In Rev. Dr. Martin Luther King, Jr.’s sermon, “The Death of Evil upon the Seashore” given at the Cathedral of St. John the Divine in New York City on May 17, 1956, Dr. King stated, “Change does not roll in on the wheels of inevitability, but comes through continuous struggle.”¹ It is with this sentiment that Richard Francis (R. Frank) Jones, MD worked tirelessly to increase the numbers of African American urologists (fig. 1).

Figure 1. Richard Francis (R. Frank) Jones, MD. Photo courtesy of the William P. Didusch Center for Urologic History.

In an article written by Dr. Jones, he chronicles the life of the first African American urologist, whose name was Dr. Milton Augustus Francis. Dr. Francis was an assistant to Dr. Harry Atwood Fowler (a trainee of Dr. Hugh Hampton Young at Johns Hopkins University). Dr. Francis had served as an assistant to Dr. Fowler from 1908 to 1917. From 1917 to 1922, when Dr. Fowler left to serve in World War I, Dr. Francis was the acting chief of the Genitourinary Service at Freedman’s Hospital in Washington, D.C. In 1922, Dr. Fowler named a new urology graduate, Dr. T. C. Thompson (from George Washington University School of Medicine), as chief of the Urology Service. Dr. Francis remained in a clinical role at Freedman’s Hospital. Dr. Jones was an intern for and later an assistant to Dr. Francis and learned the art of practicing urology from Dr. Francis at Freedman’s Hospital between 1922 and 1929. In 1933, an opportunity arose for Dr. Francis to become a urology instructor and Chief of the Division of Urology. Dr. Francis declined and promptly gave the position to Dr. Jones. In 1959, Dr. Francis instructed Dr. Jones to give his savings of $96,400 to the Howard University College of Medicine for student loans and scholarships.²

In 1936, Dr. Jones became the first African American to become board certified in the specialty of urology. Later in 1947, the Urologic Training Program at Freedman’s Hospital was officially approved with Dr. Jones as the Director. Before his retirement in 1970, Dr. Jones’s crowning achievement was training 26 African American urological surgeons.³ The African American urological society, known as the R. Frank Jones Urological Society (RFJUS), is aptly named in his honor (fig. 2).

Figure 2. RFJUS logo.

Figure 3. Percentage of African American urologists. MOE, margin of error.

Figure 4. Percentage of African American urologists from 2015 to 2020.

Figure 5. Projected percentage of African Americans in the U.S. population.

As time passes, the struggle to train more African Americans in urology continues. In the 2020 AUA Census, only 2.1% of practicing urologists identified as African American (fig. 3). The 3-year moving average of African American urologists has been consistently low (fig. 4). As Ghanney-Simons et al illustrate in their article, “Trends in the Racial and Ethnic Diversity in the US Urology Workforce,” at each stage of the educational pipeline from high school to urology faculty, there is a dwindling number of African American candidates.⁴ In opposition to the declining numbers of African American urology candidates, there is a projected increasing number of the United States population who identify as African American. Currently, African Americans represent roughly 13% of the U.S. population, but with every successive decade there is a 0.6% to 0.9% increase of Americans who identify as African American (fig. 5). The statistics represent a widening of health care disparities for African Americans by several mechanisms. First and foremost, URiM (Underrepresented in Medicine) physicians tend to practice in underserved communities and take an active role in combating health care disparity. Second, URiM physicians potentially have increased cultural competence which can translate into increased patient compliance, thus tending toward better health outcomes.⁵ Third, a diverse health care team is more likely to make better decisions resulting in better outcomes.⁶

One of our major objectives as a society to help decrease health care disparity is to provide mentorship and support for African American students who desire to become urologists. We accomplish this goal via our SAMC (Social Action Media Committee) and our alliances with organizations that provide mentorship for African American students, such as the R. Frank Jones Interest Group. In the SAMC, students (high school to urology residents) are paired with existing African American urology faculty. The students interview the faculty and then post their interviews on our social media platforms. Our goal is for the students to develop relationships with urology faculty that can be impactful and productive. RFJUS also hosts an annual residency research forum that allows African American medical students and urology residents to present their research projects.

RFJUS advocates for aggressive directives, policies and programs to address the lack of diversity in urology. In addition to establishing and supporting urology training programs at historically Black medical colleges, RFJUS encourages the AUA to endorse an AUA section-led program that identifies URiM medical students interested in urology. Each AUA section would align with medical schools within their geographic areas and offer free membership to AUA societies, thus providing an introduction to urology. As each AUA section builds a repository of URiM students interested in urology, URiM students could be provided with opportunities for structured mentorship, research and financial support for summer fellowships.

The power of mentorship is clearly illustrated in the relationship between Dr. Francis and Dr. Jones. The impact of creativity, persistence and dedication to medical education compelled Dr. Jones to create a much-needed urology residency program, thus providing essential urology services to many deserving African American patients. In that vein, the dedicated efforts of RFJUS embody our continuous struggle for change.