Health Equity

How physician organizations are doing the work to advance equity

Andis Robeznieks , Senior News Writer

A once widely used formula for calculating kidney function automatically underestimated the severity of kidney disease in Black patients, causing delays in their access to medication, specialist referral, nutrition therapy, dialysis and transplant.

The Medical Society of Delaware adopted policy in 2021 advocating to eliminate the use of clinical algorithms and decision-making tools that, like the old kidney function equations, misuse race as a proxy for genetic or biologic ancestry. 

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The society’s leaders then met with the state’s largest diagnostic laboratories and contacted local hospitals, laboratories, and the Delaware Healthcare Association to encourage them to eliminate the use of race-based  estimated glomerular filtration rate (eGFR) equations, and instead to use the updated, race-free equations developed by the National Kidney Foundation and the American Society of Nephrology eGFR Task Force.

A new AMA report examining the status of organized medicine’s role in advancing equity highlights the Medical Society of Delaware’s work as a catalyst for change, alongside data from other state medical societies and national specialty societies.

The report—AMA Health Equity in Organized Medicine 2023 Survey Report: Insights, Solutions, and Resources to Take Action (PDF)—is based on the first-ever health equity survey conducted of organizations within the AMA Federation of Medicine.

A key part of the AMA’s strategic plan to embed racial justice and advance health equity involves learning from its partner organizations about the work have they started, what they have prioritized, and how the AMA can support their efforts with tools, programs and training, said Fernando De Maio, PhD, vice president of health equity research and data use at the AMA Center for Health Equity.

“This is really a way of acknowledging the power that organizations offer physicians and trainees as a collective platform for advocacy and support,” De Maio said. “We recognize the power that medical associations, including the AMA, have to influence policy and shape narratives around health and health equity.”

De Maio and Blair Aikens, MPH, senior health equity data analyst in the AMA Center for Health Equity, discussed the survey findings during a webinar sponsored by the Institute of Medicine of Chicago.

Telling the stories behind the data

The questionnaire was developed by the AMA, with most questions derived from actions found in the professional societies’ pillar of the , a group brought together by the AMA, the Institute for Healthcare Improvement, the Council of Medical Specialty Societies, and leading racial justice organizations including Race Forward, Health Begins, and the Groundwater Institute  to coordinate actions that will have a strong national impact on breaking down barriers to health equity.

The survey found that:

  • 74% of the physician organizations responding to the survey took at least one action to ground their equity efforts in the context of local or organizational history.
  • 72% took action to make equity a strategic priority, such as aligning performance incentives to organizational equity goals.
  • 47% took at least one initiative to advance health equity—such as advocating to eliminate harmful race-based clinical algorithms such as eGFR, vaginal birth after cesarean, and spirometry/pulmonary function testing.
  • 29% took actions intended to promote a thriving community, such as addressing root causes of health inequities.

As an example of grounding efforts in the context of local history, the report highlights how the Michigan State Medical Society held health equity regional summits throughout the state to gain understanding about the health equity landscape.

The American Thoracic Society, meanwhile, made health equity a central pillar of its strategic plan, allowing it to more readily incorporate equity initiatives into all areas of its budget. That includes creating an annual health equity and diversity fellowship for two early-career pulmonologists from historically marginalized populations.

As an example of an organization engaging in collective advocacy to promote a thriving community, Aikens cited the Austin-based Travis County Medical Society’s work with the Texas Medical Association to pass legislation to address maternal health inequities by extending postpartum Medicaid coverage from two to 12 months.

“It is important for organizations to be seen, heard and recognized for their work; it is moving to see our efforts as part of a larger movement toward equity,” De Maio said. “This helps to support and even validate equity work.”

He added that reading about other organizations’ equity efforts may prompt others to develop their own.

The 2024 Health Equity in Organized Medicine survey was distributed to all members of the Federation of Medicine in January; a follow-up report is expected later this year.