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The loan presented Smith with a crisis of conscience. By taking it, he was yielding to the system that he detests. "But," he says, "if I hadn't taken it, I wouldn't be a doctor today and wouldn't be serving the Negroes of Mississippi." Serving them he is, in the heart of Jackson's Negro community of about 60,000, at an average rate of 40 patients a day. Most practitioners consider 20 patients a day a heavy load. "When you see 40," says Smith, "you obviously can't dispense the kind of medical care that you'd like to. To make things worse, white doctors dump Negro patients on black doctors—especially if they haven't any money, and most of them haven't."
Lost to Surgery. Smith has active staff privileges at one county and one private hospital, and limited privileges at Mississippi Baptist, meaning that he is restricted to the hospital's Green Annex, reserved for Negroes. He says he has to swallow hard every time he sends a patient there. It is still more frustrating if his patient needs surgery, for Smith is allowed to practice only in the annex, and of course the operating rooms are in the main building. Thus he has to turn his patient over to white doctors.
Only a few years ago, Dr. Smith would have had no hospital privileges, except in tumbledown quarters reserved for Negroes. For almost a century, "segregationists had a neatly effective exclusion device: hospital appointments were open only to members of the county medical societies. And the societies were exclusively white. For 29 years, the A.M.A. gently "urged" member groups to integrate, but few did. Smith was among the Negro doctors who embarrassed the A.M.A. by picketing its 1963 convention. The A.M.A. made its urgings a bit stronger. The Hinds County Medical Society was among those that yielded. It admitted Smith and two other Negroes, but many county societies still exclude Negroes for all practical purposes.
Even far from the South, winning acceptance for internships in the better hospitals is difficult, and getting residency training in the specialties is even harder. But what galls the Negro doctor most is the matter of appointments. As recently as 1962, some 58 of Chicago's hospitals accepted no Negroes on their staffs. It took court action, with Dr. Falls leading the attack, to break that blockade. Today, in Chicago as in other major cities, it is still far more difficult for a Negro doctor to get into a good hospital than it is for a white. Good Samaritan in Los Angeles, often cited as a good example, has five Negroes among its 473 doctors.
Dr. Elmer A. Anderson finished first in a competition for the medical directorship of a Los Angeles County hospital, but then the County Human Relations Commission had to exert pressure to get him appointed. Anderson believes that staff discrimination hurts doctor and patient alike. "If a doctor has a patient who needs some special treatment that he cannot provide, he not only loses that patient to another doctor, but in many cases he loses contact with the whole family as well. Not getting on a staff hurts a man's ego and destroys the relationship between patient and doctor."