Black dermatologists are rare gems in health care
When Dr. Shari Hicks-Graham of Downtown Dermatology in Columbus sees patients, she looks at their skin as a window to the health problems they might hold inside.
“If a patient had diabetes, or kidney disease, or an autoimmune condition, in many cases, you could see that by looking at some of the features on their skin,” Hicks-Graham says in an interview.
As one of only three Black dermatologists in the Columbus region, however, she believes other doctors sometimes look at skin of color as a barricade, rather than a window.
The tiny number of dermatologists of color in Columbus mirrors a trend around the state and country, where the population of physicians doesn’t always resemble its population of patients.
“Representation matters when it comes to patient care and outcomes,” Hicks-Graham says. “It’s evident when I see patients who come to me with very mundane conditions — eczema, hair loss, things that are kind of bread and butter for dermatology.”
For people of color, such basic conditions sometimes go undiagnosed or misdiagnosed by doctors unfamiliar with treating darker skin, she says.
According to a June 2017 study published in the Dermatology Journal of the American Medical Association, 3% of dermatologists in the United States were Black. In 2020, 13.4% of the U.S. population was Black or African American, according to the U.S. Census.
“Columbus is just like any other city that struggles with this,” Hicks-Graham says.
But she added that, because of the city’s racial breakdown, it may be particularly pronounced here. Nearly 30% of Columbus residents identify as Black or African American alone, according to the census.
From education on, need for diversity at the helm of issues
Dr. Susan Taylor, an associate professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania, says the lack of diversity in dermatology finds its roots in medical school. Taylor also serves as the department’s vice chair for diversity, equity and inclusion.
For one, she says medical students from groups that have been traditionally underrepresented in medicine sometimes feel pressured to enter primary care over other specialties to better serve minority populations.
As a medical specialty, dermatology is highly competitive. Taylor says late exposure to dermatology in school and the need for prior research experience, high board scores or status in an honor society also can prevent students from underrepresented groups from gaining placement in a dermatology residency program.
A lack of diversity in any medical field can hurt the quality of care given. And a doctor from one ethnic or racial background might be able to offer a doctor from a different background information not necessarily taught in school.
"Diversity of thought, opinion, experience — it strengthens medicine," Taylor says.
Hicks-Graham wants to buck this trend she and others see as a glaring issue in her field, but she's also a busy woman.
Beyond Downtown Dermatology, she created a hair-care line called LivSo that includes shampoos for people with curly hair who struggle with scalp irritation. She is raising two children. She goes to the gym most afternoons, to let off steam.
She also works to mentor undergraduate and medical students with an interest in dermatology and a devotion to diversity.
Looking to the next generation of dermatologists
Maiya Davis was quick to notice a reference book that sits on the table outside Hicks-Graham’s office.
Davis, 19, says it was unlike the glossy pages of published text she pored over during her first year of college, with its 21-credit-hour semesters, and it was nothing like the tattered book that weighed down her bookbag when she took high school anatomy at St. Francis De Sales.
The book highlighted skin illnesses and how they might show on darker skin.
“The references are never on skin of color, so you’re always seeing white or fair skin,” she says. “It was really cool to see a whole book that was created for skin like mine.”
When Davis was in late elementary school, her family sought Hicks-Graham out for that same reason. Skin issues began to emerge with Davis and her younger brother, and Hicks-Graham had a reputation for strongly caring about patients with skin of color.
Today, her relationship with Hicks-Graham is that of a mentor and mentee.
Davis shadowed her longtime doctor this summer in preparation for her second year of six in an accelerated, dual-degree bachelor’s and medical program at Howard University.
Her brother M.J. will take his first classes for the same dual-degree program come fall.
From taking summer classes in organic chemistry to volunteering in the community, Davis stays busy in the way that her mentor does. At the end of the day, she knows she wants to be a dermatologist.
“I’m doing the best I can, and I just tell myself that it’s all going to pay off in the end,” Davis says. “This is the path that I’m meant to be on.”
Hicks-Graham says she believes newer graduates are more open to learning about serving a diverse population of patients.
Taylor adds that in the last year, professional dermatology organizations — including the American Academy of Dermatology and the Association of Professors of Dermatology — promoted efforts to increase diversity, equity and inclusion.
She says some dermatology training departments also have prioritized similar endeavors in their residency programs.
Dr. Hicks-Graham is listed on Black Dermatologist Directory online, which was created in 2020 by Dr. Achiamah Osei-Tutu in New York for people of color seeking a dermatologist who looks like them.
Meanwhile, Hicks-Graham says work still needs to be done.
She still finds herself concerned about her patients, who tell her previous physicians haven’t taken issues as seriously or have outright said they aren’t equipped to diagnose and treat skin of color.
Hicks-Graham wants to see diversity as the norm, rather than an afterthought.
“It’s about resetting the standard, so that patients of color are not made to feel like they are once again marginalized because of who they are,” Hicks-Graham says. “We just have to begin to normalize diversity.”