How to Advance Minority Health? Further Develop the Pipeline of Minority Physicians.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Paloma Toledo, MD, MPH, an assistant professor of anesthesiology at Northwestern University, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Toledo is a Harold Amos Medical Faculty Development Program scholar.
Addressing racial and ethnic disparities has been a part of the national public health agenda for decades. The U.S. Department of Health and Human Services establishes national objectives to improve the health of Americans through the Healthy People program. In Healthy People 2000, one goal was to reduce racial and ethnic disparities. A decade later, the goal was revised. Currently, the goal for Healthy People 2020 is to establish health equity, eliminating disparities. Despite these goals, disparities persist, and minorities continue to suffer worse health than non-minority whites. Much work has focused on raising awareness of disparities and improving the quality of care for minority patients; however, increasing the number of minority physicians is equally important in combating health care disparities.
Over a decade ago, the Institute of Medicine stated that improved workforce diversity was key for addressing disparities, yet minimal progress has been made to date. For example, Hispanics are the largest minority group in the United States. Despite making up 17 percent of the population, only 5.5 percent of all physicians who graduated between 1978 and 2008 were of Hispanic origin.
There are many direct and indirect benefits to patients from increased workforce diversity. Minority physicians have a higher likelihood of serving minority patients than non-minority white physicians. Minority patients are also more likely to report greater satisfaction with their care when treated by a minority physician. This may be due to improved communication, specifically more patient-centered communication, between the patient and his or her physician. More patient-centered communication has been shown to be associated with better health outcomes in conditions that are prevalent in minority communities, such as hypertension and diabetes.
A second direct benefit also relates to communication, specifically for those patients who are of limited English proficiency (LEP). LEP patients have been shown to have a lesser understanding of their medical conditions and treatments, and lower medication adherence, than non-LEP patients. Furthermore, studies have shown that LEP patients prefer to communicate in their primary language. In a multivariable analysis of where Mexican immigrants living in California preferred to receive care, LEP status was independently associated with seeking medical care in Mexico, underscoring the importance of language-concordant care. While measures, such as the National Culturally and Linguistically Appropriate Services (CLAS) Standards, exist to provide interpreter services to LEP patients, it is unknown to what extent communication occurs in patients’ preferred language.
One indirect benefit of improving workforce diversity is that non-minority trainees benefit from training with minority medical students or physicians. This may lead to a richer cultural understanding than one that could be achieved through cultural competence training alone.
I believe that it is unlikely that we will completely eliminate health care disparities by the year 2020. We should continue to increase awareness of disparities, as well as develop evidence-based interventions to reduce disparities. However, the importance of developing the pipeline of minority physicians should not be overlooked. This is likely equally important to ensuring that we achieve the Foundation’s mission of improving health and health care for all Americans.