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The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation
From award-winning journalist Nicole Carr comes a landmark narrative revealing the untold history of Black medical professionals who have long fought to heal their communities—while confronting a system built to exclude them.
During the COVID-19 pandemic, Black Americans died at nearly twice the rate of their white counterparts—a disparity rooted not just in access to care but in a long history of systemic exclusion, exploitation, and racism. How did we get here, and why—despite generations of Black medical excellence—do these inequities persist? In The Price of Exclusion, journalist Nicole Carr uncovers that forgotten history, highlighting the Black medical pioneers who gave their all—and sometimes their lives—so others could thrive.
Told through the extraordinary life of her great-grandfather, Dr. Lawrence St. Clair Ferguson, a Jamaican-born physician who practiced in Philadelphia during the Spanish Flu pandemic, Carr’s exploration is both intimate and sweeping, taking readers from segregated hospital wards to the frontlines of recent public health crises. Tracing Ferguson’s journey—from his early years in colonial Jamaica to his fight to practice medicine in a racially divided America—Carr reveals the long-standing barriers Black doctors have faced, the systemic efforts to erase their contributions, and the consequences that still shape healthcare today.
Through vivid storytelling and meticulous research, Carr introduces us to trailblazers like Onesimus, an enslaved African who brought inoculation to the colonies; Dr. Rebecca Crumpler, the first Black woman to earn a medical degree; and Dr. Charles Drew, whose pioneering work in blood transfusion transformed modern medicine. These were not merely doctors; they were fighters, innovators, and advocates who persevered against relentless discrimination, reshaping medicine and carving paths for future generations. Carr also exposes the mechanisms used to disempower Black doctors, including the American Medical Association’s campaign to exclude Black practitioners from membership, internships, and hospital staff positions.
Here Carr uses the arc of her great-grandfather’s life, and the broader history of Black medical professionals, to expose the root causes of today’s healthcare disparities. She reveals how a century of exclusionary policies has led to the urgent shortage of Black medical professionals and a lingering distrust in medicine—barriers that continue to cost lives today.
Bold, moving, and essential, The Price of Exclusion is a fresh and necessary history, as well as a testament to the resilience and ingenuity of Black medical pioneers past and present. An urgent narrative during a time when diversity, equity, and inclusion efforts in medicine are under political attack, The Price of Exclusion forces us to reckon with the past while imagining a future where healthcare truly values every single life.
During the COVID-19 pandemic, Black Americans died at nearly twice the rate of their white counterparts—a disparity rooted not just in access to care but in a long history of systemic exclusion, exploitation, and racism. How did we get here, and why—despite generations of Black medical excellence—do these inequities persist? In The Price of Exclusion, journalist Nicole Carr uncovers that forgotten history, highlighting the Black medical pioneers who gave their all—and sometimes their lives—so others could thrive.
Told through the extraordinary life of her great-grandfather, Dr. Lawrence St. Clair Ferguson, a Jamaican-born physician who practiced in Philadelphia during the Spanish Flu pandemic, Carr’s exploration is both intimate and sweeping, taking readers from segregated hospital wards to the frontlines of recent public health crises. Tracing Ferguson’s journey—from his early years in colonial Jamaica to his fight to practice medicine in a racially divided America—Carr reveals the long-standing barriers Black doctors have faced, the systemic efforts to erase their contributions, and the consequences that still shape healthcare today.
Through vivid storytelling and meticulous research, Carr introduces us to trailblazers like Onesimus, an enslaved African who brought inoculation to the colonies; Dr. Rebecca Crumpler, the first Black woman to earn a medical degree; and Dr. Charles Drew, whose pioneering work in blood transfusion transformed modern medicine. These were not merely doctors; they were fighters, innovators, and advocates who persevered against relentless discrimination, reshaping medicine and carving paths for future generations. Carr also exposes the mechanisms used to disempower Black doctors, including the American Medical Association’s campaign to exclude Black practitioners from membership, internships, and hospital staff positions.
Here Carr uses the arc of her great-grandfather’s life, and the broader history of Black medical professionals, to expose the root causes of today’s healthcare disparities. She reveals how a century of exclusionary policies has led to the urgent shortage of Black medical professionals and a lingering distrust in medicine—barriers that continue to cost lives today.
Bold, moving, and essential, The Price of Exclusion is a fresh and necessary history, as well as a testament to the resilience and ingenuity of Black medical pioneers past and present. An urgent narrative during a time when diversity, equity, and inclusion efforts in medicine are under political attack, The Price of Exclusion forces us to reckon with the past while imagining a future where healthcare truly values every single life.
304 pages, Hardcover
First published June 16, 2026
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Displaying 1 - 14 of 14 reviews
Review of advance copy received from NetGalley
This is an important book not only for the vital history it provides but for the reality that even with a small percentage of black physicians, by 2036 the US won’t have enough physicians to care for its citizens, black and white. Prohibiting increasing Black students from contributing to health care seems blind-sided.
Carr provides a detailed history of Black contributions to health care but whose contributions were pushed aside by the powers that be. Also included are the exclusionary tactics that impacted health care for Black citizens. Weaving her family history in medicine into the story, we see the efforts by white communities and the AMA (for instance, it was only in 1968 that the AMA finally allowed Black students to enroll in white medical schools) to impede Black progress and health). Allowing more diversity in healthcare is good for all of us but with “zero sum thinking” that supports systematic racism so few understand this.
We mustn’t let history die or be whitewashed by anti-DEI initiatives which is why this book is so incredibly important. I was incredibly moved by this book. It especially hit home when I read that Western Michigan University (just a city south of where I live) “scrapped its ‘Underpresented in Medicine’ scholarship in 2024 due to the Do No Harm group that supports anti-DEI initiatives in education as the group threatened to bring a lawsuit that would be expensive and lengthy
This is a must read.
I’d like to thank NetGalley and Dey Street Books for allowing me access to this ARC.
Carr provides a detailed history of Black contributions to health care but whose contributions were pushed aside by the powers that be. Also included are the exclusionary tactics that impacted health care for Black citizens. Weaving her family history in medicine into the story, we see the efforts by white communities and the AMA (for instance, it was only in 1968 that the AMA finally allowed Black students to enroll in white medical schools) to impede Black progress and health). Allowing more diversity in healthcare is good for all of us but with “zero sum thinking” that supports systematic racism so few understand this.
We mustn’t let history die or be whitewashed by anti-DEI initiatives which is why this book is so incredibly important. I was incredibly moved by this book. It especially hit home when I read that Western Michigan University (just a city south of where I live) “scrapped its ‘Underpresented in Medicine’ scholarship in 2024 due to the Do No Harm group that supports anti-DEI initiatives in education as the group threatened to bring a lawsuit that would be expensive and lengthy
This is a must read.
I’d like to thank NetGalley and Dey Street Books for allowing me access to this ARC.
Review of advance copy received from Publisher
Nicole Carr’s The Price of Exclusion is part investigative journalism, part family history, and part testament to the generations of Black physicians who fought for the right to learn, practice, and care for their communities in a segregated America.
Through the story of her great-grandfather (he was a graduate of Howard University College of Medicine) Carr traces the systemic barriers that kept Black doctors out of medical education and professional opportunities, from discriminatory accreditation standards to the deliberate exclusion of Black hospitals and training sites. Along the way, she illuminates a sobering reality: while Black Americans make up roughly 14% of the population, only about 5% of physicians in the United States are Black.
As an award-winning investigative journalist, Carr brings both rigor and heart to this work. The book is deeply researched but it is also a moving quest for ancestry, belonging, and understanding. One of my favorite lines truly captures the spirit of the project: “I’ve been chasing the dead for several years now.” That pursuit becomes a way of reclaiming history and honoring those whose contributions have too often been overlooked.
Reading The Price of Exclusion inspired me to think about the barriers that still exist in helping professions and the responsibility we have to continue creating pathways where institutions have created obstacles. Ultimately, this book is a love letter to Carr’s family, to Black physicians past and present, and to the ongoing pursuit of a society that values humanity over race.
Through the story of her great-grandfather (he was a graduate of Howard University College of Medicine) Carr traces the systemic barriers that kept Black doctors out of medical education and professional opportunities, from discriminatory accreditation standards to the deliberate exclusion of Black hospitals and training sites. Along the way, she illuminates a sobering reality: while Black Americans make up roughly 14% of the population, only about 5% of physicians in the United States are Black.
As an award-winning investigative journalist, Carr brings both rigor and heart to this work. The book is deeply researched but it is also a moving quest for ancestry, belonging, and understanding. One of my favorite lines truly captures the spirit of the project: “I’ve been chasing the dead for several years now.” That pursuit becomes a way of reclaiming history and honoring those whose contributions have too often been overlooked.
Reading The Price of Exclusion inspired me to think about the barriers that still exist in helping professions and the responsibility we have to continue creating pathways where institutions have created obstacles. Ultimately, this book is a love letter to Carr’s family, to Black physicians past and present, and to the ongoing pursuit of a society that values humanity over race.
Review of advance copy received from Publisher
I often gravitate to books that connect the past and the present and this book does that by connecting the story of the author's great-grandfather and the challenges he faced (and eventual successes he had) in becoming a doctor with the current situation in this country and its shortage of Black doctors.
There is a lot to keep track of but Nicole guides the reader through carefully. I counted nearly 20 libraries and research institutions among her sources in the acknowledgements, and I could tell on almost every page that the book was thoroughly researched. It combines historical research and family interviews. And yet, the story can be told in 250 pages, so it's not an overwhelming read.
I like to end my reviews with "If you are interested in ... then this is a book for you." And there's a few paths here.
If you're interested in learning about long-term impacts of segregation or the history of medicine as relates to civil rights, this book is for you. It's also for you if you're interested in genealogical research and the work that goes into it (it's well-documented here). Or if you're interested in reading about early 20th century history, this is a book for you. And if you work in medicine, from aspiring physician to medical administrator, you would learn something important in reading this book.
(read in preparation for an interview with the author)
There is a lot to keep track of but Nicole guides the reader through carefully. I counted nearly 20 libraries and research institutions among her sources in the acknowledgements, and I could tell on almost every page that the book was thoroughly researched. It combines historical research and family interviews. And yet, the story can be told in 250 pages, so it's not an overwhelming read.
I like to end my reviews with "If you are interested in ... then this is a book for you." And there's a few paths here.
If you're interested in learning about long-term impacts of segregation or the history of medicine as relates to civil rights, this book is for you. It's also for you if you're interested in genealogical research and the work that goes into it (it's well-documented here). Or if you're interested in reading about early 20th century history, this is a book for you. And if you work in medicine, from aspiring physician to medical administrator, you would learn something important in reading this book.
(read in preparation for an interview with the author)
Review of advance copy received from Author
A debut that knows exactly what it’s doing. The Price of Exclusion is thoughtful, layered, and beautifully restrained, never rushing the reader, never over-explaining itself. The storytelling is precise and intentional, with an emotional depth that sneaks up on you. You think you’re reading a nonfiction book, and then you realize you’re holding something much bigger in your hands.
What I loved most is how human this book feels. It explores ambition, identity, power, and longing in a way that feels honest and lived-in. The characters are complex without being exhausting, and the writing trusts the reader to sit with discomfort, nuance, and unanswered questions.
This is the kind of book that doesn’t need shock value or gimmicks. Its strength is in its confidence. It lingers. It stays with you. And when you finish, you don’t want to rush to the next book, you want to talk about this one.
A stunning debut and a clear signal that Nicole Carr is a storyteller and a researcher that we are blessed to have preserve our history.
What I loved most is how human this book feels. It explores ambition, identity, power, and longing in a way that feels honest and lived-in. The characters are complex without being exhausting, and the writing trusts the reader to sit with discomfort, nuance, and unanswered questions.
This is the kind of book that doesn’t need shock value or gimmicks. Its strength is in its confidence. It lingers. It stays with you. And when you finish, you don’t want to rush to the next book, you want to talk about this one.
A stunning debut and a clear signal that Nicole Carr is a storyteller and a researcher that we are blessed to have preserve our history.
Review of advance copy received from NetGalley
4.25/5. This was a great read, I'm thankful to have received a digital ARC from Netgalley and HarperCollins. This book details many of the injustices Black Americans faced in the US healthcare system and discrimination in allowing Black residents to attend medical school, and how many of these injustices persist today. She tells this history using global statistics, stories from around the world, and personal anecdotes. She talks about her great-grandfather Dr. Lawrence St. Clair Ferguson and his journey growing up in Jamaica, serving in World War I, attending medical school against all odds, and his contributions to the medical field. I learned a lot reading this book, and Carr's writing style keeps you engaged. Well researched, well written, and an overall great read. Highly recommend this book.
June 29, 2026
The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation should be required reading for anyone entering the medical field, as well as anyone who cares about the current state, and future, of healthcare in the US and beyond. In this powerful book, Carr brings to light the long overlooked stories of Black physicians and their patients while exposing the systemic forces that weakened their institutions, erased their contributions, and shaped healthcare inequities that continue to this day.
I also highly recommend the audiobook. Hearing Carr narrate her own work adds a deeply personal dimension to the experience. As she recounts her journey uncovering these stories, it feels as though you're walking alongside her through every conversation, archive, and historic site, making the book's history feel immediate, vivid, and unforgettable.
I also highly recommend the audiobook. Hearing Carr narrate her own work adds a deeply personal dimension to the experience. As she recounts her journey uncovering these stories, it feels as though you're walking alongside her through every conversation, archive, and historic site, making the book's history feel immediate, vivid, and unforgettable.
June 30, 2026
When research journalism meets history, you get this masterpiece. It took no time for me to get into this book and drop everything else I was reading at the time. We can see the statistics that minorities are underserved when it comes to medical treatment, but the targeted effort to ensure that Black people are excluded from practicing healthcare draws a direct line to how Black people are mistreated and under served when it comes to healthcare needs. In search of her Great grandfather path to become a Medical Physician, I believe that Nicole Carr's The Price of Exclusion, is not just the history of Medical Apartheid but an investigative research into how white supremacy connects to various systems of oppression. From education, to medical professionals, to disenfranchisement, this book gives you endless points of entry to exam and helps you appreciate the fight to be seen as human.
Review of advance copy
As someone who enjoys history told through the lives of real people, I found The Price of Exclusion both educational and deeply engaging.
Nicole Carr masterfully intertwines the history of segregation in American healthcare with the story of her great-grandfather, Fergie, whose journey serves as a powerful reminder of the obstacles Black Americans faced when seeking medical care and opportunity.
This book tells a story of resilience, family, and the enduring pursuit of dignity and equitable healthcare. I highly recommend!
Nicole Carr masterfully intertwines the history of segregation in American healthcare with the story of her great-grandfather, Fergie, whose journey serves as a powerful reminder of the obstacles Black Americans faced when seeking medical care and opportunity.
This book tells a story of resilience, family, and the enduring pursuit of dignity and equitable healthcare. I highly recommend!
Review of advance copy
If you're interested in learning about long-term impacts of segregation or the history of medicine as relates to civil rights, this book is for you. It's also for you if you're interested in genealogical research and the work that goes into it (it's well-documented here). Or if you're interested in reading about early 20th century history, this is a book for you. And if you work in medicine, from aspiring physician to medical administrator, you would learn something important in reading this book.
Read
June 20, 2026Nicole Carr’s The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation is a powerful and deeply researched work that connects history, medicine, and systemic inequality in a way that feels both personal and urgent. Through the lens of her own family history, Carr brings forward the story of Black medical professionals who fought not only diseases but also a healthcare system built on exclusion.
One of the strongest aspects of this book is its storytelling. Instead of presenting history in a dry academic tone, Carr builds a narrative around real people like Dr. Lawrence St. Clair Ferguson, Dr. Rebecca Crumpler, and Dr. Charles Drew. Their lives are used to show how Black medical excellence has always existed, even when institutions tried to erase or ignore it. This makes the book emotionally engaging while still being highly informative.
The author also does an excellent job of connecting past injustices to present-day healthcare disparities. The discussion around COVID-19 and unequal death rates adds a modern urgency that makes the historical content feel immediately relevant. It is not just a history lesson, but a reflection on how deeply rooted systems continue to shape health outcomes today.
What stands out most is how clearly the book explains structural barriers without losing narrative flow. The reader is guided through segregation, professional exclusion, and medical discrimination in a way that is easy to understand but still intellectually powerful.
While the book is dense at times due to the amount of historical detail, it remains engaging throughout. It is especially impactful for readers interested in medical history, social justice, or the evolution of healthcare systems.
For readers exploring related informational content or guides like the Insta Gold Install Guide, this book offers a very different but equally important kind of knowledge focus, centered on history, equity, and human impact.
Overall, The Price of Exclusion is an essential read that highlights both the resilience of Black medical pioneers and the ongoing need for reform in healthcare systems.
One of the strongest aspects of this book is its storytelling. Instead of presenting history in a dry academic tone, Carr builds a narrative around real people like Dr. Lawrence St. Clair Ferguson, Dr. Rebecca Crumpler, and Dr. Charles Drew. Their lives are used to show how Black medical excellence has always existed, even when institutions tried to erase or ignore it. This makes the book emotionally engaging while still being highly informative.
The author also does an excellent job of connecting past injustices to present-day healthcare disparities. The discussion around COVID-19 and unequal death rates adds a modern urgency that makes the historical content feel immediately relevant. It is not just a history lesson, but a reflection on how deeply rooted systems continue to shape health outcomes today.
What stands out most is how clearly the book explains structural barriers without losing narrative flow. The reader is guided through segregation, professional exclusion, and medical discrimination in a way that is easy to understand but still intellectually powerful.
While the book is dense at times due to the amount of historical detail, it remains engaging throughout. It is especially impactful for readers interested in medical history, social justice, or the evolution of healthcare systems.
For readers exploring related informational content or guides like the Insta Gold Install Guide, this book offers a very different but equally important kind of knowledge focus, centered on history, equity, and human impact.
Overall, The Price of Exclusion is an essential read that highlights both the resilience of Black medical pioneers and the ongoing need for reform in healthcare systems.
July 2, 2026
Listening to this audio book was an exceptional experience. The way that Nicole Carr weaved together the journey of her Great Grandfather, history, and today is elite storytelling— as the reader/listener it was a delight to go along for the ride. The way in which history repeats itself within healthcare as it relates to Black Americans is beyond concerning, it’s disheartening and deadly. There is an immense cost for exclusion.
Review of advance copy received from Author
Read in preparation for an interview with the author. I’ve lived in North Carolina my entire life and will confess that I knew very little of the history presented about our state in this book. Really important work.
June 24, 2026
This is so beautiful, I love your book!
July 1, 2026
A good book on the state of Healthcare in Black America.
Displaying 1 - 14 of 14 reviews