Of the nearly 45,000 people who hold a Virginia medical license, only about 8% identify as African American. And that percentage is even smaller among younger physicians.

When 22-year-old Jared Bourke walked across the stage and became a graduate of Hampton University in 2018, he already had his eyes set on another graduation: VCU's School of Medicine class of 2022. His goal: Wearing a white coat.

You have to be fairly intelligent and use your brain, but you also have to be a people person and use your character to care for people. So, for me, thats the beauty of medicine and thats why this is the field for me, says Bourke.

The now 24-year-olds aware of all the barriers standing in the way of black medical students. There's the possibility of getting into immense debt, although most medical students expect some debt.

And if finances don't hamper aspiring black medical students, then there's the imposter syndrome that Bourke says many struggle with. "The first day of class was Monday and it was Saturday. I literally broke down in my car, on the way here (VCU). I'm not an emotional person, but I broke down in the car because I was like, yo, I'm really about to do what I've been trying to do since I started school. Like am I really smart enough to be here?"

One of the largest deterring barriers are the lack of African-American physicians serving as mentors.

In 2018, The Virginia Department of Health Professions (VDHP) conducted a "Physician Workforce Survey" where just over 33,000 physicians responded. Just under 1,700 respondents identified as black or African American in a state whose African American population exceeds 1.6 million, according to census data. That number is on the verge of decreasing even more as one-third of all physicians plan to retire before turning 65.

Researchers at VDHP say the overall number of practicing physicians in Virginia may be lower than 33,000 because some of those physicians have the license to practice in Virginia, but may live in another state or work on a military base.

"I grew up in Lawrenceville Virginia on the campus of St. Paul's College and my next door neighbor was a Dr. Clifton Nelson. He was a family doctor and he was the role model that I grew up with and wanted to be like him," Dr. Michele Whitehurst-Cook recounts. She's been practicing family medicine for 37 years.

She didn't tell me how much longer she'd practice medicine, but she did tell me about the watershed moment she had in high school program that provided training at VCU. "Once I spent six weeks here, seeing patients watching doctors do rounds helping nurses out, I realized that I wanted to really be involved in health care wanted to be a physician," says Whitehurst-Cook.

She attributes her medical school success to the African American physicians who nurtured her interest in Richmond and to her childhood neighbor, Dr. Nelson. But having a physician as your neighbor, especially in rural parts of Virginia, is a rarity. It's also a rarity for an African-American patient to have an African-American doctor.

In the Commonwealth, the black doctor to black patient ratio is approximately 1 doctor for every 1,000 patients. Meanwhile, the approximate ratio for white Virginians is 1 doctor for every 400 patients. And if you look at health disparity data it shows that if people are cared for by doctors who look like themselves they have a higher comfort level. They're willing to share more information. They're more trusting of their advice and health outcomes are actually better, says Whitehurst-Cook.

She says increasing the pool size of medical school cohorts and continual investment in pipeline programs will help close that ratio gap.

Policy experts like Lauren Powell, Director of the Office of Health Equity for the Virginia Department of Health, point to similar programs, but say that doesnt address structural issues. If we think about the criteria to get into medical school there historically has been a very heavy emphasis on the MCAT, MCAT scores and GPAs- how well you do doing the impact is really kind of a question of how much resource or how much money you may have to be able to really prepare.

Powell says its her job to make sure folks living in the poorest parts of Virginia have the same chance to achieve health and wellness as affluent Virginians. True health equity, as she puts it.

She believes focusing on population health and health equity, at the structural level, are the best ways to curve health outcomes for Virginians across the state. "Employment, food security, right. Reliable transportation, affordable and safe housing- All of these things combined together to really propel your health or to hinder your health," says Powell.

She admits its hard work in a burnout profession, across ethnicities, but says doctors and policy experts have to take the lead. Second year medical student Jared Bourke wants to be that doctor. A doctor who leads and empathizes with patients on a human and cultural level.

This report, provided byVirginia Public Radio, was made possible with support from theVirginia Education Association.

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Improving the Doctor to Patient Ratio in the African American Community - WVTF