Wayne State University in Detroit.

She plans to spend her career caring for the body’s largest organ, where differences in melanin give humans the skin colors underpinning the construct of race. In dermatology, only 3% of U.S. doctors are Black.

Despite her success, the girls’ pact remains unfulfilled. While her friend Charmaine became a nurse, Maria, who wanted to become a pediatrician, was killed in their hometown at the age of 19.

Her friend’s death only strengthened her resolve.

“I’m going to continue to go on this path of medicine,” Tolliver said. “Not only for myself, but for Maria, and to potentially help others in the future from similar backgrounds as mine know that they can do it as well.”

But more than two months after the Supreme Court struck down affirmative action in college admissions, concerns have arisen that a path into medicine may become much harder for students of color. Heightening the alarm: the medical field’s reckoning with longstanding health inequities.

Black Americans represent 13% of the U.S. population, yet just 6% of U.S. physicians are Black. Increasing representation among doctors is one solution experts believe could help disrupt health inequities.

The disparities stretch from birth to death, often beginning before Black babies take their first breath, a recent Associated Press series showed. Over and over, patients said their concerns were brushed aside or ignored, in part because of unchecked bias and racism within the medical system and a lack of representative care.

A UCLA study found the percentage of Black doctors had increased just 4% from 1900 to 2018.

But the affirmative action ruling dealt a “serious blow” to the medical field’s goals of improving that figure, the American Medical Association said, by prohibiting medical schools from considering race among many factors in admissions. The ruling, the AMA said, “will reverse gains made in the battle against health inequities.”

The consequences could affect Black health for generations to come, said Dr. Uché Blackstock, a New York emergency room physician and author of “LEGACY: A Black Physician Reckons with Racism in Medicine.”

“It’s really about holding these larger organizations, institutions accountable and saying: ‘Right now, we’re in a crisis — a crisis of humanity,’” Blackstock said.

With affirmative action off the table at predominantly white institutions, historically Black colleges and universities may see an increase in applications, said Dr. Valerie Montgomery Rice, president and CEO of Morehouse School of Medicine in Atlanta.

The college, which typically has 115 openings for new medical students, receives between 7,000 and 9,000 applications per year, a number Rice said she believes will increase in light of the Supreme Court ruling. HBCUs have long served as a direct pipeline of Black doctors.

Experts say diversity is especially needed within specialty medicine. In dermatology, just 65 of the 796 applicants for residencies in 2020 were Black, data from the Association of American Medical Colleges shows. Only 39 were Latino.

For a field focusing on the skin, the unequal access among patients of color is stark: Patients of color are half as likely as white patients to see a dermatologist for the same conditions.

The consequences can be devastating.

“The skin is a window to the rest of your health,” said Dr. Ginette Okoye, professor and chair of dermatology at Howard University, who is a programming lead for the American Academy of Dermatology’s Pathways program.

“If you have kidney disease, if you have cancer, sometimes those clues show up on the skin first. We are able to preemptively diagnose cancer sometimes just by the way a specific rash shows up on the skin,” Okoye said. “That’s pretty impactful.”

Black men are more likely to die of melanoma, compared with men of other races, according to a study co-authored last month by dermatologist Dr. Ashley Wysong in the Journal of the American Academy of Dermatology. They also are more likely to be diagnosed at a later stage, when the condition is more difficult to treat. Melanoma is the most invasive and serious form of skin cancer.

The reasons for the different cancer rates are unclear, and more research is needed to understand in particular how economic and social conditions impact the cancer rates, Wysong said. The study found survival rates in men with melanoma were highest among white men, 75%, while the survival rates were lowest among Black men at only 52%.

“As medical professionals, any time we see disparities in care or outcomes of any kind, we have to look at the systems in which we are delivering care and we have to look at ways that we are falling short,” Wysong said.

Without affirmative action as a tool, career programs focused on engaging people of color could grow in importance.

For instance, the Pathways initiative engages students from Black, Latino and Indigenous communities from high school through medical school.

The program starts with building interest in dermatology as a career and continues to scholarships, workshops and mentorship programs. The goal: Increase the number of underrepresented dermatology residents from about 100 in 2022 to 250 by 2027, and grow the share of dermatology faculty who are members of color by 2%.

Tolliver credits her success in becoming a dermatologist in part to a scholarship she received through Ohio State University’s Young Scholars Program, which helps talented, first-generation Ohio students with financial need. The scholarship helped pave the way for medical school, but her involvement in the Pathways residency program also was central.

Azariah Providence, a 17-year-old rising high school senior who lives in the U.S. Virgin Islands, participated in the high school Pathways program last month. She wants to become a dermatologist because of her own scalp psoriasis diagnosis, which is a skin disease causing a rash with itchy, scaly patches.

Her condition hampered her self-esteem as a 9-year-old girl. The dermatologist she saw, one of very few on the island, prescribed medication causing Providence’s skin to burn and her hair to fall out.

“It was a difficult experience because as a little girl, your hair is very important to you,” Providence recalled. “After going through that, I wanted to help little girls who have similar conditions that I have. I want to be that person for them that I didn’t have when I was younger.”

Providence, who would be a first-generation medical student, said the program exposed her to college students and doctors of color, something she had never before seen.

“I think it’s important for more Black people to get into the field of dermatology for the simple reason that some conditions may appear differently on Black skin,” Providence said. “I want to enter the field so that people who look like me can have their skin understood and fully studied so that when they come to get diagnosed, it’s a correct diagnosis and they could get the correct treatment.”

Dermatology also is working to diversify its textbooks to help improve the spectrum of skin colors so doctors can be better equipped to diagnose and provide equitable care, said Dr. Adam Friedman, chair of dermatology at George Washington School of Medicine and Health Sciences in Washington, D.C.

But targeted programs to diversify the pipeline of talent are crucial for the future of medicine, Friedman said.

As Tolliver prepares to leave residency, she hopes to be one of the people pushing for better outcomes, especially for Black women.

“Our patients are looking for us, and that kind of pushed forward my love for this field,” Tolliver said. “And that really has been my goal ongoing from when I was a little girl: for Black women to see the beauty of themselves, within themselves.”

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Two sets of twins from the Inland Empire are now doctors after graduating from Loma Linda University on Sunday.

Lauren and Karen Bathan, Loma Linda natives whose parents are LLU alums, graduated with matching degrees from the School of Medicine after previously completing their undergrad at the university’s School of Allied Health Professions. In pursuing medical careers, the Bathans follow in the footsteps of their mom, a nurse practitioner, and dad, a physical therapy assistant, but are carving their own paths.

“Although our parents first influenced us to have a healthcare career, we decided to become doctors to lead patient care,” Lauren said.

“The culture of compassion and practice of whole person care was the perfect foundation for how we want to practice medicine,” Karen added.

Lauren will embark on a career in Internal-Medicine Pediatrics and will complete a residency program at the University of Illinois College of Medicine Peoria. Karen is heading for an Internal Medicine residency at Kaiser Santa Clara in NorCal.

On the same day, twin brothers and Chino natives Christopher and Luis Chan graduated from LLU’s School of Pharmacy. Both twins completed undergrad studies at the University of California Riverside, receiving bachelor’s degrees in biology.

Born to immigrant parents from China and Hong Kong, the Chans are practicing Buddhists and said they applied to Loma Linda because of its faith-based academic health sciences center and learning environment.

“We chose LLU School of Pharmacy after interviews with other schools because everyone was so welcoming here,” Christopher said. “The faculty truly cared about our success — we weren’t just another candidate like other places.”

“Having the opportunity to integrate our faith practice as part of our studies helped us get through,” Luis added. “Although our religions are different, we are connected to God and believe in the mission to Make Man Whole.”

Both twins are staying in California. Christopher was accepted into a PGY-1 pharmacy residency program at Pomona Valley Hospital Medical Center in the fall, and Luis plans to start working at a local community pharmacy this summer.

Representatives from Loma Linda University tell Patch that while other sets of twins have graduated from the school before, this is the first time two sets have done so at the same time.

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Katy Grimes | Contributor

When seeing a doctor in California now, it is important to understand that you are now visiting a servant of some politicians, not an evidence-based medical professional, a doctor posted on Twitter.

Effective January 1, 2023, Assembly Bill 2098 authored by Assemblyman Evan Low (D-Campbell), and signed into law by Gov. Gavin Newsom, is to circumvent due process against doctors over “Covid misinformation conduct.” AB 2098 will punish physicians and surgeons for “unprofessional conduct” for advocating for the potential benefits of early treatment with off-label drugs, or those who dare to ask questions about COVID vaccine safety.

“There is no jury voting on this,” Dr. Pete Mazolewski told the Globe in September. “This is a California Medical Board decision.” Gov. Newsom could have vetoed the bill, which is likely unconstitutional. Assembly Bill 2098 would empower the Medical Board of California to go after the licenses of physicians who disseminate “misinformation” or “disinformation” regarding Covid-19. The bill in its latest iteration defines misinformation as “false information that is contradicted by contemporary scientific consensus contrary to the standard of care.”

Who decides what is “Covid misinformation?” California’s Medical Board, which is currently made up of 12 individuals: 6 Medical Doctors, 3 attorneys, a Public Relations consultant, an “Ethics Reformer,” and a Life Coach. Under AB 2098, doctors would be subject to disciplinary actions by the Medical Board of California and the Osteopathic Medical Board of California if they do not adhere to the “approved COVID treatment consensus.” Who approves the “consensus,” Dr. Pete asked.

The medical board? Public health officials? Neither the members of the Medical Board nor all of California’s public health officials are licensed medical doctors. Does the Centers for Disease Control and Prevention decide “approved COVID treatment consensus?” Even CDC Director Rochelle Walensky recently admitted her agency’s failures during the COVID-19 pandemic during a message to her staff in August. ABC reported, “To be frank, we are responsible for some pretty dramatic, pretty public mistakes. From testing, to data, to communications,” Walensky said.

As attorney Laura Powell of Californians for Good Governance noted, “Since AB 2098 explicitly restricts speech based on its content, it is presumptively invalid. The bill does not address the problem identified. The bill’s authors and supporters point to the problem of doctors who widely amplify falsehoods about Covid-19, but silencing them would violate the Constitution. To remedy the constitutional problems, it would have to be pared down to the point that it would simply duplicate existing law. Proponents are unable to cite a single example of a harm that could be prevented.” Dr. Mazolewski also addressed the threat to “Disseminating information” from doctor to patient.

“This ‘unprofessional conduct’ if the medical board disagrees with the information is the loss of a medical license.” Physicians filed a lawsuit in November against the State of California over the new law, which attorneys say violates the 1st and 14th Amendments. The New Civil Liberties Alliance, a nonpartisan, nonprofit civil rights group, and attorney Laura Powell filed a complaint and motion for a preliminary injunction on behalf of five California doctors in Høeg, et al. v. Newsom, et al., asking the U.S. District Court for the Eastern District of California to prevent AB 2098 from going into effect.

“NCLA represents five physicians licensed by the Medical Board of California (MBC), most of whom treat patients on a regular basis. Drs. Hoeg, Duriseti, Kheriaty, Mazolewski, and Khatibi allege Assembly Bill (AB) 2098, signed into law on September 30, 2022, violates their First Amendment rights to free speech and their Fourteenth Amendment rights to due process of law,” the NCLA said in a statement. “The law not only interferes with the ability of doctors and their patients to freely communicate, but it has already been used as a weapon to intimidate and punish doctors who dissent from mainstream views. Several Plaintiffs have experienced threats from other doctors and individuals on social media to use AB 2098 to have their licenses taken away, an obvious attempt to suppress the doctors’ speech. They are being put between a rock and a hard place, fearing repercussions for acting in their patients’ best interests by honestly giving them the information they believe their patients need in order to make informed care decisions.”

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Congressman Raul Ruiz, M.D. (CA-36) is leading efforts to bring home additional funding for local hospitals and providers battling surges in hospitalizations due to the Delta and Omicron variants. In a letter to the Department of Health and Human Services, Dr. Ruiz urged the agency to quickly disburse the remainder of the Provider Relief Funds, allocated by Congress in COVID relief legislation, to hospitals and providers continuing to face pandemic-related hardships, such as staffing shortages. Ultimately, Ruiz’s efforts will help local hospitals and physician offices keep their doors open, preserving vital health care access for rural communities in the region.

“Now more than ever, we must protect access to quality, affordable care,” said Dr. Ruiz. “As our local hospitals and doctors continue to battle the COVID-19 pandemic, I’m calling on the Department of Health and Human Services to expedite pandemic relief funds so that our health care heroes can get the support they need to care for patients. I will continue fighting every step of the way to ensure the people I serve get the resources and care they need.”

Providers in California and the 36th District praised Dr. Ruiz’s efforts and echoed his calls for immediate disbursement of this vital funding.

“For a small rural hospital, the immediate disbursement of provider relief funds for rural facilities may be more critical than for larger urban hospitals,” said CEO of Palo Verde Hospital Sandra J. Anaya MSHA, BSN, RN. “Rural facilities operate on thin profit margins, with less staff, and limited allocations through the traditional supply chain. The additional challenges of staff illnesses, a small number of physicians, and patient surges in a crowded emergency department, can easily overwhelm the facility. The cost of travel nurses has become prohibitive as agencies continue to take advantage of all hospitals, large and small. Prolonged waiting time to transfer patients to larger, better equipped facilities, easily causes overcrowding of severely ill patients for little to no reimbursement. Provider Relief Funds will help ease the financial burden for many hospitals, especially rural facilities that continue to be challenged by myriad socioeconomic factors, that compound the provision of care in poorer communities such as ours.”

“San Gorgonio Memorial Hospital has incurred over $7 million of unreimbursed losses resulting from the ongoing Covid-19 pandemic,” said CEO of San Gorgonio Hospital Steven Barron. “We are currently attempting to secure bridge loan financing to cover the gap. If we are unsuccessful, we will be bankrupt. We desperately need help from the government.”

“California physician practices are still struggling with the challenges of the pandemic, making it more difficult to provide the quality care patients deserve during this critical time,” said California Medical Association President Robert E. Wailes, M.D. “The California Medical Association appreciates Congressman Ruiz’s leadership and work to release important Provider Relief Funding so that patients continue to get the medical services they need.”

“The COVID-19 pandemic has wreaked financial havoc on our already fragile health care delivery system,” said Carmela Coyle, President & CEO of the California Hospital Association. “Over the past two years, hospitals in this state have lost an estimated $16.3 billion due to the pandemic. And, while some federal relief funds have been made available to hospitals and other providers, the allocations to date haven’t come close to adequately covering these losses, limiting the ability to care for communities in need. California hospitals are grateful to Rep. Ruiz for his ongoing advocacy on behalf of health care providers and the people we care for, and we urge the Department of Health and Human Services to quickly release the remaining resources in the Provider Relief Fund to those hospitals and providers most in need.”

Hernan Quintas | Contributed

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