Carolyn Barley Britton, MD, President of the National Medical Association
On Eliminating Health Care Disparities Among Minorities
After more than 20 years of specializing in neurovirology and infectious diseases of the nervous system, neurologist Carolyn Barley Britton, MD, began a new chapter in her life in late July, when she assumed leadership as the president of the National Medical Association (NMA) at the 106th Annual NMA Convention and Scientific Assembly in Atlanta.
Now in its 113th year, the NMA is the largest and oldest national organization representing over 30,000 African-American physicians across all specialties in the US. The NMA focuses primarily on health issues related to African-Americans and medically underserved populations.
Dr. Britton, an associate professor of clinical neurology at Columbia University College of Physicians and Surgeons and associate attending physician at New York Presbyterian Hospital, received her medical degree from New York University in 1975 and completed her residency and a fellowship in neurovirology at Columbia University. Before becoming NMA president, she helped the National Institute of Allergy and Infectious Diseases change federal clinical research guidelines to require inclusion of minorities and women. She also was among the first to describe the neurological complications of AIDS.
Dr. Britton spoke to Neurology Today about the challenges of leading a multispecialty, complex organization and her goals to improve the quality of health care for minorities and broaden African-American representation in medicine.
HOW DOES THE NMA GET INVOLVED IN HEALTH CARE POLICY?
We are most concerned with promoting universal coverage and access to quality, affordable health care. We've been a longstanding advocate for health care reform. For example, in the 1960s, the NMA was the only professional medical association to testify before Congress in support of the passage of Medicare and Medicaid funding legislation.
WHAT ARE SOME OF THE NMA PROFESSIONALISM PRIORITIES?
We work to better inform insurers of physician concerns and the issues that threaten practice viability. We want fair reimbursement methods for physicians and affordable access to electronic medical record systems. Our work has included reports and educational literature on pay-for-performance and its impact on African-American health care. For example, we've held town hall meetings in Mississippi, Florida, Texas, and Missouri to educate physicians about pay-for-performance; these meetings indicate how many physicians do not understand how these initiatives will be implemented and potentially affect their practices.
Our annual colloquium is a meeting of society presidents and their state and local legislators. We also work with the Congressional Black Caucus and often provide testimony on the Hill on health-related concerns.
We also focus on workplace diversity across all specialties, because in the past decade, there has been a failure to achieve a meaningful increase in the number of African-American graduates with medical degrees. The percentage of American physicians who are African-American has remained unchanged at about 3 percent for the last decade.
Lastly, another issue that concerns members is disparities in health outcome for African-Americans, those unexplained by socioeconomic status, education, and insurance status. For example, African-Americans disproportionately suffer from chronic diseases such as diabetes, heart disease, and high blood pressure.
TELL US ABOUT YOUR GOAL TO ADVANCE A CULTURAL COMPETENCY CURRICULUM
In a diverse nation likes ours, cultural competency is important — doctors need knowledge of different cultures and sensitivity to better connect with patients and help them understand how to manage their health. There should be a required uniform cultural competency curriculum for medical schools and medical licensing in all specialties. We are currently updating the NMA cultural competency guide.
We're also involved in promoting health literacy. The NMA health literacy campaign “Doctor Speak, Doctor Listen” includes training programs for doctors and community programs, such as Ask Me 3, which teaches people three questions they should always ask their doctors: What is my main problem? What do I need to do? Why is it important for me to do this?
HOW ARE THE CHALLENGES FOR MINORITY PHYSICIANS DIFFERENT TODAY THAN WHEN THE NMA WAS FOUNDED?
The overt racism that was embedded in the legal system, as well as in cultural norms, no longer exists. However, there remain subtle vestiges of racism, often an “unaware bias” that may have a negative impact on some, such as the fact that African-Americans have worse health outcomes for many disease states compared to whites and are less likely to receive optimal management advice.
Many African-American physicians enjoy educational opportunities at the best American institutions and have successful careers at the highest level. Many comment, however, that finding mentors was difficult when they selected a field with few or no African-Americans, or if they chose research or academic careers.
HOW IS THE NMA INVOLVED IN RECRUITMENT FOR NEUROLOGY?
More than 10 years ago, Dr. Patrick Griffith and seven other NMA members met with me for lunch to discuss this issue. Over time, the NMA began to sponsor the luncheon, assisting with getting grant support from the pharmaceutical company Sanofi-Aventis to bring minority medical students to the NMA for a week. The AAN Foundation has been critical to the support of this program, and each year the AAN president and NMA leaders come to greet the students. More than half those students attending the program have chosen neurology as a career. We also provide thousands of dollars in scholarships annually to medical students based on academic merit and financial need.
WHAT IS YOUR POSITION ON THE RECENT AMA APOLOGY FOR THE EXCLUSION OF MINORITY PHYSICIANS?
We welcomed the apology. For two years, the NMA and AMA have co-chaired a Commission to End Health Care Disparities. Past presidents of the AMA, Drs. John Nelson and Ron Davis were serious in their research into the issue of racial discrimination by the AMA and sincere in the apology offered by the AMA. The apology should be the beginning of a process to evaluate and propose specific initiatives to eliminate racism's effect on society.
WHAT SPECIAL PROGRAMS DOES THE NMA HAVE IN PLACE TO ADDRESS DISPARITIES IN HEALTH CARE FOR MINORITIES (PARTICULARLY IN NEUROLOGY)?
The NMA has a number of initiatives related to specific disease states. One of my goals is to specifically promote ongoing programs for HIV/AIDS, diabetes mellitus, and end-stage renal disease. There are also clinical trial training programs, immunization initiatives, and community outreach — I will be focusing during my tenure on a stroke awareness outreach campaign and one on obesity and childhood nutrition.
The NMA has more than 100 affiliate societies throughout the US, and we focus on physician education and health literacy across all diseases. Each year, experts are convened to critically evaluate specific diseases for health outcome disparities and to propose an action plan that is implemented through our physician members and affiliates. This year I will convene consensus panels on cancer, mental health (especially depression), and workplace diversity-pipeline issues.