On Wednesday, the Supreme Court will hear oral arguments in June Medical Services v. Gee, which will focus on whether doctors performing abortions must have admitting privileges, or permission to admit patients for treatment, at nearby hospitals.
These laws are being used to undermine Roe v. Wade. In Louisiana, where this case was originally filed, the law would shut down all of the state’s abortion clinics. But similar laws were long used to maintain divides not just in who has access to care, but who provides it.
Historically, hospitals used admitting privileges to maintain racial segregation. By refusing to allow black doctors to admit patients to hospitals that served whites, hospitals could ensure that black doctors (and patients) were relegated to segregated facilities. This gatekeeping practice left black practitioners without the same opportunities, facilities, and resources as their white counterparts.
Today, admitting privileges rules and other legislation, such as “heartbeat bills” that outlaw abortion after fetal pole cardiac activity can be detected, make it harder for patients seeking abortions to do so safely by limiting access. These laws stand to disproportionately affect pregnant people who are low-income and/or of color. But left out of the conversation is that they put black health care providers in danger, too, by risking criminal prosecution for those who perform these abortions.
When it comes to the medical field, black practitioners are significantly underrepresented. Black workers are only about 4 percent of practicing physicians and 9 percent of nurses. And like underrepresented professionals in other fields, black health care providers face some common challenges: assumptions of incompetence, racial stereotyping, and subtle suggestions that they are not qualified for their jobs. Laws that erode medical practitioners’ authority have the potential to worsen existing obstacles for black health care professionals who already occupy a tenuous position in the field.
For the past 15 years, I’ve been conducting research on black professionals working in the health care industry. My findings suggest that widespread racial stereotypes of black people as less intelligent, capable, and hardworking than white people create workplace environments that are unwelcoming and stressful for black health care practitioners.
In one interview, Dante, a doctor, identified here by a pseudonym to protect his privacy, told me he has always been watched more closely and had his work second-guessed by colleagues and even subordinates: “I’ve been accused of not practicing medicine correctly by a nurse, [one time] by a respiratory therapist. And they would never think to say this to a white doctor. [They would think,] ‘He did it different than we’re used to.’”
Dante went on to say that as a result of the nurse’s accusations, the hospital decided — in a violation of its written policy — to open up an investigation into his work. For Dante, this additional level of scrutiny was a source of frustration and anger. It also had material costs, as he kept a lawyer on retainer to protect him from unjust retaliation.
Other black doctors described the challenge of getting patients to trust them. Max, an emergency medicine doctor, reported, “I’ve taken care of patients [who] made it very clear—‘I’ll sue you if you don’t get me a white doctor.’” These patients did not bother to conceal their suspicion and distrust, nor the fact that their concerns were racially motivated.
Let’s also not forget how rampant stereotypes of criminality disproportionately affect black workers, even when they’ve done nothing wrong. Even black doctors from elite schools who practiced in the nation’s best hospitals were still not immune from the reach of these tropes. One doctor, Yusef, recalled an incident when he and his colleagues learned that someone had been impersonating a doctor and stealing supplies. The administrative assistant publicly accused Yusef of the theft. Despite having worked at his hospital for three years in a highly visible role, Yusef found himself a suspect.
Some doctors have already noted that legislative bans will make their jobs significantly more difficult by obstructing the doctor-patient relationship, curtailing their autonomy, and causing them to weigh providing care with the threat of prosecution. But my research indicates that these bans may have a chilling effect for black doctors in particular.
Black physicians already encounter environments where patients, colleagues, and subordinates may be more likely to undermine their authority, question their judgment, and openly doubt their capabilities. What happens when these doctors — who already deal with heightened visibility — do this work knowing that they could potentially be charged with crimes for exercising their best medical judgment?
And in states that bring criminal cases against doctors who perform abortions, bans may put black physicians at higher risk of prosecution. In 2012, a black Baltimore doctor, Nicola Riley, was charged with murder under Maryland’s fetal homicide law after an abortion she performed resulted in serious complications for the pregnant patient. Riley’s case was the first time this fetal homicide law was applied to a doctor attempting to provide an abortion in the state. It underscores the risks for doctors when abortions are criminalized, and the potential for black doctors to face higher scrutiny and possibility of prosecution.
Of course, pregnant patients who are low-income and/or people of color will likely be affected the most by these bans. But it is important to highlight that these patients are also the ones who are most likely to be seen by black providers — who are themselves uniquely impacted by these proposed laws.
Abortion bans ask black doctors, who already often face hostile environments, to surmount these barriers in an environment where they could face criminal prosecution simply for doing the work they were trained to do.
Adia Harvey Wingfield is the Mary Tileston Hemenway professor of arts and sciences and associate dean for faculty development at Washington University in St. Louis. Her most recent book is Flatlining: Race, Work, and Health Care in the New Economy.