In addition to practicing as a doctor for nearly 20 years at the Colored Orphan Asylum in Manhattan, Smith was a public intellectual: he contributed articles to medical journals, participated in learned societies, and wrote numerous essays and articles drawing from his medical and statistical training. He used his training in medicine and statistics to refute common misconceptions about race, intelligence, medicine, and society in general. Invited as a founding member of the New York Statistics Society in 1852, which promoted a new science, he was elected as a member in 1854 of the recently founded American Geographic Society. But he was never admitted to the American Medical Association or local medical associations.