Chronic kidney disease and Black America: Impact and opportunity for nephrologists of color

Dr. Jesse Roach, Senior Medical Director, Health Equity, CVS Kidney Care

When you look at the data, it’s clear that chronic kidney disease (CKD) has a disproportionately negative impact on the health and wellbeing of communities of color. African Americans have a higher risk of developing diabetes, hypertension and cardiovascular disease, all of which are a gateway to CKD. They’re almost four times more likely to have kidney failure compared to White Americans. African Americans make up only 13% of the U.S. population, but 35% of these individuals experience kidney failure, are on dialysis or need kidney transplants.

With statistics like these, you might assume there would be more African Americans pursuing careers in nephrology to create solutions for this silent killer. However, nearly two-thirds of all nephrologists are White, and fewer than five percent are African American. As we observe Black History Month and this year’s theme of Black Health and Wellness, it’s vital that we encourage minorities to pursue nephrology.

Health care impacts

Social determinants of health, including food insecurity, access to housing and transportation and lack of employment and healthcare, greatly impact communities of color and play a role in CKD. African American doctors typically establish their practices in underserved communities, which makes treatment and services readily available to patients of color, leading to better health outcomes. A 2019 study conducted by the National Bureau of Economic Research compared the results of African American men who were treated by African American doctors versus African American men with non-African American doctors. The results showed that patients with doctors of the same race were more comfortable discussing their health concerns and chose to participate in preventative services and life-saving screenings and tests. This also indicates a higher degree of trust between African American patients and physicians of color. 

Supporting increased diversity in medical programs

To encourage minorities to pursue nephrology, the first step is to encourage them to pursue medicine. According to The New England Journal of Medicine, the percentage of Black men in medical school in 2019 was only 2.9% compared to 3.1% 40 years earlier — a dismal statistic that only got worse. The Journal of General Internal Medicine reports that the percentage of Black men and women in the physician workforce has increased by only four percentage points in 120 years. There is a lack of diversity in the medical field due to the many challenges African Americans and communities of color face, including education disparities, medical school costs and bias and stereotyping. We must address these issues to make medical careers more accessible for people of color.

There are many ways to support African Americans who are interested in pursuing nephrology. Colleges and universities can implement diversity, equity and inclusion (DEI) initiatives and create mentoring programs to recruit students of color into their medical schools. For example, the University of Kentucky College of Medicine has a student-led program to recruit students underrepresented in medicine. Over two days, applicants experience medical school and meet current students who serve as mentors.

The organization Black Men in White Coats helps to increase the number of African American men in medicine through “exposure, inspiration and mentoring” by partnering with medical schools to create videos that shine a light on this issue. They also have a virtual mentoring program and provide recruitment opportunities for African American men interested in medical careers.

In October 2020, the Association of American Medical Colleges developed a plan to increase the diversity of applicants to medical schools in the U.S. and Canada. They’re also implementing DEI measures at medical schools, teaching hospitals and healthcare systems.

At CVS Health, health equity is a core part of our business. We’re addressing social determinants of health at the community level by supporting organizations and initiatives that provide access to health care services, affordable housing and medicine, which address food scarcity and promote education and job opportunities. By addressing social determinants of health, we’re breaking down barriers facing communities of color and opening doors to a brighter future. More African American nephrologists can lead to more patients of color successfully navigating the healthcare system to live longer, healthier lives.