As the first African-American to run a department at The Johns Hopkins Hospital, new surgeon-in-chief Robert Higgins leads a double life: He is both renowned surgeon and barrier-breaking pioneer.

“I want people to see me as a surgical leader here because of my attributes, my ability, my skill, my administrative leadership,” says Higgins, a cardiothoracic transplant surgeon and former chair of the department of surgery at The Ohio State University. “The fact that I am African-American is complementary to that.” 

In another light, though, Higgins’ race matters—a lot. “When I walk in the room, I’m the only African-American. And this has been so for 10, 15, 20 years. In an administrative leadership community, I’m the only one.”

Higgins, the William Stewart Halsted Professor of Surgery and director of the Department of Surgery at the Johns Hopkins University School of Medicine, aims to use his position to help foster a racially diverse and inclusive environment at Johns Hopkins and nationwide so that no one has to lead a double life.

A former president of the Society of Black Academic Surgeons and the Association of Black Cardiovascular and Thoracic Surgeons, Higgins is nationally known for his advocacy on behalf of building a physician workforce that mirrors the country’s racial and ethnic diversity.

A growing body of research shows that diversity enriches academic medicine with new insights and perspectives. Diversity also makes for better health care, reducing patient safety risks and boosting innovation. “Without a diverse student body or residents and faculty members who are representative of the community we serve,” health care can’t be delivered efficiently or equitably, says Higgins.

Priming the Pipeline

Projecting the same deliberate focus he brought to playing fullback in college on the Dartmouth football team, Higgins clears a pile of faculty reviews from the conference table in his campus office and tucks into his lunch.   

Surrounding him are dozens of family photos. They form a visual narrative of Higgins’ life and include a black-and-white portrait of his late father and namesake in his army uniform. Robert Higgins Sr., a Meharry Medical College-trained family practitioner in Charleston, South Carolina, died from injuries sustained in a car accident when Higgins was 5.

“He had a bright future as a physician and did not have a chance to fulfill his aspirations,” says Higgins, 56, who says he chose his career in part to complete the work his father left unfinished.
His family moved to Albany, New York, where Higgins and his younger brothers flourished with the support of their mother, Patricia, and maternal grandparents. The three attended Albany Academy, a private military school, through 12th grade. There, Higgins became the school’s first African-American major in the cadet battalion. “We were expected to perform at a high level in great academic environments,” he says.

When as a sophomore he came home from Dartmouth with mediocre grades, his mother warned, “You’re not going back unless you show you’re serious about your academics.” For Higgins, failure was not an option. He quickly cleaned up his act, acing organic chemistry the next semester. Her tough love approach worked as well with Higgins’ siblings. One is a partner in a law firm; the other, a bank vice president.

Such uncompromising performance expectations and unwavering support are not always the norm for many African-American kids living in disadvantaged communities today, says Higgins, who went on to earn his M.D. from Yale School of Medicine and master’s degree in health services administration from Virginia Commonwealth University. “Unfortunately, that is what is lacking in the lives of those who don’t reach their potential.”

Nationwide, racial disparities have limited the access to care for underrepresented minorities and undermined efforts to create a representative medical workforce. African-Americans make up 13 percent of the nation’s population but consist of only 4 percent of the country’s physicians, according to the Association of American Medical Colleges (AAMC).

The current outlook for greater diversity is grim, according to a 2015 AAMC report. “Altering the Course: Black Males in Medicine” found that in the nearly four decades between 1978 and 2014, the annual number of black male applicants to medical school dropped from 1,410 to 1,337. In the same time span, black males who matriculated in medical school annually decreased from 542 to 515.

Poor K-12 schools, few role models, negative perceptions of black males and the cost of higher education are among the issues contributing to the decline, according to the AAMC report. Reversing this trend, the report concluded, depends on responsive leadership, retooled admission policies, programs for aspiring minority physicians and stronger community engagement—all goals Higgins actively supports.

“We have to work diligently at the high school and college levels to get students with an aptitude for the biomedical sciences to see medicine as a viable career alternative,” he says. “That requires the presence of role models, mentorship and strategic programming.”

At the Johns Hopkins University School of Medicine, student enrollment of African-Americans/blacks has been uneven in recent years, from a high of 13 percent in the Class of 2015, to a low of 5 percent in the Class of 2018. The most recent entering class, the Class of 2019, includes 9.2 percent African-American/black students, says Paul White, assistant dean for admissions.

Daniel Teraguchi, assistant dean for student affairs and director of the Office for Student Diversity for the school of medicine, is committed to seeing those percentages rise, while also acknowledging that competition is keen for the high-achieving students who are admitted to medical school here. He’s found current black medical students to be the best ambassadors.

“Members of the Student National Medical Association [a student-run organization that supports underrepresented minorities in medicine] do an amazing job of reaching out to black applicants to show Johns Hopkins as a welcoming environment,” Teraguchi says. Once enrolled, black medical students often find the Johns Hopkins chapter of the SNMA to be a valued “home away from home” for emotional and academic support.

The key to sustaining and increasing representation, as recognized in the AAMC report, is to raise the number of underrepresented minority students setting their sights on medical school from a trickle to a steady flow. “Hopkins is already doing a tremendous amount in terms of pipeline programs,” but the need to reach even more young students remains great, says Marc Nivet, the AAMC’s chief diversity officer.

“Bob can agitate for more investment in local K-through-12 initiatives,” Nivet says. “He also needs to be active in the community.”

That’s “where my influence will be felt,” Higgins says. “Not just in the halls of academia, and the operating room and in leadership corridors, but rather making connections with the community and trying to be a role model or leader, or however I can represent the good that can come from a diverse and inclusive agenda.”

During his years at Ohio State, Higgins led a program that introduced at-risk African-American high school students to the surgical field. “We provided basic report card reviews, tutoring, mentorship,” he says. “It was a very successful program, but we won’t know what the dividends are for another five to 10 years.”

Changing the Culture

The decline of underrepresented minorities in medical school nationwide feeds a vicious cycle that results in little diversity in the upper ranks of academic medicine.

In 2016, it remains a challenge to attract and retain black faculty members, says James Page, vice president and chief diversity officer for Johns Hopkins Medicine. “It is one of the areas in which we are most challenged.”

Underrepresented minorities make up 7.6 percent of the Johns Hopkins University School of Medicine faculty, according to school of medicine data. Overall, the data also show that as rank increases, the representation of African-Americans goes down.

Of 106 full-time faculty members in the Department of Surgery at Johns Hopkins, just five are underrepresented minorities, including one professor, two assistant professors, a research assistant and an assistant, according to Johns Hopkins data.

Recruiting underrepresented minorities with “academic distinction, motivation and ambition” is a must, Higgins says. “We have to identify them, create opportunities for them to get here and nurture them to be successful.”

Johns Hopkins Medicine leaders have taken significant steps to improve the institution’s record on these fronts, starting with the faculty search. Traditionally, that process has involved placing ads and tapping into informal networks for references and referrals.

“When dealing with women and underrepresented minorities, we have to go beyond the traditional approach,” says Chiquita Collins, associate dean for diversity and cultural competence for Johns Hopkins Medicine.

Collins has served on 15 search committees involving executive leadership, faculty and trainee positions in recent months. To cast a wider net in recruitment, Collins places phone calls to promising candidates from underrepresented groups, emphasizing Johns Hopkins’ commitment to diversity and inclusion and inviting them to apply. “They are often shocked to have Hopkins call them,” she says. “My message is: ‘Yes, we want you. Your talent and expertise would be an excellent fit.’”

Faculty search committees at Johns Hopkins Medicine now strive to ensure that women and underrepresented minorities each make up 25 percent of the candidate pool. “Given that as a goal, we’re very conscientious about saying, ‘Go back to the table until we get more diverse candidates,’” Collins says.

Johns Hopkins Medicine also provides unconscious bias training to search committee members and to departments across the institution. The goal: to increase awareness and help clinicians, administrators and staff members identify—and move beyond—any unconscious biases they might hold.

“Even people who have the most egalitarian viewpoint in life find themselves to have biases,” Collins says. “It’s important to be aware of our biases and be vigilant about reducing them.

“Second, increasing our exposure to marginalized or underrepresented groups can also help reduce bias by removing ourselves from our comfort zone. Yet this must be conducted in meaningful ways and on a continuous basis.”

Higgins agrees. “Folks have to be open-minded enough to recruit underrepresented men and women from different backgrounds,” he says. “That just hasn’t been part of the culture here. Slowly, we’re changing it.”

As the chief of cardiac surgery at Ohio State’s Wexner Medical Center, Higgins recruited and trained African-American faculty members and fellows in cardiac surgery, says Leon McDougle, Wexner’s chief diversity officer and associate dean for diversity and cultural affairs. Higgins broadened his efforts when, in 2013, he became chair of surgery and surgeon-in-chief, building upon Wexner’s successful track record in recruiting underrepresented minorities, McDougle says. Currently, 26.2 percent of Wexner’s general surgery residents are African-American.

With his reputation as an effective champion of diversity and web of professional connections, Higgins himself is a draw for potential faculty members, Collins has found.

Page welcomes Higgins as a mentor who can attract and help hold on to black faculty members. “It’s one thing to bring them here. It’s another thing to ensure that they successfully move up in the organization,” Page notes.

Higgins has acted quickly to make diversity and mentorship visible priorities, Collins says. One of his first hires was Errol Bush, an African-American heart and lung transplant surgeon recruited from the University of California, San Francisco. In the works as well is an onboarding program that will introduce new faculty members to the academic environment at Johns Hopkins and provide mentorship.

Shortly after he arrived in Baltimore, Higgins also established an endowed memorial lectureship in honor of Levi Watkins Jr., the first African-American chief resident in cardiac surgery at Johns Hopkins. In October, the lectureship’s inaugural speaker, Edward Cornwell, surgeon-in-chief of Howard University Hospital, addressed trauma in urban settings and academic mentorship in leadership.

In front of a standing-room-only audience, Cornwell—who served as chief of trauma here from 1998 to 2008—paid tribute to former mentor Watkins as “a great surgeon and socially conscious member of the faculty who guided the institution’s thinking about how we live and serve in this community,” Higgins says.

Big Egos, Sharp Elbows

If running the Department of Surgery, advocating for equitable health care and serving as a nationwide exemplar seems like too much work for any one person, think again, says a former colleague of Higgins’ at Wexner Medical Center. “While leading the department, he was often up all night doing transplants and taking the big load of cardiothoracic surgery,” says Clay Marsh, now vice president and executive dean for health sciences at West Virginia University.

An adroit administrator, Higgins revived Ohio State’s troubled lung transplant program, Marsh says. “Bob really came in as a stabilizing influence. He got us back on board with lung transplants thanks to his own surgical acumen and his recruitment activities.”

Prior to his time at Ohio State, Higgins served as surgical director of thoracic organ transplantation at Henry Ford Hospital in Detroit, where he led the surgical team that performed the first lung transplant in southeast Michigan. He also created a Medicare-approved lung transplant program and a pediatric heart transplant program in collaboration with the Children’s Hospital of Michigan.

At Johns Hopkins, Higgins sees himself as a catalyst for elevating patient care, teaching and research. But he’s hardly sanguine about the challenges ahead. “Big egos, sharp elbows and big intellect are often a tough combination to manage while trying to be successful and creating a vision of common good to get people going in the right direction,” he says.

As Higgins has settled into his job in Baltimore, his wife, Molly, a former transplant nurse who is now a preschool teacher, remains home in Chicago with their youngest son, Grant, a high school junior. His daughter, Grace, is a senior at Vanderbilt University. John, Higgins’ eldest child and a recent graduate of Dartmouth—where he also played football—is applying to medical school.

Higgins flips through a customized calendar that marks each month with a family portrait. “Here’s my favorite picture of my kids,” he says, revealing an image of three beaming siblings ready to take on the world.

For them, as it was for Higgins and his own siblings, it seems that failure is not an option.

Linell Smith and Sue De Pasquale contributed to the reporting of this article.