A Tale of Two Hospitals: A Black Physician Serves NYC’s Richest and Poorest Patients
Racial injustice was there all along. But it wasn’t until the COVID-19 pandemic brought it to the forefront of public consciousness that Dr. Steven McDonald, a Black physician who works in the emergency department at Columbia University Irving Medical Center, began to realize its weight and ubiquity.
He recalls, for example, clocking in for a shift one morning in the fall of 2019. Among his patients was a Black man who was experiencing back pain. McDonald diagnosed the pain as benign and prescribed him a round of analgesics. But the man refused to leave.
“I knew that he had no real emergency, so I let the nurse manager know that this person could be removed by security. Security got involved, and he still refused to leave,” McDonald remembers. “What ended up happening—this was now out of my hands—he ended up getting arrested on the spot for trespassing. And he was taken to jail.”
Months later, in the spring of 2020, two white women came into the emergency department with back pain. “This was right before the murder of George Floyd,” McDonald recalled. “I treated them both for back pain as I normally do, and I assured them there was no emergency here.”
He tried to discharge them, but both women refused to leave. Again, McDonald informed the nurses and called security to escort them out.
“And instead of being arrested on the spot for trespassing, both of these patients were offered a patient services representative so they could file a complaint against me,” McDonald explains. “One left the emergency room, immediately called 911 and was brought back in and got to see a different doctor. You know, that's a really night-and-day example of what Black patients experience and versus white patients. Same doctor, same chief complaint; the only difference there was the color of the skin.”
Becoming a doctor
McDonald isn’t the first clinician in his family. His father was an ICU physician and his mother began her career as a nurse before becoming the dean of Health and Human Services at a local university in New Haven, Connecticut, where McDonald grew up.
“My dad, he always hammered home the idea of education, especially as a Black man, as the one thing that can never be taken away from you,” McDonald says, adding that a focus on service was also woven into his family’s core values. “Medicine was an easy way to meet both of those objectives.”
McDonald earned his medical degree at Columbia University before completing his residency in emergency medicine at Bellevue and NYU Langone Health. It was here, he says, that the US healthcare system's implicit bias became clear.
Like many who enter the field, McDonald believed medicine was about serving patients and giving back to local communities. But “the reality is that the system is really stacked against you,” he says.
This was especially true at Bellevue, a safety net hospital where patient distrust in the healthcare system was plentiful and insurance coverage was rare. Working at Bellevue illustrated how social programs were failing too many New Yorkers. McDonald describes his time at the hospital as “Sisyphean,” in an allusion to the Greek myth of Sisyphus, the man damned to eternally push a boulder up a hill, only for it to fall back to the bottom every time he neared the top.
This period marked the beginning of McDonald’s “coming to racial consciousness.” Having been raised in a mostly white suburb of New Haven and attending several predominantly white educational institutes, McDonald felt he sailed through his youth with “the luxury of not thinking about my race.” His parents taught him that assimilation into a white world was the only route to success.
“I didn't really critically think about being Black while in medical school. It just didn't totally occur to me that I'm in an institution where all of these physicians that I'm working with, all of the residents, are all white,” he says.
But most of the patients were Black or Brown at Bellevue. And they were sicker than any he’d seen before. Rescuing patients in cardiac arrest was gratifying in the short term, but watching these patients return to the hospital over and over left him questioning how much of a difference he made.
During his second year at Bellevue, he saw Black and Brown patients churning through the system with alcohol or drug use disorders. Others had chronic disease and cancers that had gone unchecked for years, often because of a lack of insurance coverage. McDonald began to feel that practicing medicine under the umbrella of the status quo wasn’t enough.
That feeling crystallized as he continued his residency at NYU Langone. The hospital catered to New York’s wealthiest, who often benefited from Cadillac insurance plans. There were almost no Black patients and the affluent white patients would often question where he went to medical school. Some would even ask if he was really a doctor.
“That's their entrenched racism, and their response to seeing a black physician come into the room,” he explains.
McDonald notes there were no Black men in the faculty at NYU, which meant he was left to endure this entrenched racism alone. In fact, McDonald ranks among the 5% of American physicians who are Black. He says that while he’s grateful for many of the values his parents instilled in him, he regrets their encouragement to assimilate to white culture and avoid thinking critically about race.
“That ultimately delayed the coming-of-age or realization that I think could have really helped me. Because I've been delivered now into a world where I don't have many Black connections from college or from high school. The last few months have been very trying, and I wish I had more Black voices in my life to look to,” McDonald says. “And I think, ultimately, that hurts everyone. You can't be anti-racist, if you're not thinking about race.”
Now, McDonald is now doing his utmost to amplify Black voices—and to become one of those Black voices he sorely missed during his education.
Dr. Steven McDonald
Becoming an activist
After McDonald finished residency in 2018, he returned to Columbia University Irving Medical Center, where he became an assistant professor of emergency medicine. Soon after, the coronavirus pandemic arrived, bringing with it a disparate burden to Black and Brown communities. He had never considered himself an activist, but if there was ever a time to act, it was now.
“With all of our normal systems disrupted, people are starting to examine things like, ‘How does my job make the world a better place?’ And that's what started happening for me,” he explains. “Once it started becoming crystal clear that the government abdicated any sort of responsibility of caring for these people … it became clear to me that someone needs to start saying what they're seeing.”
Data released by the US Department of Health and Human Services in March 2021 illustrates that racial and ethnic minorities not only suffered higher rates of infection, but also higher rates of hospitalization and death from COVID-19. Now that vaccinations are rolling out, early evidence suggests that minority groups are being vaccinated at a proportionally lower rate compared with white Americans, according to HHS.
Research suggests that Black physicians are more likely to contract the virus than their white colleagues, in part because they often practice in underserved communities and at institutions that have fewer resources such as protective equipment. McDonald saw the data play out in real life. He experienced all of this first-hand.
Just weeks after the murder of George Floyd by Minneapolis police in May 2020, McDonald joined a group to protest police brutality in lower Manhattan. At the time, police brutality and COVID-19 were killing Black people at twice the rate of white people. He told The Guardian that the protests felt like “a natural extension of that injustice.”
In an opinion piece published in The New York Times in June 2020, he described protesting as a “medicine for both ills,” arguing that the disparate fallout from COVID-19 and the murder of George Floyd are only the most recent manifestations of racial injustice in the US that has existed for centuries.
“These protests are essential to America. They are necessary for the recognition and eradication of injustice. These protests are the first dose of medicine needed to rid the system of metastatic racism. To ask, ‘What do you think, as a Black doctor, about Covid-19 and the protests?’ is to ask me to choose my skin color or my health,” he wrote.
McDonald remains vocal throughout the pandemic. In an article for The Atlantic in April 2020, he said he has “ceased to expect appropriate help from administrators, institutions, and the government itself.” In an interview with VICE News in February, he railed against local governments’ inaction in response to low rates of vaccination in Black communities.
“After the year of the biggest civil rights protests that the United States has ever seen, I wish I could tell you, yes, we're living in a totally different world,” he told VICE News. “The reality is we're not. I mean, just look at the vaccine rollout. We're still having debates over how much we can protect the Black community at the expense of Americans at large.
“Is it unimaginable to think of a world where the department of health would go door to door in Black neighborhoods offering the vaccine?” he continued. “I think we need to be engaging these communities a lot more than we currently are. And if we're not going door to door, that sounds like a start.”
Looking to a better future
Injustice runs deep in America. Ridding it from our culture remains a complex challenge. But there are easy steps we can take now to make an immediate difference. These include pushing for policies surrounding Medicare for all, policing reform, and new definitions of criminality.
While we demand policy reform, individuals can take action and enact meaningful change in their own lives and those of their neighbors.
“For me, it's about seeing patients that look like me, who are completely disenfranchised from the health care system, who are completely disenfranchised from employment opportunities. People who are living their life between the shelter and the emergency department,” he says. “Anything that you can do to improve those people's lives, to shelter them, to get them employment, to get them basically off the street and out of the emergency room, that would be hugely helpful.”
Hospital administrators can make the lives of Black physicians easier by addressing discrimination in the workplace, introducing policies that promote patient equity, and focusing on diversity, equity, and inclusion among faculty.
And everyone can help push toward a more equitable society by recognizing that racism is woven into the fabric of American life. Pulling out the threads starts with this awareness.
“I just can't underscore enough how what we're talking about was revealed by COVID, and not because of COVID. These problems are decades long, centuries long, even. These are not new problems that we're facing.”
-Alistair Gardiner