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Tuesday Nov 22, 2016

Doing My Part to Help Physician Workforce Reflect Diverse Population

As I watch the news or scroll through my Facebook feed, I see all that is happening in the world today and feel sad, angry and overwhelmed. I know, too, that this year's ill-fated events in Tulsa, Okla.; Charlotte, N.C.; Baton Rouge, La.; Dallas; Falcon Heights, Minn.; Orlando and many other cities have affected my patients -- even though we are separated from all of those violent acts by more than 1,000 miles.

Media accounts of these events have typically focused on race and injustice. I do not need to turn on my TV or check my smartphone to see what is going on with black lives. I see the impacts of racism, stereotypes, discrimination and social injustices every day -- sometimes all too close to home. And as a family physician, I see these factors play a role in the health disparities and inequities in our country.

Blacks represent nearly 13 percent of the U.S. population but less than 4 percent of the physician workforce.

Health inequities can be defined as health differences adversely affecting socially disadvantaged groups. Research has shown that when minority populations experience discrimination and racism, it can negatively impact their physical and mental health(www.ncbi.nlm.nih.gov). Such experiences have also been shown to influence the likelihood that members of these populations will turn to harmful coping mechanisms such as tobacco, drugs and unhealthy foods to deal with stress. Minorities also are disproportionately affected by chronic diseases such as heart disease and diabetes. Many minority groups have less access to care, lack insurance coverage and receive poorer quality of care compared with nonminority populations.

I take care of various disadvantaged populations. I diagnose and treat illnesses, but there are things patients are born with that I cannot change, and, unfortunately, people often are judged by the color of their skin, the languages they speak and the country where they were born.

I may not be exactly #whatadoctorlookslike in the eyes of many people(www.huffingtonpost.com), whether or not they're aware of holding that view. Most minority patients who see me for the first time are surprised when I walk into the room. "Are you the doctor?" they ask. After I say yes, they smile and say something like, "Wow, a young, black female doctor? That is great."

This exchange is usually followed by them asking how old I am and saying that I remind them of one of their relatives. This helps me build great rapport with my patients. I seem familiar to them, and this fosters trust.   

Sadly, this familiarity is lacking in many U.S. health care settings. Although blacks, Hispanics and Native Americans represented 12.8 percent, 11.3 percent and 0.9 percent of the population, respectively, in the 2000 census, those same groups represented only 3.3 percent, 2.8 percent and 0.3 percent of the physician workforce in 2004(www.aamc.org). According to the Association of American Medical Colleges (AAMC), there actually has been a decline in the number of black men in medicine(news.aamc.org). One factor the AAMC cited for this trend is the negative public perception of black men -- a perception that may have worsened in light of the recent shootings and media coverage.

I have a passion to actively recruit and mentor minority students and residents. I think it is important to get more underrepresented minorities into the field of medicine. Research has demonstrated that minority doctors serve the majority of minority and underserved neighborhoods(archinte.jamanetwork.com). Thus, building a physician workforce that is more representative of the U.S. population could help address inequities in health and health care.

When minority physicians treat patients of the same minority group, it can lead to increased patient satisfaction and delivery of more culturally proficient care. Strong mentorship is key to encouraging interest in a career in medicine, and minority youth need role models to offer hope and guidance.  

Writing this blog is one way for me to say, "I am listening, I am here to help, and I understand." So what is my perspective? Black lives matter to me; all lives matter to me. That is why I became a doctor -- to help people. One of the reasons I specifically chose family medicine was so I could help a wide variety of people from birth to death. I chose to work in an urban population so I can help people who need it and who have limited access to that help.

It is important to me to inhabit a working environment that aligns with my mission, which is to improve access to high-quality, patient-centered primary health care targeted to the needs of medically underserved communities. As doctors, we wish we could fix all of the social and political injustices we see. When we sit down with our patients in the exam room, we can certainly make a difference there, whether it is just to acknowledge that racism exists and that it affects their health, or whether it is to listen to their stories, advocate for them and -- most importantly -- give excellent care to those who need it the most.

Joyce Robert, M.D.,C.L.C., is an associate medical director at a federally qualified health center/teaching health center in Harlem, N.Y. Her interests include minority health, lactation health and diversity in medicine.

Posted at 12:44PM Nov 22, 2016 by Joyce Robert, M.D.

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