Chapter 1:
Founding: The Philosophy and Psychology of an NMA Medical Student Affiliate
"Every human has four endowments - self-awareness, conscience, independent will, and creative imagination. These give us the ultimate human freedom...the power to choose, to respond, to change."
- Stephen Covey
We see SNMA today as a great organization, with thousands of current members and tens of thousands that have walked through its doors. It's interesting to surmise about whether the founding members ever thought their noble idea would bear the fruit and have the impact that their organization now does. There were three easily identifiable concerns that facilitated the founding of the Student National Medical Association. The first involved the aspirations of a group of Black medical students to align and advance their interests while enrolled in medical school. The second involved the motivations of the National Medical Association (NMA), the largest and oldest organization representing African American physicians and their patients in the United States, established in 1895. The third was the reality of the state of healthcare for Black medical professionals and Black citizens in America. These considerations collectively prompted students and physicians into action.
In the period after the Supreme Court's 1954 decision in the Brown v. Board of Education case ended segregation in education, there was a hope that opportunities would increase for Blacks across colleges, as well as graduate and professional schools. Unfortunately, this didn't occur in significant numbers until the successes of the 1960s Civil Rights Movement, Black medical students did exist. When opportunities existed, the vast majority (as many as 98% in the period preceding the Brown decision and over three-fifths in 1968, after passage of the Civil Rights Act) of Black medical students had been trained at two universities: Howard University College of Medicine in Washington, D.C., and Meharry Medical College, in Nashville, Tennessee.6
The support for Black medical students during this time was almost nonexistent except for a few defined avenues. These included their medical schools, physicians of color (on staff or in the community), and the mentorship offered externally by the NMA. One might ask, "What about the American Medical Association? Of course, they supported matriculating physicians/medical students!" It is important to note that by and large, Blacks did not consider the American Medical Association (AMA) or its Medical Student Section (AMA-MSS) as an available resource. In fact, the message that Black physicians were not welcome was being delivered to Blacks in stark terms. The Flexner Report of 1910, commissioned by the AMA's Council of Medical Education and others, contributed to the closure of five of the then seven Black medical schools and all three women's medical schools. Also, ever since the AMA became a confederation of state societies in 1901, it allowed individual state medical societies to determine their own admission policies, amounting to tacit approval of the overtly racist policies of many of these groups, particularly in the South. Nathan Smith Davis, self-styled "father" of the AMA, specifically argued that admission standards with respect to sex or color should be left to local societies.
"The AMA tolerated institutional racism in its affiliated societies. On more than a dozen separate occasions, starting in 1939 and repeated in 1944, 1948, 1949, 1950, 1951, 1952, 1963, 1964, 1965, 1966, and 1968, the AMA reiterated its condemnation of racial discrimination and yet, in very same year, invoked Davis's 'local autonomy' principle to vote against motions prohibiting racial discrimination by member medical societies." 7
Despite repeated proposed resolutions by state societies for the AMA to act, it wasn't until 1968 that this significant change occurred. After the Massachusetts Medical Society proposed that the AMA amend its constitution and bylaws to give its judicial council the authority to expel constituent societies for race discrimination in membership policies, the AMA finally adopted a resolution directly accepting responsibility for the actions of its member societies and for directly confronting its racist history. According to the AMA itself, for decades, the organization "failed to take action against AMA-affiliated state and local medical associations that openly practiced racial exclusion in their memberships, practices that functionally excluded most African American physicians from membership in the AMA."8 In fact, the problem of groups of Black physicians consistently having sought and having been denied membership in the AMA then led to the creation of the NMA in 1895.9 On behalf of the AMA, immediate past-president Ronald Davis formally apologized for their past race-related history in 2008.10
It was against this backdrop that students at Howard University, led by Dr. Alyce Gullattee, rebelled against the notion that Howard automatically extracted dues from students' tuitions to support the American Medical Association-Medical Student Section. The idea was clear to the students that those funds could instead be used to support an organization comprised of and led by Black students. In time, this membership practice was shifted to the new Student National Medical Association. Meharry Medical College also began to transfer students' dues payments to the SNMA. This simple gesture, along with additional support provided by the National Medical Association, provided the financial underpinning for the fledgling SNMA. In fact, Howard and Meharry remain the only schools that collect dues from all their students on behalf of the SNMA.
The attraction of mentorship and the cultural considerations of aligning with a parent organization at that time cannot be overemphasized. The NMA was viewed as the path forward for Black medical students. Amid the activism of the 1960s, the NMA had already demonstrated a willingness to fight the AMA and to secure its own destiny. It was logical and desirable that students sought the guidance and support of the organization to which SNMA members would ultimately gravitate and belong. In the narrower view, the concerns of the students were different than those of working physicians. For the professionals, it was more about combatting the AMA. Black physicians were also fighting discrimination in licensing, and in being admitted to advanced training, research, and other professional practice opportunities. Conversely, students were struggling with the concerns of students. Their challenges were primarily getting into a medical school, then meeting academic challenges and subsequently graduating. Most students were also challenged financially. Funding support just was not easily available to minority students. It is to the eternal credit of Dr. W. Montague Cobb that he recognized that the immediate concerns of students and physicians were qualitatively different.
W. Montague Cobb, MD, was the first African American to obtain a PhD in physical anthropology. He served as Chairman of Howard University's Department of Anatomy, as well as President of the American Association of Physical Anthropologists (1957-1959), the National Medical Association (1964-1965), and the NAACP (1976-1982). It was an inspired notion that Dr. Cobb and other similarly inclined leaders within the NMA would actively work with students at Howard and Meharry to establish the SNMA, but to be clear, it was not intended for SNMA to be an independent arm but rather a subsidiary (i.e., a medical student section). The motivation was clear in that SNMA would create a pipeline into membership within the NMA. The mechanism of creating an NMA subsidiary was an overt gesture toward that end. Yet, the students' motivations and needs were different.
The urgent need for an effort including both medical students and medical professionals to combat the healthcare challenges and disparities among African Americans was great during the time of SNMA's founding, as it was when NMA was founded and as it remains today. In the 1960s, segregation was still prevalent in medicine. Historically, Black patients in Southern hospitals would often be placed in all-Black wards. White nurses were prohibited from caring for Black patients in some hospitals. The National Medical Association's agenda specifically focused on: (1) how to address the healthcare needs of a population that approached 20 million; (2) how to increase the number of minority physicians needed to adequately treat them; and (3) how to improve the overall health of the Black population.11
According to NMA history, "As late as 1912, only 19 of New York City's 29 hospitals would admit Black patients, and only three gave Black physicians the right to tend to their patients or perform operations."11 As a result of this lack of support and training, Black physicians carved their own path forward. Between 1865 and 1910, up to 14 Black medical schools were created.12 However, in 1908, the AMA commissioned college reformer Abraham Flexner and the Carnegie Foundation for the Advancement of Teaching to evaluate the state of American medical education, leading to a visit and review of every medical school in the country. The resulting Flexner Report called for every Black medical school except for Howard and Meharry to be closed, which occurred by 1923. Over the coming two decades, the number of Black doctors fell so...
