Kirch, Darrell G. MD; Nivet, Marc A. EdD; Berlin, Anne MA
Dr. Kirch is president and CEO, Association of American Medical Colleges, Washington, DC.
Dr. Nivet is chief diversity officer, Association of American Medical Colleges, Washington, DC.
Ms. Berlin is diversity research specialist, Association of American Medical Colleges, Washington, DC.
Editor’s Note: This is a commentary on Peek ME, Wilson SC, Bussey-Jones J, et al. A study of national physician organizations’ efforts to reduce racial and ethnic health disparities in the United States. Acad Med. 2012;87:694–700.
Correspondence should be addressed to Dr. Nivet, 2450 N St., NW, Washington, DC 20037; e-mail: email@example.com
A research report in this issue of Academic Medicine by Peek and colleagues describes how physician organizations are mounting different initiatives targeted at reducing health disparities. The study emphasizes how these organizations are attempting to promote health equity through policies and programs focused on education, clinical care, research, and advocacy. They found that 68% of surveyed organizations have at least one initiative targeting health disparities.
This commentary acknowledges the positive trend uncovered by Peek and colleagues which characterizes the engagement level of national physician organizations on this critical issue, and suggests four ways to enhance future efforts. First, health equity should be linked to overall quality of care and emerging initiatives aimed at transforming the delivery of health care. Second, the effect of such efforts can be magnified by evaluating what works and sharing best practices. Third, interventions must be targeted at institutions as well as individual physicians. Finally, it should be emphasized that the driving rationale for physicians to strive for health equity is the ethical imperative to promote justice in health care.
In this issue of Academic Medicine, Peek and colleagues1 report the results of research to characterize the number and type of health disparities initiatives undertaken by national, membership-based physician associations. This study represents the authors’ efforts to gauge whether health equity is receiving the attention it deserves from these organizations, which should be well positioned to influence the fight against health disparities through thoughtful policies and programs across the domains of education, clinical care, and research. They found that, of 167 organizations eligible for inclusion in the study, 68% had at least one disparity-reducing activity in place, with the most popular approaches being educational content for physicians and trainees on communication skills and cultural competence; pipeline programs; advocacy efforts, especially related to access to care and workforce diversity; and the development of materials to help patients overcome language barriers. Notably, these activities were more prevalent among organizations with over 5,000 members, as 88% of large organizations had active initiatives.
Despite this good news, 53% of surveyed groups had either zero or just one activity, and the preponderance had fewer than five total initiatives, including those that were passive in nature, such as position statements. Smaller organizations (<1,000 members) were the least likely to have active initiatives, a finding likely linked to resource constraints. Further, of the initiatives profiled, most were focused in the educational domain, with much less activity in the research and clinical care domains.
To be sure, supporting their member physicians in the fight against health disparities is a necessary and timely enterprise for professional associations. Physicians are increasingly held accountable for effectively delivering quality care to all patients, and efforts such as the ones described above are critical to this goal. The data collected by Peek and colleagues1 will allow associations and other organizations to benchmark their efforts and should encourage those organizations with sparse efforts to engage more substantially, given the robust efforts of their peers.
A Positive Trend
We interpret these results as a promising trend in which health care professionals are increasingly taking ownership of the factors outside the hospital and clinic that contribute to positive patient outcomes. Fueling this trend is a growing recognition of the powerful association between the measure of our excellence as practitioners and institutions and the degree to which we are meeting the needs of our patient communities.2 Ultimately, meeting the mission of improved health for all should be the metric of success for physicians and for the medical schools and teaching hospitals where they are trained.
As these disparity-reducing initiatives grow, they undoubtedly will accelerate our collective push to serve as part of the solution to health disparities. To uphold this positive trend, organizations must continue to shift their efforts from symbolic statements toward substantive initiatives.
As we look ahead toward eradicating health disparities, we believe there are four key ways to enhance ongoing efforts.
Link to quality
As the call for health system transformation intensifies, associated movements are emerging (quality and safety in patient care, accountable care organizations, holistic admissions practices for medical schools, and community-based participatory research, to name a few), but in many cases these movements are developing in relative isolation from one another. We must stop seeing these as separate initiatives and link them by their common goal: better health for all. Just as we cannot improve quality in a meaningful way unless we address health disparities, we will not alleviate health disparities without connecting our efforts to the broader clinical transformations sweeping across medicine.
Measure and share
The study at hand provides a needed baseline measure for the field. Although we must continue to quantify and categorize what organizations are already doing, we also need to evaluate the effects and outcomes of these efforts and then share best practices. For instance, 52% of the organizations surveyed addressed health disparities through the provision of educational content for physicians and trainees. What this metric does not reveal is the methods employed and concepts included in the educational content. Further, it does not tether the value of educational initiatives to measures such as changed physician attitudes or improved outcomes for patient communities. We can magnify the influence of our efforts by evaluating what works and sharing best practices. The crucial next step is, thus, to move from isolated initiatives toward collective action founded in a body of empirical evidence.
Engage all stakeholders
Many of the activities catalogued by Peek and colleagues1 target individuals to build cultural competence, deconstruct unconscious biases, and improve communication during clinical interactions. These efforts are in general designed to cultivate the professionalism, humanism, and service orientation of individual physicians, and we commend them. However, we believe the battle to alleviate health disparities requires concomitant efforts on the part of the institutions where physicians train and practice.3 In short, the problem is too pernicious, and relates to so many factors outside the physician–patient relationship, that individual-level interventions alone may fall short. As such, academic medical centers and the associations which represent them must join the fight with renewed vigor. These organizations can elevate the dialogue on health equity to the level of other mission-critical initiatives while also coordinating efforts to eliminate health disparities with other organizational change initiatives.4 The Association of American Medical Colleges (AAMC) is particularly well positioned to lead the field because it represents the institutions and academic societies which influence the recruitment and education of future physicians and, as such, help shape the future of medicine.
Acknowledge the ethical imperative
For too many physicians and others in health care, the elimination of health disparities is viewed as a task requiring a political solution. Although government certainly can be a powerful factor in achieving health equity, the motivation for physicians to focus on this issue is fundamentally ethical.5 In addition to beneficence, nonmalfeasance, and patient autonomy, justice is commonly cited as the fourth core principle of clinical ethics for physicians and other providers. It will help mobilize the efforts of physicians and their professional organizations to emphasize that we share an ethical imperative to engage in the promotion of health equity.
Taking a Step in the Right Direction
To support us as we strive to fill this prescription, the AAMC has assembled an Advisory Panel on Health Equity. We expect that this august and diverse body of experts will provide ongoing inspiration to enrich our efforts to alleviate health disparities and hold us to account for this critical work.
Acknowledgments: The authors would like to thank Mackenzie Henderson for her assistance in editing the manuscript.
Other disclosures: None.
Ethical approval: Not applicable.
1. Peek ME, Wilson SC, Bussey-Jones J, et al. A study of national physician organizations’ efforts to reduce racial and ethnic health disparities in the United States. Acad Med.. 2012;87:694–700
3. . Association of American Medical Colleges. Addressing Racial Disparities in Health Care: A Targeted Action Plan for Academic Medical Centers.. 2009 Washington, DC Association of American Medical Colleges
4. Nivet MA. Diversity 3.0: A necessary systems upgrade. Acad Med.. 2011;86:1487–1489
5. Kirch DG, Vernon DJ. The ethical foundation of American medicine: In search of social justice. JAMA. 2009;301:1482–1484