March 4, 2021, 1:30 pm Michael Devitt — (Editor’s note: In the first two parts of this interview, AAFP President Ada Stewart, M.D., discussed her upbringing and entry into health care, along with her own experiences with racism. In this third and final part, Stewart [pictured here moments before she was announced as president-elect in 2019] touches on the Academy’s achievements and ongoing efforts to promote diversity, equity and inclusion.)
AAFP News: The Academy has made some progress on diversity, equity and inclusion in the last few years. Could you discuss some of the Academy’s accomplishments in this area, and some of the things AAFP is currently doing to recognize that we can continue to get better or do things differently?
Ada Stewart, M.D.: It has been said that with crisis comes opportunity, and there are areas where we have made some positive advances. The Academy established the Center for Diversity and Health Equity in 2017. That’s less than four years ago, but at that time, no other medical society had created an infrastructure to operationalize equity in service to members, patients and communities.
This has been a collaborative effort on the part of AAFP staff, members and chapters. The Academy has done a tremendous job with the center and with efforts like The EveryONE Project and the Neighborhood Navigator in developing and disseminating policies, educational materials and practice tools to assist the organization and members in advocating for health equity and addressing the social determinants of health.
Internally, in 2018 the Board of Directors and our commission members started undergoing unconscious bias training. The following year, they underwent anti-racism training to help better understand how we as an organization can become more inclusive, equitable and multicultural. Our work has also included rolling out an implicit bias training program to chapters and an implicit bias livestream that will be available online to both members and nonmembers. It’s work like this that positioned us to respond urgently to the events of 2020 with a statement condemning all forms of racism and another statement declaring racism a public health emergency.
Likewise, our Congress of Delegates has been very progressive by pushing the AAFP to develop several policies and position papers that address issues of diversity, equity and inclusion. This includes striving for birth equity, and addressing implicit bias, race-based medicine, institutional racism in health care and social determinants of health.
We also support our members in operationalizing equity on the ground in their communities and organizations through our Health Equity Fellowship program, which was launched in 2018. I’m extremely proud of the work our fellows are doing.
Moving forward, we continue to advocate for health equity and Health Care for All. Last year, we held a Virtual Town Hall that featured Dr. Gary LeRoy and several others, titled “The Public Health Crisis of Racism,” and we will have another Virtual Town Hall on a similar topic in March. And last year we were honored to have Dr. Uché Blackstock speak at our Virtual FMX on health equity. I was honored to share the virtual stage with her.
Those are just some of the things that come to mind. I’m sure there are more. So we have made progress, but there is always room for more.
AAFP News: What else should the Academy be doing on the issues you mentioned, such as increasing workforce diversity and addressing health equity?
AS: First, let me say I am honored to have the opportunity to serve our Academy at this time — a time where we are looking at our future, looking at achieving health equity and health care for all that is affordable and equitable. I am also very proud to have the honor of following in the footsteps of another person of color, Dr. Gary LeRoy.
We’re working on many areas, making sure that we look at everything that we do through a health equity lens and addressing diversity and inclusion. Growing a diverse workforce was one of the four strategic priorities of The EveryONE Project, and now is one of the four strategic priorities of the entire organization. The AAFP has had a long history of addressing workforce development and supporting medical students on a path to family medicine. We know that access to primary care — and specifically access to family physicians — is a determinant of health outcomes for all communities, and we desperately need to grow the workforce to achieve our vision of healthier communities. But it’s not just a numbers game in terms of workforce quantity; we also need a workforce that is distributed to the communities that need it, that is reflective of those communities in its composition and that is of the highest quality.
So, the AAFP is drastically expanding our efforts well beyond the medical school space to support students in the middle school, high school and postsecondary stages of their education. We’re working with community organizations and have a few exciting national partnerships to announce soon that include support from the for-profit sector for these workforce efforts. And we’re going beyond student support to also change the systems and structures that are holding our workforce problem in place. We’ve been a leading organization in championing diversity at the medical school stage for decades; now we’re becoming a leading organization for the pathway to medical school.
One other item that I’ll mention is the importance of teaching. We know that students who are underrepresented in medicine are more likely to choose family medicine. I’d like to encourage all members of the Academy to either get more involved in teaching or allow students to shadow them, and in particular to seek out students from underrepresented groups. I think that will go a long way in improving diversity in the workforce.
AAFP News: March is Women’s History Month, and the Academy is recognizing that month as well. You mentioned earlier that it was difficult for you as a woman in medical school. Could you provide some details about the things you experienced as a woman physician?
AS: Women continue to experience gender pay issues in that we make less than our male counterparts. In addition, there continues to be fewer of us in leadership roles. Even as we see more women matriculate into medicine, we still represent less in the active workforce and even less in leadership. As the late Ruth Bader Ginsburg said, “Women belong in all places where decisions are made.” It should not be that women are the exception. I have personal experience with not being recognized as a physician in many instances as I previously mentioned, but I find it important to stand on the shoulders of the women who came before me. I am also proud that the AAFP offers events like the National Conference of Constituency Leaders, which provides a path for women to leadership and to address issues related to women.
AAFP News: With everything that you have achieved, what, if anything, would you change about your decision to become a family physician?
AS: I cannot think of anything that I would change. Everything that I have experienced, the good, the bad, the struggles, the hurdles that I had to go over, I would not change them because this is what has shaped me into the person I am today.
I have no regrets. None. Maybe there are things where I could have done better — in school, for instance, or maybe I could have become a family physician earlier in my journey — but my time as a pharmacist really helped me to be a better physician. The loss of both my parents, my sister and brother — although devastating — allowed me to grow even more spiritually. I am so sad they are not here with me today, but their struggles helped me be the physician and the person that I am today. It has guided me as I talk and listen to my patients.
A patient came into the office with his wife the other day. He has had issues with alcohol and drugs, and I sat there with the two of them and had a conversation. I talked about my family and the issues they went through, and how what he’s doing now is impacting his family and his life. At the end of that conversation, his wife thanked me. She said, “Thank you for being the person you are. Thank you for being the doctor and friend that you are to us and thank you for saving our marriage.”
AAFP News: So now you can add marriage counselor to your list of accomplishments.
AS: Yes! (laughing) Right!
Like I said, I’m able to talk about my experiences in a way that can help others. For young folks, I can talk about some of the things I went through and was able to achieve.
AAFP News: What advice would you have for the medical students, residents and young physicians of color who are just starting out and getting involved in the specialty or in the Academy?
AS: It is important to find a mentor — someone that can help guide you on your journey.
Also, listen. Actively listen. Listen to people who are in the profession, listen to your patients — you can gain a great deal of knowledge from them.
I am amazed how much our younger generation is involved with social issues — and we as seasoned physicians can learn from them. If you want to see change, you have to be part of that change. You have to make sure that your voice is heard; do not be afraid to stand up and make sure that you are that voice of change. As the saying goes, “You have to be the change you want to see.”
Finally, I think it’s really important to be humble. Never stop learning. Continue to strive for health equity and for equitable health care for all.
I hope that I can lift up the younger generation so they can stand on my shoulders, because I stood on the shoulders of others to get to where I am today.