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Medicine serious about meeting diversity goal by Dick Peterson Public Relations When the National Medical Association holds its annual convention and scientific assembly Aug. 2 in Philadelphia, MUSC’s Department of Medicine will be there to recruit faculty. That’s the NMA, the group of black physicians formed in 1895 after institutionalized segregation in the U.S. made it virtually impossible for African Americans to study medicine, practice medicine and update their skills in association with white doctors who dominated the profession. Consequently, black colleges and universities fed their graduates into black medical schools and their graduates found professional enrichment by forming the NMA. Times have changed, but not that much. Institutionalized segregation no longer forces the races apart, but a look at the ratio of under-represented minorities to whites in the College of Medicine faculty doesn’t come close to the racial mix in South Carolina. Department of Medicine chair, John R. Feussner, M.D., wants to change that. No, make it “will” change that. He believes the health of South Carolina citizens depends on it and bristles at the notion that diversity is nothing more than just a good thing to do. “Part of medicine is science and technology,” Feussner said, “but it is also a healing art in which the patient is a key player.” Ultimately, patients have preferences and they deserve to have the physicians they prefer. Their health outcomes—especially of chronic diseases like diabetes, hypertension, cancer and stroke—depend on their having choices. And in South Carolina, where incidence of diabetes, hyper-tension, cancer and stroke runs high in minority populations, the level of health statewide depends on their having choices. The College of Medicine Diversity Plan, ongoing now and planned to 2008, has as its goal: To increase ethnic diversity reflecting the diverse population of South Carolina including women. The plan expands and enhances opportunities within the College of Medicine at all levels for individuals from all backgrounds. “We have to recognize that we serve a diverse population,” said College of Medicine Dean Jerry Reves, M.D. “Since that’s the population we serve, we should reflect that population in our composition of faculty, housestaff, post-docs, staff and students. The fact is, we have the greatest mortality among our minorities, and some data indicate that some of that is due to less-than-optimal communication between clinicians and patients. That communication can be enhanced by a more representative clinician base.” Reves said the college has to work on both the student and faculty fronts to be successful. But the problem is a lack of qualified minority student applicants in a field of qualified applicants that number far more than the college can accept.  “It’s tough getting that applicant base sufficiently large that there are enough qualified minority applicants. We’re dealing with a very small group of people who can go virtually anywhere. Any admissions person can tell you that we have many more qualified applicants than we have room for. Therefore we have to take race into account to create a diverse student population to serve our state population.” He wonders if there is something about the public educational system that fails to produce the numbers of qualified minorities the country and state need in professions like medicine, science, and law. “Even the youngest students should be programmed from pre-school on to be successful in the professions.”  The college offers department chairs a general plan for achieving its goal and requires departments to develop their own plans, said COM Diversity Advisory Committee co-chair Deborah Deas, M.D., but it’s up to the creativity and initiative of the departments to find ways to comply. “We’re not dictating to the departments how to do it. But where department plans fail to be consistent with the college plan, we offer assistance and advice.” Deas said that the College of Medicine diversity committee has found working with the departments “exciting.” The seriousness with which they have taken to the task has been encouraging and many of the department plans look good.  “It’s not just about numbers,” Deas said, referring to the numbers of COM students, housestaff, post-docs and faculty, although it’s the numbers that place MUSC on the low end of average in the Southeast.  “We want them to find ways to bring in under-represented minorities in various collaborative efforts, such as seminar speakers, grand rounds speakers and as co-investigators and consultants on grants.”  Deas would like to see an environment at the college that recognizes and appreciates the value of including people from many cultures, and racial and ethnic backgrounds in its activities and events to the point that it becomes a way of thinking. While the college’s plan includes students among its groups targeted for diversity, Feussner’s more specific aim is his department’s faculty, housestaff, post-docs and staff. He sees achieving diversity among these groups as key to attracting minority students who will likely flavor the practice of medicine throughout the state. And Feussner has a plan of his own to “operationalize” the goal.  “I think if you have a good idea, you need to put it out there. And when you have your first success, you need to put it out there again, and again when you achieve your goal.” Although Feussner’s lead-follow-or-get-out-of-the-way bearing sounds like it could achieve faculty diversity out of sheer momentum, he expects slow starts, few early successes and a sustained effort that will pay off later rather than sooner. His only regret is that the diversity initiative is just now getting the momentum it needs. As for MUSC at the NMA convention, “I do not expect us to be an immediate hit. I think we will have to sustain our presence and show our commitment by returning year after year as a matter of routine. As we develop some recruiting success, that success will also speak to the sincerity of our intentions.” Also speaking to MUSC’s commitment to achieve ethnic diversity commensurate with the South Carolina population will be sustained advertising in the NMA Journal, Women in Science and the Affirmative Action Register. Duke is the only  medical school not listed among the predominantly black institutions that have a continuing faculty recruiting presence at the NMA convention. MUSC will join Duke University School of Medicine this year. It was Feussner’s initiative while at Duke in the early 1990s that established that institution’s commitment to diversity with a year-after-year presence at the NMA. Reves expects most of the college’s success in recruiting minority faculty will come from “growing our own staff, housestaff and then ultimately faculty.”  Although progress will be slow, he remains undeterred. “Thirty-five years ago when I was a medical student, there was one woman in our class. Now 50 percent of the College of Medicine students are women.” He said with persistence and in time, “we will enrich our college and state with minority physicians.”   Health care disparities drive diversity push While some may question the fairness of setting College of Medicine diversity goals and eligibility standards that consider race, culture and ethnicity in the mix with academic achievement and MCAT scores, one compelling factor remains: “Despite steady improvement in the overall health of the U.S. population, racial and ethnic minorities, with few exceptions, experience higher rates of morbidity and mortality than non-minorities.” That’s from studies compiled and their results published by a committee of the National Institute of Medicine in the report, “Unequal Treatment, Confronting Racial and Ethnic Disparities in Health Care.” The report continues: “African Americans, for example, experience the highest rates of mortality from heart disease, cancer, cerebrovascular disease and HIV/AIDS than any other U.S. racial or ethnic group.” And this: “Racial and ethnic minorities tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled.” Here’s one among a number of solutions offered by the institute’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care: “The health care workforce and its ability to deliver quality care for racial and ethnic minorities can be improved substantially by increasing the proportion of under-represented U.S. racial and ethnic minorities among health professionals.” “We’ve known all along that there are differences in quality of care by race and ethnicity. The difference is that there is renewed interest in identifying the factors responsible for those differences,” said Leonard Egede, M.D. He specializes in general internal medicine and conducts research on health disparities and their effects on minority populations. Egede identifies factors at the patient, physician, and health systems levels as contributors to health care disparities.  Patient preferences—that minorities may be less likely to accept the treatments offered because of distrust of physicians and the health care system that stems from years of racial segregation and discrimination or lack of effective patient-physician communication due to socioeconomic and cultural differences;  Physician factors—that the physicians may stereotype their minority patients as people unable to afford the treatment they need or unwilling to follow a prescribed therapy, or they may overtly discriminate against their minority patients;  Health care system—that the racial distribution of the health care workforce is not representative of the larger population so that there are few minority physicians relative to the proportion of minority patients.  “Studies have shown that patients prefer to be seen by physicians of similar color and ethnic background,” Egede said. When it comes to the challenge of admitting minority students to medical school or recruiting minority faculty to the college, “We have to evaluate people’s strengths in other ways than we’re used to doing it,” he said. Colleges have typically looked for students with high MCAT scores and those with exceptional extracurricular activities—factors that look good and are thought to predict future successful performance.  “But if you’re struggling for your basic existence, come from a poor background, or are a product of a less-than-ideal public school system (as is the case with several rural or inner city minority communities),” Egede said, “then you’ve never had a chance for a diverse life experience.” Egede said that the push in Congress to increase diversity in the workforce is based on the notion that if diversity can be increased in the workplace, people of diverse cultures will become more familiar with each other, and the level of distrust among races and ethnic groups may decrease. “In recent times at MUSC, I perceive a renewed interest in reducing health care disparities and a sense of commitment from the president, the deans and the departments to achieving a more diverse faculty and student body,” Egede said.  “But one of the problems that will have to be overcome is that of achieving a critical mass (of minorities) so that when a minority faculty member is recruited he won’t say, ‘I don’t see any minority faculty who is a full professor or who holds tangible academic positions.” A qualified minority faculty is more likely to go to a place ‘where they see that there are people like them who have been successful in climbing the academic ladder.’”     Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.