Gabriel Felix is on track to graduate from Howard University’s medical school in May, reports USA Today. The 27-year-old from Rockland County, N.Y., has beaten the odds to make it this far, and knows he faces challenges going forward. He and other Black medical school students have grown used to dealing with doctors’ doubts about their abilities, and other slights: being confused with hospital support staff, or being advised to pick a nickname because their actual names would be too difficult to pronounce.

We’re still on a steady hill toward progress,” says Felix, president of the Student National Medical Association, which represents medical students of color. But “there’s still a lot more work to do.” After decades of effort to increase the ranks of African-American doctors, Blacks remain an underrepresented minority in the nation’s medical schools.

USA Today examined medical school enrollment after the wide coverage of the racially controversial photo that appeared in the 1984 Eastern Virginia Medical School yearbook entry of Virginia Gov. Ralph Northam. The picture showed one person in blackface and another in a Ku Klux Klan hood and robe. The proportion of medical students who identified as African-American or Black rose from 5.6 percent in 1980 to 7.7 percent in 2016, according to the Association of American Medical Colleges. That’s a substantial increase but still short of the 13.2 percent in the general population.

The disparity matters, physicians, students and others say, because doctors of color can help the African-American community overcome a historical mistrust of the medical system – a factor in poorer health outcomes for Black Americans. “It’s been a persistent, stubborn racial disparity in the medical workforce,” says Dr. Vanessa Gamble, a professor at George Washington University. “Medical schools have tried, but it also has to do with societal issues about what happens to a lot of kids in our country these days.”

Those who have studied the disparity blame much of it on socioeconomic conditions, themselves the legacy of systemic racism. African Americans lag other Americans in household income and educational opportunity, among other indicators. Medical schools and professional organizations have tried to boost enrollment and graduation rates by considering applicants’ socioeconomic backgrounds when reviewing grades and test scores, connecting doctors of color with elementary and middle schools and awarding more scholarship money.

They’ve achieved some success: The number of medical students who identified as African-American or Black grew from 3,722 in 1980 to 6,758 in 2016, an 82 percent increase. But further progress toward a more representative student body nationwide remains elusive. That’s due largely to the high cost of medical school – student loans average $160,000 and can take decades to pay off – and the attraction of other professional options available to the strongest minority students that cost less and require fewer years of training.