One year ago, the American Academy of Pediatrics (AAP) published a landmark policy statement identifying racism as a core social determinant of health and a driver of health inequities.1 Seventy-five years ago, the AAP admitted its first Black members, Drs Alonzo deGrate Smith and Roland Boyd Scott. As the AAP continues to evolve its equity agenda, it is essential that the tortuous experiences of Drs deGrate Smith and Scott on their pathway to AAP membership be truthfully acknowledged and reckoned with.
At the time of their initially rejected applications in 1939, both Drs deGrate Smith and Scott were busy clinicians and well-established leaders in the pediatric academic community as faculty at the Howard University College of Medicine in Washington, DC. Dr deGrate Smith, through the practice pathway, and Dr Scott, via examination, were among the earliest pediatricians to achieve certification under the Advisory Board of Medical Specialties (ABMS) when the American Board of Pediatrics (ABP) was established in 1933. However, the ABMS required American Medical Association (AMA) membership to honor certification, and the local AMA chapter, the Medical Society of the District of Columbia, was segregated.2 According to the oral history interview of Dr Melvin E. Jenkins Jr, advocacy on the part of the inaugural ABP president, Dr Borden Veeder, was necessary to permanently eliminate this exclusionary barrier and to make certification possible for all eligible candidates regardless of race or ethnicity.3 Drs deGrate Smith and Scott faced other systemic barriers, including the inability to gain admitting privileges to care for even their own patients at local hospitals in the District of Columbia. This was a hurdle that Dr Scott was not able to overcome until 1955, fully 6 years after he had already been appointed Chair of Pediatrics at Howard University.4
Although AAP bylaws did not explicitly prohibit physicians of color from membership, and Drs deGrate Smith and Scott were finally admitted in 1945, it is clear that the AAP Executive Board struggled with unbiased consideration of their applications. The characterizations related to Drs deGrate Smith and Scott in the following passages excerpted directly from meeting transcripts of AAP Executive Board meetings in November 1939, November 1944, and June 1945 are elucidating, instructive, and painful to read. The verbatim dialogue and proceedings highlight the racist attitudes and beliefs from which early AAP leaders were clearly not immune.
November 1939—American Academy of Pediatrics Executive Board
[Region I Chairman] then presented the application of Dr Alfred [sic] deGrate Smith. Motion made by [Region I Chairman] that this application not be accepted and that a letter be sent to his sponsor outlining the educational advancements being outlined by the American Academy of Pediatrics for negro physicians; motion seconded by [Region I Associate Chairman] and carried.5
[Region III Chairman] moved that all of these [Region III] applications, with the exception of Dr Scott, be accepted into membership; motion duly seconded and carried. Motion made by [Region I Chairman] that the same action be taken on Dr Scott as had been taken on Dr Smith; motion seconded and carried.5
November 1944—American Academy of Pediatrics Executive Board
“I know Smith and he is a very nice fellow. Scott has for a year or two attended the Sunday morning clinical conferences at Children’s Hospital. He has taken part in the discussion of cases at Freedman’s Hospital. I think the local men in Washington would like to have something to say about men taken into the Academy from that particular location. I think they would rather resent an effort being made to put these men in. I would like to hear what [Region II Chairman] has to say.”5
“We allow negroes to come to our meeting and we fix a separate place for them to sit. They do not become members. If they became members they would want to come and eat with you at the table. You cannot hold them down.”5
June 1945—American Academy of Pediatrics Executive Board
“We talked with them for about a half hour and they conducted themselves as gentlemen. They said their only interest in wishing to join the Academy was for educational purposes. They said they would not attend any meetings held South of the Mason and Dixon line. They would attend meetings in other parts of the country, but under no circumstances enter into the social side for the reason that they did not want to get hurt themselves. I impressed upon them the importance should they be elected, of their being leaders and not pushers, and their acceptance in the Academy would be guidance for those who would come at a later time.”6
“I think the problem is of much more concern to us than it needs to be. In the first place, we have a definite responsibility to these negro representatives and to the negro population of the country. The only trouble is the social implication. The burden lies much heavier upon Smith and Scott than upon us. As the President (of the Academy) says, we have the authority to say who will not be admitted. In the event that either of these men transgress the social lines, they completely stop the advancement of the negro.”6
In the United States there is a tendency to be ahistorical when it comes to race. The lack of acknowledgment, or worse, the intentional whitewashing of history and the longitudinal relationship of 400 years of oppression on the present-day expression of racism is not uncommon. As the AAP turns the corner toward the 2030 centennial anniversary of its founding, we cannot do so without authentically acknowledging, owning, and reconciling past discriminatory transgressions like the shameful gauntlet to membership experienced by Drs Alonzo deGrate Smith and Roland Boyd Scott.
In honoring the memory of these two trailblazers and their contributions to pediatrics and the AAP,7 be it resolved that, we, the Board of Directors of the AAP:
1) Apologize for the racism that contributed to the inequities that Drs deGrate Smith, Scott, and other pediatricians have endured, and;
2) Commit to a bylaws referendum to explicitly codify that AAP membership does not discriminate on the basis of race, ethnicity, religion, sex, sexual orientation, gender identity, disability, or national origin.
The AAP as an organization is on a firm pathway to broadly establishing an equity agenda through meaningful diversity and inclusion and a societal commitment to combating bias and discrimination in all its forms, including structural and systemic anti-Black racism (Fig 1). This country is already majority represented by children of color when it comes to the pediatric population.
Embracing racial and ethnic socialization is critical for all children and families as well as for the pediatricians who care for them. Healing starts at home with truth, reckoning, and honest reconciliation.
The AAP is proud to transparently acknowledge, proud to publicly reconcile, and proud to continue to lead on behalf of the best interests of children, adolescents, and young adults and the people who care for them.
This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.
American Academy of Pediatrics Board of Directors Executive Committee
Sara H. Goza, MD, FAAP
Lee Savio Beers, MD, FAAP
Immediate Past President
Kyle E. Yasuda, MD, FAAP
Warren M. Seigel, MD, FAAP
CEO/Executive Vice President
Mark Del Monte, JD
Board of Directors
Wendy S. Davis, MD, FAAP
Warren M. Seigel, MD, FAAP
Margaret C. Fisher, MD, FAAP
Michelle D. Fiscus, MD, FAAP
Richard H. Tuck, MD, FAAP
Dennis M. Cooley, MD, FAAP
Gary W. Floyd, MD, FAAP
Martha C. Middlemist, MD, FAAP
Yasuko Fukuda, MD, FAAP
Lisa A. Cosgrove, MD, FAAP
Charles G. Macias, MD, FAAP
Constance S. Houck, MD, FAAP
Joseph L. Wright, MD, FAAP