Health Equity

Fellowship helps physicians connect the dots on health equity

Timothy M. Smith , Contributing News Writer

AMA member Jerry P. Abraham, MD, MPH, CMQ, knows an awful lot about advocacy. A family physician and director of Kedren Vaccines at Kedren Health, a community health center and psychiatric hospital in South Los Angeles, Dr. Abraham is also president of the Los Angeles County Medical Association, a trustee of the California Medical Association and vice chair of the AMA Council on Constitution & Bylaws. He has even done a fellowship in faculty development, health policy and advocacy.

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So why, when he heard last year there were openings for the second cohort of the Medical Justice in Advocacy Fellowship, an education initiative from the AMA and the Satcher Health Leadership Institute at the Morehouse School of Medicine, did he feel he needed to apply?

Jerry P. Abraham, MD, MPH, CMQ
Jerry P. Abraham, MD, MPH, CMQ

“No matter how educated I am or how many degrees I have, I still need to grow,” he said during an interview at the 2023 AMA Annual Meeting. “Anyone who says they’re done growing actually has a lot of growing to do, and I hope I go to my grave still growing.”

One of his big interests is mitigating the health harms of climate change, but he’s also driven to improve physician well-being. In fact, given how heavily enmeshed each is with social determinants of health, they can hardly be seen as separate.

“Both are emergencies,” Dr. Abraham said. “We need work-life balance. We have to figure out how to do this work but also be family members and normal people who look after their health. That's really why this fellowship is so important—because everyone needs to get to their next level, and whether you're an expert or novice, that requires infrastructure and support and space and time.”

Dr. Abraham spoke with the AMA about how the fellowship is helping him advance equity in his day-to-day practice and his work with policymakers and other key decision-makers.

At the top of his list: Seeing ever more dots that are just waiting to be connected.

AMA: You have a depth of experience in health advocacy, including almost 15 years in various roles at the AMA. What drew you to the Medical Justice in Advocacy Fellowship?

Dr. Abraham: I knew that through the fellowship I'd be able to take on an issue like improving the climate health situation. Climate change is presenting profound challenges for doctors like me, working in South Los Angeles, where I mainly care for people who are minoritized and marginalized, mainly a Black and brown population.

I serve a lot of people living with HIV, people experiencing homelessness, people with substance-use challenges and disorders, people that have histories of incarceration, people with severe mental illness. I need to figure out how to better advocate for them not only in my county and my state house, but also in Congress and elsewhere in the federal government.

So, it was a natural fit to go somewhere where they would hold my hand and help me cultivate that agenda. The people most exposed and the most at risk for harm and becoming a climate refugee, having to move, have your communities burned down, getting asthma because you live right by the highway, are going to be Black and Latino communities in the United States. I want to figure out better ways to ... address social determinants of health, including things like housing, food security, economic empowerment, education.

When you think of things that truly make up health, you can't be healthy if you're not educated. You can't be healthy if you can't pay the bills. All those go together. So that's why I need to learn how to better advocate for all of that with a health lens, an equity lens, a justice lens.

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AMA: One thinks about a traditional fellowship as being a year or two of training after residency because there’s something you're trying to subspecialize in or you feel the need to enhance some specific training or knowledge. Maybe it’s something in the term “fellowship,” but the average person looking at your CV might think, “This guy doesn't seem to need more training.”

Dr. Abraham: I think that's the wrong way to approach it. The people in this program are the experts. The fellowship is all about facilitating our ability to do our work even better.

I did a fellowship like the kind you were just describing. I was trained as an epidemiologist at Emory University and Harvard School of Public Health. But after all of that, I still did a fellowship in faculty development, health policy and advocacy, in Los Angeles. I learned how to become a faculty member, how to advocate and how to develop policy. This is about getting to that next level so we become more effective.

AMA: What is one thing that you have been thinking about, working on or learning during the course of this fellowship that you have applied in your day-to-day practice?

Dr. Abraham: Where we are in L.A., we have a lot of Black and brown seniors who live in high-rise buildings with no working elevators or air conditioning, and last summer we saw several of them pass away from excessive heat, so we've got a real emergency here. They need fans, they need air conditioning and they need a way to get out of their homes if the temperature gets to a certain degree.

Because of my vaccine work and all the things that I've done during COVID-19, I've built a lot of goodwill with the local Korean American community. So, when the Korean consulate asked, “What more can we do to help improve the lives of Black and Latino people in Los Angeles?” I was able to help them get Korean fan manufacturers to donate a barge full of fans. That was just an example of seeing the dots and then connecting them.

But the fellowship has also opened my eyes to new ways to advocate through the AMA. For example, there are screening tools that help us assess the risk of climate change. If physicians are using these screening tools, there should be ICD or CPT® codes associated with them—so we can get paid for that work.

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AMA: It sounds like you’re saying the fellowship is teaching you how to be a different kind of doctor. Is that correct?

Dr. Abraham: Yes. My patients are children, they're parents, they're family units. I'm a family physician, so I care for families and communities. But as a physician who practices street medicine, operating out of a van on Skid Row, the world is my exam room. Sometimes I’m seeing an entire family unit in a tent. I’m seeing Grandma and grandbaby and maybe even a family in a neighboring tent. The climate emergency will make this experience a lot more common.

Physicians, in particular, are going to be on the front lines during wildfires and floods. We’re going to have to figure out what to do, and you’d better believe that many of us will say: Wait a minute, I didn’t sign up for this. Why am I still practicing? I wasn’t trained to work in an emergency room full of children who just had an asthma exacerbation because the air quality is so horrific. I wasn’t trained to evacuate 200 people out of a hospital.

Well, we’re working on that.

AMA: So what would you say to physicians who may be interested in applying for the fellowship’s third cohort?

Dr. Abraham: If you want to change the world and move the dial on health equity and racial justice, and if you're not sure you have all the tools, but you think that if we empowered you a little more you could get to the next level, then this is the fellowship for you. You should not deny yourself.

It’s the family you didn't know you had. It was like I knew these people for decades. We're all early career and we just clicked like that from the very beginning that our fellowship crew cohort two came together—it was just like peanut butter and jelly. We gelled so well. And even today, we're all here. We're actually really enjoying this week. We know we have each other. We debrief, we check in. We're all always texting each other. So, that support alone has been amazing.

Also, it’s not a one-off experience. We're building a fellowship alumni base so we can continue to learn and grow the community. So, if you want to be a part of a community that's going to tackle health equity and racial justice long term, then definitely apply. We will end up working together for decades.