Achieving Health Equity: The importance of academic medical centers

1. Achieving Health Equity: The importance of academic medical centers Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Professor, Department of Medicine Internal Medicine Program Director University of Arizona Medical Center-South Campus

2. Academic Medical Center Provide Patient Care Train Healthcare Professionals Advance Medical Knowledge Through Research INCLUSION AND EQUITY PROMOTES EXCELLENCE IN ALL THREE AREAS

3. Objectives • Definitions • Review the role of academic medical centers in providing care to populations at risk • Review what population is at risk • Understand why training more underrepresented minorities improves health care equity • Review the makeup of physician work force • Discuss improving the cultural diversity of the academic center

4. Diversity---- as a core value embodies inclusiveness, mutual respect, and multiple perspectives and serves as a catalyst for change resulting in health equity. In this context, we are mindful of all aspects of human differences such as: Race Ethnicity Socio-economic status Language Nationality Sex Gender identity Sexual orientation Religion Geography Disability Age

5. Inclusion---is a core element for successfully achieving diversity. Inclusion is achieved by nurturing the climate and culture of the institution through professional development, education, policy, and practice. The objective is creating a climate that fosters belonging, respect, and value for all and encourages engagement and connection throughout the institution and community

6. Health Equity ----- is when everyone has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance

7. Social Factors Can Affect Our Health as Much or More than Medical Care Income Education Status Lifestyle Living Conditions $ Difficult to separate Race and Ethnicity

8. Low Socioeconomic Status Lack of Inclusiveness Educationally Deprived Health Equity Race Ethnicity

9. Role of Academic Medical Centers in the Provision of Care

10. Role of Academic Medical Centers in the Provision of Specialty Care

11. Uninsured in the U.S

12. Comparison Uninsured to US Population

13. Role of Insurance on Health Care Kaiser Commission on Medicaid and the uninsured

14. Achieving Health Equity: The importance of academic medical centers • Academic Medical Centers provide the largest proportion of care to the underserved. • Academic Medical Centers are the foundation of the healthcare safety net.

15. Importance of Diversity in Physician Workforce for Achieving Health Equity • Patients would rather see a physician who is similar to themselves • Diversity challenges assumptions and broadens perspectives • Students feel that they are better able to provide care to individuals who are different from themselves when they train in a heterogeneous environment • Underrepresented minorities are more likely to practice in underserved regions

21. Importance of Diversity in Physician Workforce for Achieving Health Equity • Black physicians who make up 6% of doctors treat 25% of all black patients • Hispanic physicians who make up 5% of doctors treat 23% of all Hispanic patients • Patient preference?? • Geographic preference of physician Saha S et al. Health Aff. 2000, 19:76

22. Importance of Diversity in Physician Workforce for Achieving Health Equity • 23% of Blacks will choose a Black physician • 22% of Hispanics will choose a Hispanic physician • 43% of Hispanics will choose a physician who speaks Spanish Saha S et al. Health Aff. 2000, 19:76

23. University of Arizona Medical Center at South campus • Proportionally provides the most care to the vulnerable population of Tucson 2012 Percent

24. University of Arizona Medical Center at South campus • There are 6 post-graduate training programs at South Campus (103 residents) • Obtaining a diverse population of residents has been difficult

25. Borrowed from Dr. Joe “Skip” Garcia, Vice-Chancellor Health Affairs, U of Illinois, Chicago

26. Diversity as a Tool to Drive Excellence • Identifying Excellence • Attracting and supporting diverse talent to academic medicine • Promoting Excellence • Creating a culture and climate in academic medical centers that helps all talent thrive • Sustaining Excellence • Transforming healthcare delivery by academic medicine and using science to implement positive change

27. A Paradigm shift in Admissions From To Prerequisite competencies Demonstration of competencies Pre-screening review of personal competencies Factual knowledge is only part of what makes a skilled doctor Broad signals that reflect medical school and AAMC values Which applicants are the best fit for the healthcare system of the future Prerequisite courses Memorization of information Post-screening review of personal competencies Good MCAT scores mean good doctors Academic-only signals to potential applicants Which applicant will get the best USMLE scores

28. Diversity as a Tool to Drive Excellence • Although Academic Medical Centers need to do more, there needs to be an increase in the pipeline • Academic Medical Centers need to work in partnership with the community to develop innovative programs that will help to expand the number of appropriate URM in the pipeline

29. Train Diverse Physician Workforce Inclusiveness Care for the Underserved Academic Medical Centers Promote Health Equity