Carlos Cream, MD, PhD, is an internist with UPMC in Central Pa. He is board-certified by the American Board of Internal Medicine. Dr. Cream is UPMC Central Pa.’s director of diversity for graduate medical education and serves on its internal medicine residency faculty. He earned his medical degree at Geisel School of Medicine, Dartmouth University, and completed his residency at Penn State College of Medicine.
What was your own personal journey to medicine?
At my elementary school graduation, I gave a speech on the “Moving Forward” theme. It was my “I’m going to be a doctor” declaration. I grew up in Camden, New Jersey, so when people heard me, they would say, “Isn’t that cute? He thinks he is going to be a doctor.” I did not realize at the time that it was seen as an irrational expectation. And statistically, that was true: Very few of my classmates had the chance to even go to college.
I have been blessed with many influential role models. I will mention two for their special contributions to my development. My father was a Baptist minister who gave me a grounding in faith and my grandfather Jersey Joe Walcott, was the world heavyweight boxing champion of his time and the first Black sheriff of Camden County. Their successes helped me believe I could accomplish my goals with faith and hard work.
I attended Rutgers University-New Brunswick as a James Dickson Carr Scholar, which recognizes minority students who demonstrate academic promise. I faced early academic challenges as a first-year student, not because I was Black but because of the environment I had grown up in. Race disproportionately connects to economic status. If you are from a poorer community, you do not have access to things like advanced placement classes, great labs, and all the other trimmings. So, when you are sitting in a college chemistry class surrounded by 1,600 other students — many of whom grew up in higher socioeconomic communities — you come into the game at a disadvantage. I recognized the challenge and the necessary work and made changes to overcome the deficiencies.
What were some of the barriers you faced getting to medical school?
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My advisor at Rutgers told me that my GPA would not be competitive enough to be admitted to medical school. As an upper-class student, my grades were good enough to be considered by the most competitive of schools. I began to reconsider going to medical school and decided to obtain my PhD. I entered the physiology program at Dartmouth.
The Gulf War started in the second year of my PhD program. Federal funding for research was diverted to support the country’s defense efforts. Graduating classmates were entering a dismal job market. My PhD mentor was a physician who had left medical practice to teach and do research. He suggested that, if I had an interest in attending medical school, now was the time for me to make that decision. Thanks to his good counsel, I transitioned into the Geisel School of Medicine.
Dartmouth was an eye-opening experience. I never had imposter syndrome (a sense of feeling unworthy to be there) like many minority medical students, but I did feel like a fish out of water. I also quickly discovered that many of my classmates had never interacted with someone like me before. So, for both of us, it was a new experience.
What I did not know at the time was that this experience would benefit me in my future medical practice. I have always worked across the cultural spectrum. It has made me comfortable in about any situation. That has allowed me to make other people feel more relaxed, too. I know there are always going to be people who are more xenophobic and tribalistic than others. But if we are mindful and connect with one another as human beings, that commonality allows us to make a difference.
Role models and mentors can be so important to academic and professional growth, but especially for students of color. Who were the sources of influence and support throughout your life?
Retrospectively, I wish that someone in my family had been in medicine. It would have helped prepare me for what was ahead instead of finding things out on my own. I have been fortunate to have great mentors at Dartmouth and during my residency at Penn State. A few were African American, but most were people who cared deeply about the medical profession and about humanity. It is important to recognize the critical contributions they made to the careers of people like me.
Mentoring should not be segregated — we all have much to learn from each other. If you genuinely care, if your heart is in the right place, the rest of it will take care of itself.
I am committed to making sure that I help create opportunities for underrepresented students today — especially those growing up in central Pennsylvania’s economically disadvantaged communities. We need more doctors and health care professionals who look like me. It is paramount to the future of health care.
At UPMC Central Pa., we are actively involved with groups such as Patients R Waiting, a physician-led initiative throughout Central Pennsylvania focused on decreasing racial health disparities by increasing diversity in medicine. We are also supporting minority doctors in practice and working to increase the pipeline of future health care professionals of color. We partner with the Harrisburg School District to introduce high school students to career options in health care and medicine. We offer shadowing and mentoring opportunities. We will not see a yield for years, but this is a critical step. It will not address current health disparities but portends better things for the future.
Why is “having someone who looks like you” so important to both medical students and patients?
Patients are still surprised when a Black doctor enters their room. Patients and doctors bring their own implicit bias to health care. Meaning we apply our past experiences to the current situation. It is a shortcut in thinking, and we are conditioned in ways that we may not ever understand. Helping people open their minds is crucial for them to see the doctor in a different way.
In the early 2000s the Institutes of Medicine (IOM) published In the Nation’s Compelling Interest, a report focused on America’s workforce and Unequal Treatment, a book about the health care disparities that existed across the United States. Now, more than 20 years later, it is clear that these disparities have been unresolved. As a result, during COVID-19, the most medically, socially, and economically vulnerable communities were disproportionately affected by the pandemic. Yes, it was a race-related problem, but race is a surrogate marker for underlying disparities.
The pandemic has opened the door for greater conversations, but that has not changed the hearts of everyone. Some people remain closed to candid discussion, effectively saying, “I don’t care, so don’t teach me about this because I don’t want to know.” We are going to have to move forward as caring people to address these systemic disparities and ensure history is not repeated.
I was born 20 days after Martin Luther King, Jr. was assassinated on April 4, 1968 — a time when race and culture in America collided in an unprecedented way in our history. With that as my backdrop, I have always been keenly aware of my racial identity. But it is not the only thing that defines me and my actions as a person. For me, the need for activism as a Black man is when it is specifically relevant to a situation or need. I do not believe it is where the conversation should end. When you are forced into that space you must tell your truth.
Are you hopeful for the future? What are some of the initiatives you have engaged in that are helping to continue the conversation and promoting change?
Today’s medical residents and fellows are a generation-and-a-half removed from my own experiences. It has been very impressive to see the different expectations and perspectives they bring to their training — particularly post-COVID. This has been a time of learning for us all.
At UPMC Central Pa., we have a policy built around the belief that everyone should be treated with common courtesy. That is true not only for patients, but their caregivers too. No one should feel uncomfortable receiving or providing care. We are developing a network of diversity and inclusion physician champions throughout UPMC in Central Pa. to guide resident education and ensure a supportive learning environment.
I am fortunate to be working with Tina Nixon, UPMC Central Pa.’s vice president of Mission Effectiveness, Diversity, and Inclusion, to create a more “just culture” environment. Instead of assigning blame when a problem arises, we are working to understand the root cause. Is punishment the only recourse? Or is there an opportunity for education, coaching, and remediation?
We also are developing a subcommittee to reframe how we investigate incidences of potential discrimination. We should be open to the possibility that we may be offended by things people have said or done although that was not necessarily their intent. We are trying to move things forward in a way that supports a more inclusive, open, and welcoming culture for everyone at our hospitals.
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