Practicing medicine at a predominantly Black institution gave me the gift I didn’t realize I needed

“You have a big voice, Dr. Grubbs,” the clinic manager said.

I flinched. The last time I heard similar words, they were part of a common refrain that I had encountered often. “You’re too direct.” “Too outspoken.” “Intimidating.” Peers who looked like me encouraged me to put my head down, make myself smaller, endure — and never, ever call out racism. This, they insisted, was the pathway to success in a predominantly white, academic medicine institution like those where I spent most of my medical career.

Until now.

“No,” the clinic manager said, “that’s a good thing.”

In that moment, I realized why I love working at West Oakland Health so much. It wasn’t just because the federally qualified health center’s new leadership (including my husband, Robert Phillips, the president and CEO) articulated a vision to be an unapologetically Black-led, Black-serving, and Black-focused organization striving to be a hub for the health and dignity of the Bay Area’s Black community.

It wasn’t even just because of the look of relief on Black patients’ faces when I assured them that I was their new primary care doctor and that I would continue to be their doctor as long as I continued to breathe.

A big reason I love working at West Oakland Health is that I can be my full, authentic, un-code-switched self. It’s the gift I didn’t realize how much I needed.

What does the freedom to be my authentic self look like?

No tokenization

It looks like showing up for my first Saturday clinic to find a Black woman at registration, a Black woman nurse, and a Black woman medical assistant. I felt an overwhelming desire to chant “Black Lady Clinic! [clap] [clap], Black Lady Clinic! [clap] [clap]” à la the courtroom segment on “A Black Lady Sketch Show.” Now I greet these co-workers who frequently sport new braids, faux locs, weaves, or hair colors with, “OK, hair!” They return a smile and perhaps a flip of their new hair, and nobody will need to block the hand of someone trying to touch the hair or answer the tiresome question, “How much of that is yours?”

It looks like me pointing out a need, proposing a solution, and being encouraged by open-minded leadership to develop it — so much so that I recently was named director of adult medicine. It didn’t work this way in the predominantly white institutions (PWIs) where I worked. In those organizations, I was repeatedly tokenized to meet the diversity requirement on unpaid committees whose majorities drowned out my voice or tone policed me for being too direct.

It also looks like me not having to lead with my alma mater when I see a new patient. At this clinic, no one doubts my qualifications. No one assumes I’ve gotten where I am today because of affirmative action, because everyone knows the old adage about Black people having to work twice as hard to get half as much.

Admittedly, when I saw white patients in PWIs, I felt a bit on edge, as if I had to prove myself. It was an anticipatory reaction to all the times white patients had asked me where I went to medical school. As nonchalantly as possible, I would say “Duke” to back them down. But it didn’t really matter where I went to school — I still had to pass all the same board certification examinations as everybody else. At best, I figured, they were going to think of me as “different” from other Black people.

In fact, I even feel smarter at a predominantly Black institution, because at the clinic I sense my intelligence is assumed, not questioned. When I enter an exam room to greet a white patient (of course we take care of everyone who comes in), I don’t feel that edge. By walking through the doors of West Oakland Health, they’ve demonstrated they have no objection to me being Black. At the clinic, my non-Black colleagues (we have those too) have demonstrated they have the humility to care for a predominantly Black population and embrace our mission to center Black people.

While I’ve never heard anyone wonder about the need for La Clínica de La Raza or Asian Health Services, others in our clinic network have questioned why a Black-focused space in health care is necessary. The answer comes from literature that has consistently shown that Black people prefer Black health care providers and have better health outcomes when they get them.

Mission-aligned work

I’m not the only one who feels this difference. OB-GYN Kevin Smith, M.D., who chaired his division at a PWI, left that role for similar reasons. When I learned of his resignation, I encouraged him to join me at West Oakland Health. After learning our new leadership was truly all about fulfilling our mission to focus on the health and dignity of the Black community, Kevin was in.

“I went into medicine to support communities most in need. It’s really fulfilling at this stage of my career to have amassed a skill set that I can use in this mission-aligned work specifically supporting Black people, who we know have the worst health outcomes across the board,” he said. “I’ve never practiced in any other organization that was so intentional about explicitly focusing on Black people.”

After years of being fought at every turn, Dr. Smith is finding wholehearted institutional support for his efforts to build and lead our Division of Gynecology and Reproductive Health. His early accomplishments included recruiting OB-GYN Yvette Gentry, M.D., from private practice. She had frustrating professional experiences that were similar to mine and Dr. Smith’s.

“I was called intense, angry, hostile, difficult just for demanding the same level of respect or even equipment as my colleagues,” she said. “And the more successful I became, the more problematic I was deemed to be.” But things are different for Dr. Gentry at West Oakland Health. “The entire energy here is different,” she said. “I feel welcomed, and my ideas are welcomed.”

One might wonder what took me so long to leave the PWI world. It’s the same misconception that afflicts many of us: being raised to believe that the white man’s ice is colder, which is also known as internalized racism. That belief had me always chasing the approval of whiteness to validate my worth and that I did belong.

My parents were blue-collar folks from Alabama, born in the early 1930s when White Only and Colored spaces were the norm. My mother could only take a bookkeeping class or two before the demands of motherhood and family bills left no time to advance her own education. But she strongly stressed that it was important for her children to advance theirs. As it turned out, I, the youngest of six, became the first in my family to earn a bachelor’s degree.

I remember one day shopping with my mother — I think it was for something to wear to my high school graduation. As the Black woman cashier rang up our purchase, the conversation turned to my plans.

“I’m going to college in Durham,” I announced proudly.

“Oh, to North Carolina Central?” she asked.

“No, Duke,” I replied with an air of snootiness, I’ll admit, implying that I was better than the folks at NC Central, the historically Black college a short drive from Duke. The cashier lifted a brow and curved her mouth downward slightly. I couldn’t tell if that meant, “Oh, aren’t you a smart one,” or, “So you think you’re too good for NC Central?”

My mother said nothing, but I sensed her pride. Her baby was going to Duke.

Regaining autonomy

It wasn’t until many years later, when I learned how everybody who looked like me had a story like mine, that I questioned the real value of predominantly white spaces. Some stories were more extreme than others, but we all suffered slights and indignities and felt the loss of autonomy in predominantly white spaces.

I know my Duke degree opened doors into white spaces for me, but I also wonder how much it hindered me. I regret not going to a historically Black college or university (HBCU) for my undergraduate and medical degrees. Had that happened, I could have been nurtured to learn and even be wrong about things without people blaming my mistakes on my being Black — and without making opportunities harder to come by for other Black people.

Recently, an HBCU-educated elder gave me permission to forgive myself. “There aren’t enough spots at HBCUs for all Black college-bound students,” she said. One could choose to look at this limitation in a couple of ways: that so many of us are going to college, or that the vestiges of 250 years of slavery, followed by 100 years of the American apartheid known as Jim Crow, gutted our ability to create enough spaces uniquely geared to us.

I hope white people — and people of color who have accepted near-white status rather than cast their lot with Black, brown, and Indigenous people — will acknowledge how much we suffer in spaces that had to be forced to admit us, and that it is their responsibility to fix that. By “fix,” I mean make it right through adopting equal pay and accountability, not by offering Band-Aids in the form of platitudes about diversity along with occasional implicit bias trainings. I mean stop telling us we’re making progress as we watch largely powerless diversity, equity, and inclusion (DEI) efforts created in the wake of George Floyd’s murder get dismantled one by one. As Malcolm X said, “If you stick a knife in my back nine inches and pull it out six inches, there’s no progress. If you pull it all the way out, that’s not progress. The progress is healing the wound that the blow made.”

I hope Black providers will realize they don’t have to suffer in PWIs that repeatedly disrespect, discount, and deny our genius. We don’t have to sell our spirits to earn prestige. Come on home. Come help us build West Oakland Health, or help others build similar organizations.

Is there work to be done? Of course. But to paraphrase a prolific poet of our time: We got 99 problems, but — unlike our predominantly white counterparts — being Black ain’t one.

Vanessa Grubbs, M.D., is a board-certified nephrologist and internist, founder and president of Black Doc Village, a nonprofit organization focused on expanding the Black physician workforce, the author of “Hundreds of Interlaced Fingers: A Kidney Doctor’s Search for the Perfect Match” (Amistad, 2017), and a member of STAT’s 2023 Status list.

This essay was originally published on the California Health Care Foundation blog on April 10, 2024, and is reprinted here with permission.