Onward and Upward

The Evolution of Black Physicians in Organized Medicine and Urology

Class in Capillary Physics at Hampton Institute, VA
Library of Congress

The evolution of Black physician professional advancement in medicine and urology in the United States of America is contextualized by the history of organized medicine in this country. From the time of the Civil War to the Civil Rights era, the traditions of organized medicine dictated the medical training and professional practices of Black Americans, with long-lasting effects on the size of the existing Black physician workforce in the US and the current status of health care disparities in this country.

The American Medical Association

The establishment of organized medicine relates to the origins of medical societies in America. Whether formed at the regional or national level, these institutions have served for professional inclusion and advocacy as well as opportunities for academic advancement in medicine. The American Medical Association (AMA), founded in 1847, is well known, representing the national federation of medical societies and colleges. In its Code of Medical Ethics, the AMA espoused the tenet that scientific accomplishment alone (in reference to a “regular” medical education) should qualify membership. However, in routine practice, members uniformly opposed Black physician membership and interactions professionally or socially, and only by the 1940s had AMA constituent societies allowed occasional membership to Black physicians.

Medical Licensing

Another factor constraining advancement for Black physicians was disapproval of medical licensure by state licensing bodies. This routine practice limited membership in medical societies and precluded hospital admitting privileges, which also regularly required documentation of medical society membership. Without medical society memberships and specialty board certifications, Black physicians commonly endured professional isolationism, deterioration of professional competencies, and reduced sources of income.

The Flexner Report

Abraham Flexner
Library of Congress

The Flexner Report, commissioned at the behest of the AMA, is widely heralded for advancing the quality of medical education in the United States. Its publication in 1910 resulted in the reduction of 160 medical schools existing at the time to 31 institutions. Among the evaluated schools were 15 “black” medical schools with proprietary or church affiliations and seven officially recognized “black” medical schools. By recommendation, all were closed with the exception of two schools of medicine, Howard University College of Medicine in Washington, DC and Meharry Medical College in Nashville, Tennessee. This consequentially reduced opportunities for medical education for Black physicians, since their admission into “white” medical schools was not uniformly possible.

The Flexner Report also contained the pointed conclusion that segregated and unequal education should be afforded Black Americans. It carried the recommendation that Black physicians should be trained differently, specifically that “negro doctors” should be educated not as surgeons or specialists but primarily as “sanitarians” to “humbly and devotedly” teach hygienic principles to “their people.”

Meharry Medical School
Nashville, Tenn. Postcard
ca. 1930–1945

In the era following the Flexner Report, Howard and Meharry medical schools can be credited with graduating 85% of trained Black physicians in the United States.

Students studying at tables in a library at Howard University, Washington, D.C., 1958
Library of Congress

Black Medical Organizations

Washington Post, 1963
The Herb Block Foundation

In response to the exclusion from AMA-affiliated societies, Black physicians founded their own medical societies. These included local and regional medical societies such as the Tennessee Colored Medical Association established in 1877, the Medico-Chirurgical Society of the District of Columbia founded in 1884, and the Old North State Medical Society of North Carolina founded in 1887, among others. At the national level, the first minority medical association was the American Medical Association of Colored Physicians, Surgeons, Dentists, and Pharmacists, formed in 1895, although its name was changed in 1903 to the National Medical Association (NMA). Such organizations have served to support Black physicians and promote the welfare of all racial populations in America.

Formal acceptance of Black Americans into the medical profession only occurred by the late 1800s. In 1868, Howard University College of Medicine was founded as a “black” medical school. In the era following the Flexner Report, Howard and Meharry medical schools can be credited with graduating 85% of trained Black physicians in the United States.

A multitude of pioneering “firsts” in medicine are credited to Black physicians, who have persevered and charted progress through difficult times in American history. Following the Civil War, Black physicians became faculty members at Howard and Meharry medical schools. Following the Civil Rights movement, increasing numbers of Black physicians achieved specialty board certifications, entered and led faculty ranks of predominantly “white” medical or graduate schools, and obtained leadership positions in integrated medical societies including the American Urological Association (AUA). Given opportunity, Black physicians achieve competencies and participate actively in medical education and organized medicine.

TEXT BY:
Arthur L. (Bud) Burnett, MD, MBA
The Johns Hopkins University School of Medicine

Black Innovators in Urology

Dr. R. Frank Jones

Richard Francis Jones graduated from the Howard University College of Medicine in 1922. In 1936, he became the first Black urologist in history to be granted board certification by the American Board of Urology.

Dr. Jones played a pivotal role in establishing the first urologic training program at Howard University Hospital, formerly Freedmen’s Hospital, in 1947, which allowed Black physicians to train in urology. He was the program’s first director and retired from that role in 1970. In a 1972 profile of Dr. Jones in the Journal of the National Medical Association, he called his role in this training program his “greatest professional contribution.”

Dr. W. Bedford Waters

Dr. Waters graduated from the Vanderbilt University School of Medicine in 1974, becoming only the second African American medical school graduate in the history of the University. He completed his internship and one-year residency in general surgery at the University of California, San Diego in 1976, completing his urology residency at Harvard in 1980. Dr. Waters then joined the faculty at Loyola University Chicago in the Stritch School of Medicine, where he remained for 20 years. He joined the staff at The University of Tennessee Medical Center in 2001, where he was named the first chair of the new Department of Urology in 2017.

Dr. Waters was a pioneer in urologic oncology and became the first African-American to be elected to membership in the American Association of Genitourinary Surgeons in 2008, as well as the first African American President of the American Board of Urology. He spearheaded the development of urologic research and global partnerships for education in the practice of urology in African countries. For this work, he was named a “Friend of PAUSA” by the Pan African Urological Surgeon’s Association.

Dr. Curtis Pettaway

After receiving his degree in biology from Millersville University in 1978, Dr. Curtis Pettaway went on to earn a medical degree from Temple University before completing post-graduate training in urology at the University of Texas Southwestern Medical Center and, later, a urologic oncology fellowship at the center. Dr. Pettaway is now a Professor of Urology at The University of Texas MD Anderson Cancer Center in Houston, Texas.

His pioneering contributions to the field of urology, specifically in the realm of penile cancer, have redefined the standard of care and improved patient outcomes. He developed innovative surgical techniques that successfully reduced the extent of inguinal lymph node dissections while maintaining accurate staging. His dedication to improving the treatment of advanced penile cancer has resulted in substantial breakthroughs, including a Phase 2 study of a combination therapy involving cisplatin, paclitaxel, and ifosfamide, which became the standard approach for treating penile cancers.

Dr. Isaac Powell

Dr. Powell graduated from the Indiana University School of Medicine in 1969 and now has over 54 years of experience in the medical field. He is a Professor of Urology at the Wayne State University School of Medicine and Urologic Oncologist at the Karmanos Cancer Institute in Detroit, Michigan. Dr. Powell is considered a pioneer in prostate cancer research, particularly in addressing the health disparities faced by Black Americans.

His team at Wayne State University determined that a CYP3A4 gene variant was more common in African American men and associated with aggressive prostate cancer characteristics. His work continues to provide crucial insights into the disparities in prostate cancer outcomes among African American men. In 2021, Dr. Powell received a Presidential Citation from the AUA for outstanding contributions regarding the biology, genetics and environmental impact of prostate cancer in African American men.

Dr. Arthur “Bud” Burnett

Dr. Arthur (Bud) Burnett II, received his AB degree in Biology from Princeton University and MD and MBA degrees from Johns Hopkins University. His post-graduate training in general surgery, urology, and reconstructive urology and urodynamics was performed at the Johns Hopkins Hospital. He subsequently joined the faculty at the Johns Hopkins University School of Medicine and ascended to his current rank as the Patrick C. Walsh Distinguished Professor of Urology.

Dr. Burnett has significantly contributed to understanding the molecular mechanisms behind sickle cell disease-associated priapism. His groundbreaking research has also paved the way for transformative advances in the clinical development of oral medications to treat erectile dysfunction. In 1992, he discovered that nitric oxide, a vasodilator that neurons and endothelial cells produce, plays a crucial physiological role in penile erection. In 2018, Dr. Burnett and a team of surgeons at The Johns Hopkins Hospital performed a groundbreaking total transplant of the penis, scrotum, and lower abdominal wall on an injured veteran, the first of its kind.

Dr. Frank Staggers

Dr. Frank E. Staggers earned a degree in medicine from Meharry Medical College in Nashville, Tennessee, leading to a residency in the Navy as a Lieutenant Commander with a surgical subspecialty in Urology. He served as Assistant Chief of Urology at the U.S. Naval Hospital in Oakland, California from 1961-1963. He would later go on to become President of the National Medical Association in 1988.

Dr. Staggers was a pioneer of the concept of community advisory boards in urology focused on patient-centered care and outreach. He founded several organizations and initiatives, including the UCSF Comprehensive Cancer Center community advisory board, the Prostate Conditions Education Council, the St. Luke’s Society (an alliance between East Bay Black doctors and ministers), and the Network of Ethnic Physician Organizations.

Dr. Carol Bennett

In 1987, Dr. Carol J. Bennett became the first Black woman to be board certified in Urology. Her training under Dr. Edward J. McGuire gave rise to her establishment of the spinal cord injury fertility program, which led to the first pregnancy in the United States from a semen sample obtained from a paraplegic man by electroejaculation.

Following training, Dr. Bennett joined the faculty at the University of Michigan, making her the first woman on urology faculty in the university’s history. Shortly after, in 1996, she accepted a position as Chief of Urology at West Los Angeles VA to become the first woman on faculty at the University of California Los Angeles (UCLA). Dr. Bennett was appointed to the Henry E. Singleton Chair in Urology at UCLA in 2019 in recognition of her service to our veterans for over 25 years, and in 2022 was awarded the Lifetime Achievement Award by the Association of Black Women Physicians (ABWP).

Dr. Cheryl Lee

Dr. Lee completed her training in Urology at the University of Michigan and her fellowship in Urologic Oncology at the Memorial Sloan Kettering Cancer Center. She was a faculty member at the University of Michigan for 16 years, rising in ranks to Professor with Tenure, and was the inaugural Dr. Robert H. and Eva M. Moyad Research Professor. When she became the Dorothy M. Davis Chair in Cancer Research in 2016 at The Ohio State University, she also became the first Black woman in the country to lead a Urology department.

Dr Lee has developed innovative ways to provide outreach to bladder cancer patients with an emphasis on improving quality of life, surgical outcomes, and survivorship for bladder cancer patients. She created a model care plan for bladder cancer survivors and has championed a voice for these patients in her role as former President of the Bladder Cancer Advocacy Network.

Dr. Ray Littleton

Dr. Ray Littleton graduated from the University of Michigan Medical School in 1975 before completing his residency at Henry Ford Hospital in Detroit, Michigan. He joined the Senior Staff at Henry Ford Hospital in 1980 and helped pioneer minimally invasive surgery by performing the first percutaneous kidney stone removal in Michigan in 1983. He also performed the first shockwave lithotripsy for kidney stones in Michigan in 1985. Dr. Littleton remains a practicing urologist at Henry Ford Hospital, where he specializes in diseases of the urinary tract and the male reproductive system.

Dr. Littleton was one of the first urologists to extend endourology to the care of animals, adapting instruments for the treatment of bladder calculi in a tiger. In 1997, he successfully performed a bladder endoscopy on a 350-pound Sumatran Tiger named Paul at the Detroit Zoo.

Dr. Willie Underwood

Willie Underwood III, MD, MSc, MPH, is a board-certified urologist with more than 20 years of overall urologic surgery experience, including more than ten years focused on robotic urologic surgery. He received his undergraduate degree from Morehouse College, and his Doctor of Medicine and Master of Science in Anatomy and Cellular Biology degrees from the State University of New York, Upstate Medical University, Syracuse, New York. He received his general surgery and urologic surgery training at the University of Connecticut Health Center.

After his residency, he became the fifth urologist admitted into the prestigious Robert Wood Johnson Foundation Clinical Scholars Program, which he completed in 2002 at the University of Michigan, Ann Arbor. He was elected to the American Medical Association Board of Trustees in June 2019 and became Chair in June 2023. Dr. Underwood holds patents in the U.S. and Japan for his development of a prostate cancer biomarker. He is an expert in health care disparities and health care policy and has used this expertise to effect change.

Dr. Fenwa Millhouse

Originally born in Nigeria, Dr. Fenwa Millhouse immigrated to the US with her family when she was a young child. She earned her medical degree from the University of Texas at Houston, where she discovered her passion for urology. She trained at the University of Chicago for urology residency and completed her fellowship in female pelvic medicine and reconstructive surgery at Metro Urology in Woodbury, Minnesota.

Dr. Millhouse is a distinguished recipient of the 2023 Healthcare Impact Award by Top Docs and was named Top Urologist in Chicago in 2023 by Women in Medicine. Dr. Millhouse has fully embraced the concept of bringing urology to the masses. She pioneered dynamic and accessible social media engagement with the public on all areas of urology and has expanded these efforts with her new television show “Dr. Down Below.”

TEXT BY:
Kymora Scotland, MD, PhD
University of California Los Angeles

Sharing Our Power to Improve the Health of Our Marginalized Patient Communities

A Case for Engaging Black Patients and Communities in Urologic Care and Research

A recent study evaluating the relationship between race and health in the US estimated that the 1.63 million excess deaths among Black Americans between 1999-2020 accounted for 80 million years of life lost among Black individuals. This sobering statistic reflects the fact that structural and social determinants of equity and health have and continue to drive inequitable healthcare access, delivery, and quality. Within the field of urology, we have the largest racial disparity in cancer death, with Black men being 2-3 times more likely to die from prostate cancer than the average US population. There are also well-documented racial disparities in incidences of benign urologic disease, such as benign prostatic hyperplasia, female urinary incontinence, and kidney stones.

According to the U.S. Department of health and human services office of minority health:

black men are 2-3 TIMES more likely to die from prostate cancer than the average us population

black men have lower 5 Year Survival Rates for most cancer sites.

From 2015-2019, black men were 1.7 TIMES more likely to have new cases of prostate cancer.

Formulating an Effective Strategy

Institute of Medicine, Quality of Health Care in America, 2001

In its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, quality health care was defined as safe, effective, patient-centered, timely, efficient, and equitable. The question remains: how do we overcome structural and social determinants of equity and health, such as systemic racism, economic systems, laws and policies, and healthcare infrastructures that disadvantage Black Americans and other marginalized communities from accessing equitable, safe, timely, efficient, and effective care? Current investigation of inequities in urologic care and outcomes has focused solely on describing healthcare inequities among Black urology patients and other marginalized patient populations.

An effective strategy for eradicating racial inequities in health and urologic care must develop interventions to address the underlying root causes of health inequities and must rigorously test and evaluate population-level interventions to create more equitable care and outcomes for marginalized communities.

The Charge to the Urologic Community

Ultimately, it is up to the urologic community to develop, implement, and sustain interventions that will improve the health of our Black and marginalized communities.

The challenge is that a history of experimentation, trauma, and abuse combined with a power differential between the medical field and marginalized communities creates opportunity for exclusion and distrust that drives Black urologic patients away from high quality care and important clinical studies.

according to 2022 aua census data, the number of practicing black urologists in the us is 293, which is 2.2% of all urologists

As a discipline, community partner participatory research and patient-centered outcomes research both rely on fundamental pillars of trust, cooperation, and cooperative learning to empower patients to participate in care delivery and research as equal partners with established medical institutions and practices. This approach, which is a challenging and resource-intensive endeavor, allows us to transfer power to our patients by centering Black individuals and communities as true partners in our clinical and research activities. This transfer of power is an important step in overcoming the structural and social barriers in the U.S. that have served as the foundation for inequities that we observe in urologic care and outcomes.

By sharing our power, we allow ourselves to understand the lived experience of the Black community, to value their concerns about their care, to honor their desires for care delivery in their communities, and to elevate the activism of our Black communities in seeking better health outcomes.

TEXT BY:
Yaw A. Nyame, MD, MS, MBA
Fred Hutchison Cancer Center, University of Washington

Richard Frank Jones, MD

Samuel W. Jones, the paternal grandfather who bought his freedom on the “installment plan,” shown with his wife, Eloisa, and two of their children, Samuel L. (Dr. Jones’s father, at top) and Frank (c. 1870).

Dr. Richard Frank Jones (1898-1979), former Medical Director of Freedmen’s Hospital,
was Professor of Urology at the Department of Urology at the College of Medicine at Howard University, Washington, D.C., and the first Black Board-certified urologist in
the United States.

In 1978, the AUA Forum on the History of Urology, started by Drs. Frank Bicknell and Elmer Belt, invited Dr. R. Frank Jones to speak. The following quotes are from his presentation, published in 1981 by the AUA and Hoffman-LaRoche, Inc.

“If I have been persistent, inventive and dedicated, the credit accorded me is not fully mine. It truly belongs to two incredible men who were my earliest recorded ancestors: Robert Gunnell, a slave in Virginia; and Samuel W. Jones, a slave in Maryland. Both men achieved freedom and moved toward economic and cultural substance some two decades before the Emancipation Proclamation of 1863. It was they from whom I inherited the spiritual, economic and cultural standards which unmistakably held me to my purpose.”

Early Education

Samuel L. and Mary Payne Jones - Parents of R. Frank Jones, MD

“My entire formal education was obtained in the public schools of the District of Columbia and at Howard University…In the summer following my second year at Howard, I worked as a waiter in Saratoga Springs, N.Y. When I returned to Washington, my father arranged to have me hospitalized on a between semester date for what was thought to be an inguinal hernia but was actually a varicocele. I spent 14 days in the hospital completely fascinated by what went on! Luckily, following my return to school, there was enough time to take the biological sciences required to qualify for medical school in the fall of 1917.”

Fun Fact: Dr. R. Frank Jones’ grandmother Eloisa Benson was indentured to a “doctor” who taught her midwifery skills. “She was proficient at her calling and in demand locally as well as in other states. She traveled, for example, to Cincinnati and Chicago to deliver the babies of Charles Howard and his brother, General Oliver Otis Howard, most notably known as the founder of Howard University in 1867.

Medical Training

“From the beginning I was successful in my medical studies. Between the end of my junior year and graduation, I lived in a surgeon’s scrub suit and was available to any surgeon as second or third assistant for all kinds of operations at any time that did not conflict with medical courses and lectures (then generally given in the afternoon).”

“It was also at that time [1930] that I was given the choice of becoming either a gynecologist or a urologist. I chose urology.”

“Although Negro community hospitals existed in Kansas City, St. Louis, Chicago, Philadelphia and Baltimore, no residency training programs in urology had been undertaken at those hospitals. Until 1936 or 1937, when I instituted a four-month program for assistant residents in general surgery, there were but four black men in America who had received any formal training in urology.”

Medical Certification

“To be accepted for Board evaluation in 1936, it was necessary to get endorsements from two local [Board-] certified members… Despite the prevalent venom of that day, I was examined with other urologists from this area. Nine of us were successful in becoming Diplomates of the Board that year (1936).”

1936

Board Certified in Urology

1937

Clinical Assistant Professor in Urology

Instituted a Training Program for Urologic Residents

1942

Clinical Associate Professor in Urology

1945

Clinical Professor in Urology

1947

Training Program Approved for Urologic Residents

1958

Medical Director of Freedmen’s Hospital

The NMA and R. Frank Jones Urological Society

The American Medical Association (AMA), founded in 1847, espoused in its Code of Medical Ethics the tenet that scientific accomplishment alone should qualify membership. However, in routine practice, members uniformly opposed Black physician membership and interactions professionally or socially, and only by the 1940s did AMA-constituent societies allow occasional membership to Black physicians.

In response to the exclusion from AMA-affiliated societies, Black physicians founded their own medical societies, both locally and nationally. At the national level, the first minority medical association was the American Medical Association of Colored Physicians, Surgeons, Dentists, and Pharmacists, formed in 1895, although its name was changed in 1903 to the National Medical Association (NMA). Such organizations have served to support Black physicians and promote the welfare of all racial populations in America.

Members of the R. Frank Jones Urological Society

The Urology Section of the National Medical Association adopted the name of the R. Frank Jones Urological Society (RFJUS). The Society was incorporated as a 501(c)(3) nonprofit corporation in 2009. It is dedicated to increasing the number of culturally responsible Black Urologists who excel academically, succeed professionally, and positively impact the community.

onward and upward: “As I reflect upon my modest contributions to medicine, to urology and to my medical school during a lifetime of racial discrimination, I can take comfort in the much wider opportunities we helped to forge for the present and future generations of black physicians.”

Medical Association –The AUA

“Years later, in 1973, I entered the AUA golf tournament and won the much - coveted Golden Cystoscope, which I donated to the College of Medicine of Howard University.”

“The year after I was certified, I applied for membership in the Mid-Atlantic Section of the AUA - a prerequisite for AUA membership.”

“After the Mid-Atlantic meeting, I was notified that I had been elected to membership. I immediately sent $25 for the initiation fee, then proceeded to get endorsements from Dr. Harry Rolnick, and from Dr. Guy Hunner of Johns Hopkins University. Case presentations were delivered posthaste to the AUA and approved. About three weeks after the [annual] meeting in Quebec, I was shocked to receive a letter from the secretary of the Mid-Atlantic section stating that my acceptance for membership was faulty because I did not have the necessary endorsements. At intervals thereafter, I applied directly for a membership application. I never received one. Thirty years later, in 1965, when the atlarge category was established, my application was accepted directly into the AUA. I am now pleased to be a member of the American Urological Association!”

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