KEITH D. CARTER, MD

PROFESSOR & CHAIR DEPARTMENT OF OPHTHALMOLOGY

AND VISUAL SCIENCES

SCCMA

SEPTEMBER 17, 2020

Minorities in Medicine: A Look at Physician

Diversity

Diversity, Equity, and Inclusion

• The biggest challenge is to recognize the need for

action

• Diversity brings value

• The journey continues to be a long one

• Society changes slowly

• Sharing of resources and influence

• Your neighborhood, organization, company, or

university benefits

Diversity, Equity, and Inclusion

Diversity, Equity, and Inclusion

Diversity, Equity, and Inclusion

Implicit Bias

• Attitudes, Stereotypes, and Mental

Shortcuts that affect our understanding,

actions, and decisions in an unconscious

manner

Bias in the Workplace

Diversity, Equity, and Inclusion

• Minorities in health care has lagged the % for these

minorities in the national census for the past 30 years

• Health Care Challenges

• Doing what is best for our patients

• Our patient populations are changing

– Language- Huge impact

– Socioeconomic- access, infrastructure

– Ethnicity – e.g dermatology

– Aging

Economic Impact of Disparities

• Joint Center for Political and Economic Studies

• Studies of racial and ethnic disparities have cost the US $1.24 trillion

dollars

• $229 billion in direct costs spent in direct medical care associated with

disparities

• $1 trillion in indirect costs

John A. Poisal, M. Kent Clemens and Joseph Lizonitz et. al.. “The Outlook Health Spending Projections Through 2018: Recession Effects Add

Uncertainty.” Health Affairs 28, no.2 (2009):w346-w357, originally published online February 24, 2009. doi: 10.1377/hlthaff.28.2.w346.

Ethnicity Trends:Accelerated Ethnic Population Growth With Increased Coverage

• 69% are under age 40

• Lowest access to health care

• Highest literacy issues

• Culturally relevant, in-language health information is a must

• Prefer generics

• Rely heavily on smartphones for health info

• Less trusting of the health care industry

• Less engaged in eye care than average

• Highest mortality rate among ethnic groups

• Comorbidities like hypertension, obesity, diabetes, and smoking need to be addressed for better patient outcomes

• 69% use the Web to access health-related information

• Skeptical of Western medications

• Concerned about language barriers → prefer Asian PCPs

• Culturally relevant, in-language health information is a must

• Prefer generics

• Rely heavily on smartphones for health info

• 75% want health care providers to discuss diagnosis with a family member first

• 90+% have health coverage

• More engaged on Eye Nutrition

Ethnic Population Trends Emphasize Continued Need for Focus on Diversity

Spoke to HCP after seeing Rx Drug ad

80%

2.5x

Hispanics health coverage in 2015 (45M)1

• Commercial = 48.7%; Government = 39.5%

Higher engagement from Spanish vs. English only ads

African American insurance coverage in 2015 (35M)1

• Commercial = 54.1%; Government = 44.2%

24%

88%

Source: US Census Bureau 2014 National Population Projections

Population Growth

Hispanic

African American

Asian

Caucasian

(18%)(19%)

(62%) (60%)

Others

Time

(12%)(12%)

12%

5%

13%

1%

Mexican Americans* African Americans

Asian Americans* Whites

“An Analysis of the Medical School Pipeline: A High School Aspirant to Applicant and Enrollment View”, Analysis in Brief,

Association of American Medical Colleges, March 2014

Thomas LaVeist And Colleagues

from the Johns Hopkins University and the University of Maryland,

Kaiser Family Foundation Study

commissioned by The Joint Center for Political and Economic Studies,

2008. http://kff.org/other/state-indicator/total-active-physicians/

LocationPrimary Care

Physicians

Specialist

PhysiciansTotal

United States 432,726 472,335 905,061

Kaiser Family Foundation -

http://kff.org/other/state-indicator/total-active-

physicians/

The National Academies of

SCIENCE ENGINEERING

MEDICINE

• Advocates for a

population health

approach to ensuring eye health

• “Avoidable vision loss disproportionately

affects URM and the

poor.”

• Workforce approach

is another valid

method of addressing

eye health disparities

URM practice in medically underserved areas addressing

populations vulnerable to health disparities

Trends for African

Americans in Ophthalmology

2010: 2–3 % of the 420 grads

were African American

1935-1970 1.5 grads / yr

1970’s 6.8 grads / yr

1980’s 8.8 grads / yr

2000 - now 9.4 grads / yr

Physician Race/Ethnicity in the US*

* Source: AMA Physician MasterFile 2010 Data “Physician Characteristics and Distribution in the US", 2012 Edition** For US Census, Hispanic /Latino origin asked separately

Includes Native Hawaiian/Pacific Islander

Adapted from https://www.aad.org/File%20Library/Global%20navigation/Member%20tools%20and%20benefits/Diversity%20Mentorship/Und

errepresented_by-Specialty.pdf - Compiled by the American Academy of Dermatology

Date of dow nload: 11/6/2016Copyright © 2016 American Medical Association. All rights

reserved.

From: Current and Future Status of Diversity in Ophthalmologist Workforce

JAMA Ophthalmol. 2016;134(9):1016-1023. doi:10.1001/jamaophthalmol.2016.2257

Proportions of Ophthalmology Residents Stratified by Sex, Race, and Ethnicity From 2005 Through 2014The data source is GME Track, 2005-2014 (December 31 snapshot). Please note that the 2015 data are not available. URM indicates underrepresented in medicine.

Figure Legend:

Pipeline

• Recruitment programs

– College

– High School

• URM meetings

• Undergraduate health symposia

National Medical Association

Rabb-Venable Applicants

Bonnie Simpson Mason, MD

• Board Certified Orthopaedic surgeon

• Nth Dimension is an organization which develops

and facilitates scholarship programs

• Focuses on increasing diversity in medicine,

decreasing gender and health disparities

• Promotes professional development of

aspiring physicians

• 245 engaged student in Nth Dimension Pipeline

• 85 Volunteer Faculty

• 70 residents engaged in all phases of the pipeline

AAO/AUPO Task Force Charge

• Gather information about the current status of URMS in

Ophthalmology and make recommendations to the BOT

• Develop an estimate on number of URMs

• Identify barriers and challenges that contribute to situation

• Seek effective ways to enhance URM representation in

Ophthalmology

Task Force Actions

• Identified need to increase URM medical student exposure to

ophthalmology

– AAO/AUPO Pilot program initiated with long term commitment

• Invited URM Medical Students to the AAO Annual meeting for a one

day program

• Contacted Diversity representative at Chicago medical schools

• Contacted local Student National Medical Association (SNMA)

• Need to increase awareness among program chairs and directors

• Applicant self-reporting now on SF Match Form

• Increase dialogue with AUPO regarding assessing applicant merits

with greater emphasis on holistic attributes

Study

• Formulation of a short

sheet highlighting a more

holistic assessment of

applicants

• Race as an important

criteria to help decrease

health disparities

• Predictors of Student

Productivity in

Ophthalmology ?

– Studies by UNC, Vanderbilt &

UCLA

• no correlations of test scores,

grades, research experience

• recommendation letter were

significantly stronger for students

who published multiple first author

papers

• Traditional quantitative metrics

(test scores) are minimally

predictive of future student

productivity

Mentoring: Task Force members and volunteer physicians are

connected to medical

student mentees. As

mentors, they can

personalize guidance about research opportunities and

help strengthen student

applications.

Expectations of mentors and mentees formulated as a

packet.

Mentoring: Task Force members and

volunteer physicians are connected to medical

student mentees. As mentors, they can

personalize guidance about

research opportunities and help strengthen student

applications.

Expectations of mentors and

mentees formulated as a packet.

Collaborations

• Association of American Indian Physicians (AAIP)

• Association of Native American Medical Students (ANAMS)

• Latin American Native American Medical Association (LANAMA)

• National Hispanic Medical Association (NHMA)

• SACNAS – Advancing Chicanos/Hispanics & Native Americans

in Science

• Student National Medical Association (SNMA)

Minority Ophthalmology

Mentoring

(MOM) Program

2018-19

Purpose and Mission• A partnership between the Academy

and the AUPO

• Attract underrepresented minorities in

medicine to careers in ophthalmology

• Provide valuable guidance for

medical career planning and

decision-making

• Help students become competitive

ophthalmology residency applicants

Purpose and Mission• A partnership between the Academy

and the AUPO

• Attract underrepresented minorities in

medicine to careers in ophthalmology

• Provide valuable guidance for

medical career planning and

decision-making

• Help students become competitive

ophthalmology residency applicants

Student DemographicsThe MOM program officially launched in 2018 with a

class of 22 students.

Student Demographics (cont.)

Underrepresented minorities in medicine include those who identify as African American/Black,

Hispanic/Latino, or Native American (American Indian, Alaska Native, Native Hawaiian).

2018 – First Official Year

• 22 Students in the Class of 2018

in Chicago

• Matched with Mentor

Ophthalmologists

• Provided with educational and

career resources

• In April 2019, completed a

detailed survey assessing

– Program satisfaction

– Academic progress

– Interest in Ophthalmology

Educational Resources for Students

• Full access to Academy educational

materials

• Comprehensive Step 1 exam

preparation for MS2s:

– Enrollment in an 8-month web-based

prep course

– Full complement of self-study resources –

First Aid, Qbanks and self-assessments

Student FeedbackStudent Feedback

MOM Physician Participants

• Mentors guide individual

students through their formal

education.

• Speakers introduce medical

and undergraduate college

students to ophthalmology and

the MOM program.

AUPO Champions

Champions serve as liaisons for

the MOM program at academic

institutions.

• Generate support and enthusiasm

for the MOM program within

institution and department

• Recruit qualified medical students

• Identify colleagues to serve as

Mentors and Speakers

Survey Highlights

Survey Highlights

Most Important Parts of the Program – As Rated by Students

Class of 2019

• Class of 2019 welcome 32 students

from 23 schools

• Race/ethnicity:

• 14 Black or African American

• 14 Hispanic or Latino

• 1 Native American

• 1 URM mixed race

• Gender:

• 13 female students (43%)

• 17 male students (57%)

•

Class of 2019

• Student Engagement Weekend at AAO

2019 program

– Describes the many facets of

ophthalmology and types of practices

– Offers tips on applying for residency

– Impact of eye disease on minority communities

– Skills Lab: suture pig eyes

– Networking with ophthalmologists

– Time with Mentor

Class of 2020

• 50 students. 39 schools

• Female-25 Male-25

• MS1-15 MS2-31, MD/PhD-2

– College senior-2

• Race/Ethnicity

– African American:32

– Hispanic or Latino: 16

– URM Mixed Race: 2

Physician Participation

184 Ophthalmologist Participants

• Committee and Task Force Members

• Mentors for Students

• Speakers at Student Engagement

Weekend

• Presenters on the MOM program at

Medical Schools

• Champions in Ophthalmology

Departments

Thank You to MOM Program Sponsors!

Changing the Face of Ophthalmology

Faculty Recruitment

• Diversity Officers are increasing- use them

• Driven by attention by AAMC & ACGME

• Faculty participation is crucial

• Involve your minority community

– Department

– College

– University

Faculty Recruitment

• Develop a pipeline

• Send faculty to minority medical meetings

• Sell your program

• Recruitment doesn’t stop with the visit

• Provide contacts outside chair or division chief

Faculty Recruitment

• You are successful, now what?

• Provide mentorship

• Involvement in department activities

• Collegiate committees – be careful

• Provide a vision for this recruit

• Provide equal resources for success

• Establish the home = success

Thank You

Questions