In a statement issued here, the AMA acknowledged "its past history of racial inequality toward African-American physicians."
An editorial in the July 16 issue of the Journal of the American Medical Association by Ronald M. Davis, M.D., of the Henry Ford Health System in Detroit, the group's immediate past president, added that "the AMA failed, across the span of a century, to live up to the high standards that define the noble profession of medicine."
Wrote Dr. Davis, "The medical profession, which is based on a boundless respect for human life, had an obligation to lead society away from disrespect of so many lives. The AMA failed to do so and has apologized for that failure."
The apology grew out of an AMA-sponsored review, begun in 2005, of the history of physician segregation.
The review, led by Matthew K. Wynia, M.D., M.P.H., of the AMA's Institute of Ethics, was recently completed, with a report also appearing in the July 16 issue of JAMA.
It found that although the AMA itself never formally disallowed black members, it permitted its state affiliates to do so.
Many state societies openly excluded black doctors, particularly in the South. Because membership in a state society had been a requirement to belong to the national group, this policy was a de facto barrier to AMA membership for most African-American physicians, Dr. Wynia and colleagues found.
In 1938, blacks were 0.3% of AMA membership, they said.
Black doctors had consequently formed their own groups, including the National Medical Association.
Over the years, the AMA turned away many efforts by the NMA and others groups seeking closer ties. For example, in 1944, the AMA rejected a proposal that NMA members be allowed "associate membership" in the AMA.
Dr. Wynia and colleagues found the AMA failed to adopt 10 separate proposals from 1948 to 1965 to expand African-American membership.
It was not until the late 1960s that the AMA began applying anti-discrimination policies to its state affiliates.
Nevertheless, in 2006, African-Americans were 12.3% of the general population but only 2.2% of physicians and medical students -- less than the 1910 level of 2.5%.
The entire healthcare system remains largely segregated along racial lines, Dr. Wynia and colleagues added.
Dr. Davis said the group has worked to reduce these effects of discrimination in recent years.
In June of 1995, Lonnie Bristow, M.D., a Walnut Creek, Calif., internist, became the first African-American president of the AMA. He was the 150th president of the group.
In 2004, the AMA joined with the NMA and the National Hispanic Medical Association to form the Commission to End Health Care Disparities. The commission has involved state medical associations, specialty societies and groups representing other health professions to develop strategies for eliminating racial and other differences in healthcare.
The AMA also sponsors efforts to attract and train more minority physicians, through scholarships and outreach programs.
Nelson Adams, M.D., president of the NMA, welcomed the AMA's apology.
"We commend the AMA for taking this courageous step and coming to grips with a litany of discriminatory practices that have had a devastating effect on the health of African-Americans," he said in a statement.
Dr. Adams called on the AMA to participate in the NMA's effort to make "cultural competency" training compulsory in medical education and licensing.
"Mandatory training in cultural competency would provide physicians with the cultural knowledge, behaviors, and interpersonal and clinical skills that would enhance their effectiveness in managing patient care, and would begin to eliminate the health disparities that take a deadly toll on millions of African-Americans and other people of color," said Dr. Adams.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine
Journal of the American Medical AssociationSource Reference: Wynia M, et al "African American physicians and organized medicine, 1846-1968: origins of a racial divide" JAMA 2008; 300: 306-14.
Journal of the American Medical AssociationSource Reference: Davis R "Achieving racial harmony for the benefit of patients and communities: contrition, reconciliation, and collaboration" JAMA 2008; 300: 323-25.