achieving health equity: the importance of academic medical centers
DESCRIPTION
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. Academic Medical Center. Provide Patient Care. - PowerPoint PPT PresentationTRANSCRIPT
Achieving Health Equity: The importance of academic medical centers
Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKFProfessor, Department of Medicine
Internal Medicine Program DirectorUniversity of Arizona Medical Center-South Campus
Academic Medical Center
Provide Patient Care
Train Healthcare
Professionals
Advance Medical Knowledge
Through Research
INCLUSION AND EQUITY PROMOTES EXCELLENCE IN ALL
THREE AREAS
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
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
EthnicitySocio-economic statusLanguageNationalitySexGender identitySexual orientationReligionGeographyDisabilityAge
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
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
Social Factors Can Affect Our Health as Much or More than Medical Care
IncomeEducationStatusLifestyle
Living Conditions
$Difficult
to separate
Race and
Ethnicity
Lack of Inclusiveness
Low Socioeconom
ic Status
Educationally
Deprived
RaceEthnicity
HealthEquity
Role of Academic Medical Centers in the Provision of Care
Percent of Hospitals that are Academic
Medicare Medicaid Free Care0
5
10
15
20
25
30
35
40
45
6
22
28
41
Perc
en
t
Role of Academic Medical Centers in the Provision of Specialty Care
Tota
l of a
ll Hos
pita
ls
Tota
l of a
ll Car
e Pr
ovid
ed
Neona
tal I
CUs
Tran
spla
nt S
ervice
s
Pedi
atric
ICUs
Leve
l 1 T
raum
a
Burn
Uni
ts0
1020304050607080
6
20
4050
6254
75
Perc
en
t
Uninsured in the U.S
Unins
ured
Hispa
nic
18-3
5 ye
ars ol
d
< 1
8 ye
ars ol
d
empl
oyed
0
10
20
30
40
50
60 55
2016
9
27
In m
illion
s
Comparison Uninsured to US Population
Hispanic Whites Black
35.9
1722.8
16.3
63
12.2
UninusredPercent US Popula-tion
Role of Insurance on Health Care
Could not Af-ford Prescrip-
tion Drug
Needed Care but Did Not
Get it Due to Cost
Postponed Seeking Care Due to Cost
No Usual Source of Care
0 10 20 30 40 50 60
PrivateMedicaidUninsured
Kaiser Commission on Medicaid and the uninsured
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.
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
White Black Hispanic Asian Native Am
63
12.2 16.44.8 0.7
62
6.5 7.721.7
0.8
75
6.3 5.213
0.5
Comparison of Medical School Graduates to US
Population
U.S. Population Medical School GraduatesU.S. Physicians
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
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
University of Arizona Medical Center at South campus
• Proportionally provides the most care to the vulnerable population of Tucson
Emergency Department
Outpatient Inpatientry05
101520253035404550
44 42
35
25
3
13MedicaidSelfpay
2012
Perc
ent
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
Borrowed from Dr. Joe “Skip” Garcia, Vice-Chancellor Health Affairs, U of Illinois, Chicago
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
A Paradigm shift in Admissions
FromPrerequisite 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
ToPrerequisite 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
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
Inclusiveness
TrainDiverse
Physician Workforce
Care for the Underserved
PromoteHealth Equity
Academic
Medical Centers