Historically Black Colleges and Universities (HBCUs) have played an essential role in producing pioneers and Black innovators in urology. R. Frank Jones, the first board-certified Black urologist in the United States, graduated from Howard University College of Medicine in 1922. Dr Jones was pivotal in establishing the first urologic training program at Howard University Hospital, formerly Freedmen’s Hospital. The program was accredited in 1947. He considered this his “greatest professional contribution,” as stated in the Profiles of the National Medical Association (1972).¹ Howard University Hospital’s urology suite is named after Dr Jones for his many contributions to the field. The Figure shows his original gold cystoscope, which is still located in Howard University Hospital. Dr Jones’s dedication to the field of urology and his pioneering efforts have laid the groundwork for the many Black urologists who followed in his footsteps, many of whom graduated from HBCUs.

Figure. R. Frank Jones’s gifted golden cystourethroscope at Howard University Hospital.

The importance of equitable representation in medicine has recently been underscored by a series of decisions from the Supreme Court, striking down student loan forgiveness programs and their declaration that affirmative action is unconstitutional. These latest changes highlight the urgent need to address the financial burden faced by Black students and the systemic barriers that hinder equitable access to higher education. Additionally, these decisions have far-reaching implications for pursuing diversity and representation in the medical field, especially urology. To build a diverse health care system, we must improve access to high-quality and culturally responsive medical education and training for future Black physicians representing various communities.

Although HBCUs comprise only 2.4% of all medical colleges, they significantly impact the diversity of the medical field. HBCUs are home to 31% Black chairs, 10% Black faculty, and 14% Black students.² It is essential to acknowledge that the onus of improving racial diversity in the medical field should not solely rest on HBCUs. While these institutions play a vital role in supporting Black medical professionals, all academic institutions must act toward achieving equitable representation in the health care system.

The field of urology must reflect the communities it serves, and this requires a concerted effort from all medical schools and residency programs to improve diversity through sponsoring mentorship opportunities, offering specialized training programs, and increasing funding for research. HBCUs have a rich history of educating Black students who often encounter barriers to higher education. These institutions offer tailored programs supporting Black students excelling in medical school and beyond, including comprehensive premedical preparation, academic support services, research opportunities, mentorship, networking, scholarships, and community engagement activities. By leveraging these resources, HBCUs significantly promote representation in medicine and address health care disparities.

The lack of progress in increasing the representation of Black urologists highlights the need for interventions to address this disparity and promote diversity within the field. Simons et al in 2021 analyzed data from 2007-2008 to 2019-2020 and found a decrease in the proportion of Black urology applicants (−0.13% per year). The proportion of Black individuals in the urology resident population showed no significant change (−0.03% per year), despite an overall increase in the total number of residents. These findings underscore the attrition of Black urologists at critical stages of their education and highlight the need for interventions to address this disparity and promote diversity within the urology workforce.³ According to the AUA’s 2021 Annual Census report, “The State of the Urology Workforce and Practice in the United States,” only 321 African American/Black practicing urologists were identified, comprising just 2.4% of the total number of practicing urologists in 2021.⁴ This is concerning as African Americans comprise 12.1% of the population and are disproportionately affected by many urologic conditions. This is especially true when considering the higher mortality rates of Black women in various urologic cancers and the significant underrepresentation of Black female urologists.⁵ Moreover, Black men experience higher rates of prostate cancer. They are also more likely to experience aggressive forms of the disease, higher mortality rates, and delays in accessing treatment than White men.⁶

The underrepresentation of doctors who are ethnically alike to their patients can have severe consequences for patient outcomes and may increase barriers to care. A study by Nagdee et al found that patients have better health outcomes when their health care providers share their cultural background.⁷ Black patients must have access to urologists who can address implicit health biases in care and provide a more appropriate, culturally responsive understanding of this population’s unique health needs. During my time at Howard University College of Medicine, I have witnessed the profound impact of representation in medicine. Seeing patients’ faces brighten and their willingness to disclose sensitive family history at the bedside, I realized the significance of shared cultural backgrounds between doctors and patients. This connection is crucial considering the long history of health disparities, exploitation, and deep-rooted distrust among the Black community. By prioritizing representation in urology and all other areas of medicine, we can rebuild trust, address historical injustices, and work toward a more equitable health care system that values and uplifts all patients.

As the American population continues to diversify, the field of urology must reflect the communities it serves. We must celebrate diversity—only then can we hope to improve the disparities that have long plagued health outcomes for Black patients. As we move forward, let us strive to build upon the foundation laid by those who came before us and make a concentrated effort to improve access and support for future generations of Black urologists.

Acknowledgments

We thank Dean Andrea A. Hayes Dixon, MD, FACS, FAAP, and the Division of Surgery at Howard University College of Medicine.