Shadowed legacy: Black doctors confronting structural inequality and reimagining opportunity in postgraduate medical...

Black doctors have long navigated a medical field marked by exclusion, resistance and resilience. From legalized hospital segregation in the 19th and early 20th centuries to enduring racial and gender biases in contemporary residency programs, systemic barriers continue to drive the underrepresentation of Black physicians across specialties. Situating personal testimony within this historical context, this narrative examines statistical patterns in Black physician representation and the present-day challenges faced by Black residents through the lens of the Black narrative tradition of bearing witness and asserting truth. It honors the legacies of pioneering physicians-Drs. Daniel Hale Williams, Thomas R. Peyton, and Isabella Vandervall-whose lives exemplify both the persistence of structural inequality and a blueprint for achieving justice in medicine. Their influence resonates in the work of Black doctors today, who develop programs and initiatives (e.g., pipeline programs, racial affinity groups, and global health exchanges) that expand access, foster inclusion, and promote cross-cultural collaboration in medical education and training. By highlighting historical and contemporary strategies for overcoming systemic barriers, this article emphasizes the critical role of justice-oriented initiatives in transforming medical institutions and advancing equity, representation, and belonging across the profession.