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Fixing EM's Diversity Problem Has to Start with Medical Schools

Katz, Alissa

doi: 10.1097/01.EEM.0000480795.05447.2e

    The lack of diversity in emergency medicine prompted Alden Landry, MD, to start a ... circus.

    Bet you thought we were going to say a task force. But, no, he said it's more of a pop-up circus, though its real name is the Tour for Diversity in Medicine. Dr. Landry and his colleague, Kameron Matthews, MD, started the project to encourage minority students to become health care providers. Their first tour popped up, as it were, in 2012.

    “We throw up our program for one day and tell students what it takes to get into medical school, and then we leave the campus. We do it anywhere from three to six times in a row over the course of a week. We try and focus on historically black colleges and universities, we focus on Hispanic-serving institutions, we focus on institutions with students from disadvantaged backgrounds, and we also try to focus on schools that don't have readily available ties to medical institutions,” said Dr. Landry, an emergency physician at Beth Israel Deaconess Medical Center and the faculty assistant director at the Office of Diversity and Community Partnership at Harvard Medical School, both in Boston.

    The reality, he said, is that emergency medicine is not as diverse as it could or should be, and generally speaking, it's less diverse than many other specialties. A total of 9.1 percent of emergency physicians were of Asian descent compared with 17.5 percent in internal medicine, according to the Association of American Medical Colleges.

    Likewise, 4.5 percent of emergency physicians were African American compared with 8.5 percent of obstetricians/gynecologists, and 4.8 percent of emergency physicians were Latino compared with 6.0 percent of physicians in physical medicine and rehabilitation. (AAMC, 2014;

    “It's early in the pipeline that medical schools aren't diverse. For the most part, minorities aren't going into medical school,” Dr. Landry said. “So if they're not going into medical school, there's clearly a pipeline issue. And minorities aren't going into emergency medicine as a specialty. I can speak from my personal perspective that minority students may feel encouraged to go into primary care as opposed to specialty care. And a lot of that is these outside factors are sort of put on students where they're going to be the doctor for their community and they can go back and help their community through a primary care role or being a primary care physician.”

    Cultural Understanding

    Dr. Landry said it matters whether under-represented minorities are in emergency medicine; they are needed to serve those who need it most, to encourage a sense of affinity, to offer cultural understanding, and to enhance the field of medicine overall. ( Other studies and reports support the idea that patients prefer to be cared for by physicians who look like them, he said.

    “Increased cultural sensitivity fosters better patient-doctor relationships and communication, and, in turn, may play a role in reducing observed health care disparities. Because minority groups disproportionately use the emergency department (ED) for many aspects of their care, the ED serves as an ideal venue to investigate strategies to reduce disparities and advance culturally competent care,” Padela, et al. wrote in Academic Emergency Medicine. (2008;16[1]:69.)

    It became clear, too, that patients feel more comfortable and a stronger sense of cultural identity when more under-represented minorities work in emergency departments. “It's also clear that it's not a one-size-fits-all,” said Sheryl Heron, MD, a professor of emergency medicine at Emory University School of Medicine.

    Progress has already been made since 1996 when Dr. Heron was accepted as the first black faculty at Emory University. She said she was surprised by the lack of minority health professionals when she arrived as a fellow in Atlanta, a city renowned for its role in the Civil Rights movement. “I was struck in 1996 that there were not really a lot of under-represented minorities, specifically African Americans, at Emory in emergency medicine,” she said.

    Increasing the number of under-represented minorities does not necessarily solve the problem, however. Cultural identity and awareness — being responsive to the cultural and linguistic differences that affect the identification, assessment, and treatment of patients' needs — is just as significant, and it's just as important to be able to speak to that as the world develops and grows to be more diverse, Dr. Heron said.

    Now the vice chair of administrative affairs in emergency medicine and the assistant dean of clinical education and student affairs, Dr. Heron has devoted herself to finding ways to increase under-represented minorities in the specialty. It became clear to her after looking at recruitment and retention issues, she said, that as the population grew and diversified, looking at demographics needs attention. Over time, the numbers have certainly increased, but the percentage of under-represented minorities in emergency medicine has remained fairly stagnant. That's no reason to get discouraged, however, Dr. Heron said.

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