Diversifying medicine: The time is now

The medical profession should view health care disparities as a health care quality issue.

Editorial. Nov. 17, 2003.

The Sullivan Commission on Diversity in the Healthcare Workforce hit Chicago last month on the fourth stop of its seven-city tour.

The 15-member commission, convened by former U.S. Secretary of Health and Human Services Louis Sullivan, MD, is holding hearings across the country as it sets about developing some comprehensive, tangible recommendations for addressing the widening gap between the diversity of the health care profession and the diversity of the population it serves.

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Hispanics make up nearly 12.5% of the U.S. population, according to the U.S. Census Bureau, but according to the American Medical Association, only 3.4% of physicians are Hispanic. Blacks make up 2.5% of the physician work force, but they are 12.3% of the general population.

There has been no shortage of recent studies bringing to light the existence of racial and ethnic disparities in health care in this country. Most notable is the 2002 Institute of Medicine report, which found that minorities were likely to receive lower-quality health care regardless of income and insurance coverage.

Eliminating health care disparities needs to be viewed by the medical profession as a quality issue, as well as an ethical one. AMA President-elect John C. Nelson, MD, MPH, put it this way when he testified before the Sullivan Commission: Physicians have a professional and moral obligation to deliver the best possible quality care to everyone.

It is commonly accepted that training more minority physicians would go a long way toward eliminating disparities. As recently as last month, an AMA-convened task force that included representatives from state and medical specialty societies, the National Medical Assn., the National Hispanic Medical Assn. and the federal government agreed that now is the time to increase work-force diversity.

There are several ways the Sullivan Commission could go about facilitating that increase. Here are some suggestions:

Future generations of physicians are sitting in elementary, middle and high school classrooms right now. They need to be cultivated. Recognizing this, the AMA has implemented a Doctors Back to School program in which minority physicians are encouraged to visit their local schools as role models and to offer academic encouragement to children of color. This model could be used to create other community partnerships. It is also essential to implement motivational and educational goals at every level of the education system as well as enrichment programs to supplement the education of students with potential.
Once these students are ready for medical school, it is imperative that models for successfully recruiting and retaining minorities in medical education have been implemented. Academic institutions should be encouraged to incorporate into their mission statements the benefit of admitting students on the basis of serving diverse patient populations.
Giving minority students the academic tools to work their way into and through medical school will go only so far if the financial barriers are not also addressed. One way to do this -- creating or enhancing scholarship and loan forgiveness programs.

These are just three of the suggestions Dr. Nelson recommended to the Sullivan Commission, which is funded by the W.K. Kellogg Foundation and administered by the Duke University School of Medicine, Durham, N.C.

Taken together, these and other AMA recommendations have the potential to change the face of medicine and substantially improve the quality of care provided to minorities.

The commission should take them to heart and then to the policy-makers, foundations, academics and legislators it hopes to influence. In that way, it will plant the seeds for substantive change.