Medical Director Midwest Glaucoma Center USA.
The Institute of Medicine (IOM) report documented that racial and ethnic minorities experienced higher mortality rates, worse health outcomes and were less likely to receive routine procedures. Such practices reduce high quality health and effective, patient-centered, timely and efficient management. Recent national data suggest that some disparities are declining or have been eliminated, but many others have remained the same or even increased in the last few years [National Healthcare Disparities Report, 2008].
Five years ago the Commission to End the Health Disparities was created and formed objectives regarding this subject. The Commission is made up of medical and subspecialities. Their emphasis was on healthcare disparities rather than the more broad, complex landscape of health disparities. Different racial and ethnic groups have poorer health status for many reasons that are not directly linked with healthcare delivery. Even the most active leadership group would not be able to solve such widespread problems as patients who live in poverty, lack transportation, or do not live within reasonable proximity to a physician’s office, while also trying to transform the current system into one that is more culturally sensitive and diverse.
The heart of their mission, the participants decided, was to attack disparities from the perspective they knew best: clinical medicine. Even though an array of social problems contribute to healthcare disparities, physicians can fulfill their roles in society most effectively by providing high-quality care regardless of patients’ racial or ethnic backgrounds. Unequal Treatment also suggested that although health professionals dedicate themselves to providing the highest quality of care possible to every patient, they also may harbour unconscious biases and stereotypes that affect their decision-making and attitudes towards minority patients. For example, the report cited a 1999 study by Schulman et al. that showed physicians were significantly less likely to refer black women for cardiac catheterisation than black and white men and white women, even when they had the same symptoms. Another study cited in the report (vanRyn and Burke, 2000) examined actual clinical encounters and revealed that physicians viewed black patients, in comparison with white patients, as less intelligent, less educated, more likely to abuse drugs or alcohol, and less likely to comply with treatment advice, despite their knowledge of patient income, education and personal characteristics. Based on research on the reverse situation—how patients’ biases and attitudes influence clinical encounters—the IOM report indicated that minority patients perceive higher levels of discrimination in healthcare settings than do non-minority patients.
The development of workshops to help train physicians to understand the impact of healthcare disparities and improve communications with their diverse patient populations was undertaken. More specific recommendations that addressed how to meet the ultimate goal of eliminating racial and ethnic disparities in healthcare were also put forward. Recommendations prioritised the following activities:
The creation and maintenance of a diverse workforce changes the cultural experience of non-minority students and exposes those students to a culturally rich learning environment. Incentives such as loan repayment programmes could help reduce physician shortages in underserved communities. The Workforce Diversity Advisory Committee had focussed its efforts on increasing minorities in training programmes by taking an in-depth look at how medical schools’ admissions processes affect minority student enrollment.
A first step is to examine the racial and ethnic composition of admissions and selection committees, and factors involved in their first-tier selection process. Next, a broader assessment would be made of the differences between schools that enroll higher proportions of minority students compared to those with lower minority enrollments.
The Committee also discussed plans to convene key stakeholders—educators, organisations representing minorities, financial groups, government agencies, and the media—in 2006 with the goal of implementing some of the 37 recommendations of the highly regarded report, Missing Persons: Minorities in the Health Professions. This 2004 report was released by the Sullivan Commission on Diversity in the Healthcare Workforce, which was named for its chair, former US Secretary of Health and Human Services Louis Sullivan. Recommendations in the report addressed the underlying reasons why minorities are under-represented in the health professions, in spite of the country’s increasingly diverse population. Another way to increase representation is through the Doctors Back to School (DBTS) programme, was launched in 2002 by the AMA Minority Consortium. Minority physicians and medical students who volunteer in the DBTS programme act as role models by visiting elementary and high schools to talk with students, particularly those in under-represented racial and ethnic groups, about careers in medicine. The programme demonstrates to minority students that a medical career is well within their reach.
Residency and fellowship selection committees should consider the importance of recruiting under-represented minorities. Programme chair meetings should address identification of racial and ethnic disparities and strategies to reduce or eliminate them.
Health disparities / cultural competence education should be required in states with CME requirements. Disparity and diversity issues should be included in certification examinations.
Data collection to improve the factors effective to improve that quality improvement initiatives intended to eliminate disparities is needed. Collection of patient data, identifying factors that help or hinder practitioners and organisations in their efforts to eliminate disparities and gathering physician and patient data on race, ethnicity and language groups (Hasnain-Wynia & Baber, 2006, Siegel 2007, IOM) should be collected by health plans, hospitals, large medical group practices and community health centres (Audet et al., Health Affairs 2005; Nerenz et al., HSR, 2006). Instead, many of this type of data are collected in a non-systematic and unreliable way (Hasnain-Wynia & Baber 2006). Among smaller groups of physicians—practices with 1-5 members—there is reason to believe that collecting and using demographic data to track and reduce disparities is even less common.
Implementation of these various objectives throughout the healthcare community allows each of us to take a part in trying to eliminate healthcare disparities by increasing our self-awareness, increasing minority representation in the workforce and collecting data and evidence based medicine to increase the quality-of-care for all individuals.
Mildred M G Olivier is an Associate Clinical Professor at Midwestern University and Assistant Professor at John H. Stroger, Jr., Hospital at Cook County and at Olympia Fields Osteopathic Hospital. She is currently the CEO of Midwest Glaucoma Center. Olivier received her bachelor’s degree from Loyola University and her medical degree from Rosalind Franklin University of Medicine and Science, formerly The Chicago Medical School.