Updated at 1:23 PM, February 10, 2012
“I’m an ER physician,” Dr. Alden Landry told me. “When I walk into patients’ rooms and start speaking to them and introduce myself as their doctor, often older black women will say, ‘Thank you for being my doctor! I’m so proud of you. I’m glad you’re going to be taking care of me.’ They say they feel more comfortable with me as their physician.”
Dr. Alden Landry practices emergency medicine at Beth Israel Deaconess Medical Center, but he’s more than just a doctor — he’s helping lead the movement to diversify medicine. He heads up projects on the issue at Beth Israel, Massachusetts General Hospital, and Harvard Medical School
“It’s not always a rosy picture talking to my patients,” he explained. “Early in my career, there was a patient — an older black man — [who] had been in the emergency department for a number of hours, and they’d placed him in the hallway to wait. I went over to talk to him and ask him if he needed anything. ‘Why do they always put the black patients in the hallway?’ he asked me.” I can’t necessarily say he was placed there because of his race – but when you hear comments like that, it shows that patients don’t feel appreciated when they’re receiving medical care, that they feel like second- or even third-class citizens, that their concerns are being overlooked.”
Dr. Landry, among many in the medical field, feels there’s a way to help solve this problem: recruit more African-Americans and Hispanics to be doctors. That’s why he’s heading up the Tour for Diversity as its co-director. The tour is a new initiative funded by the Aetna Foundation — and, yes, it is an actual tour. Later this month, Dr. Landry will join four other doctors, four medical students, a dentist, and a health professions advisor on a bus tour to five historically black colleges and universities in the South where he and the team will hold sessions about applying to medical school, encourage mentorship and connect with student organizations.
The Importance Of Diversity
So how pressing is the need for more minority doctors? It turns out the physician workforce is a far way from reflecting the diversity of the general population. While 1 in 8 Americans is African American, only 1 in 15 doctors is. And though 1 in 6 Americans identifies as Hispanic/Latino, only 1 in 20 doctors does. (For more detailed diversity data, check out the 2010 U.S. Census and the American Medical Association’s Diversity in the Physician Workforce: Facts and Figures 2010.)
After speaking with Dr. Landry, I decided to have a chat with Dr. Samantha Kaplan, an obstetrician gynecologist and professor at Boston University School of Medicine, where she is the assistant dean for Diversity and Multicultural Affairs and the director of the Early Medical School Selection Program. If Dr. Landry’s Tour for Diversity helps stimulate interest in medical school, Dr. Kaplan’s program helps sustain and cultivate that interest. Her program partners with historically black colleges and universities as well, offering undergraduate students a chance to take courses at the BU School of Medicine and participate in summer and year-long programs that help them transition to medical school.
I felt an instant rapport with Dr. Kaplan. She’s of mixed heritage too, ambigously brown like myself. She told me a story of her early days at the adolescent gynecology clinic at Boston Medical Center: “I’m of small frame, and I looked kind of like a kid. I looked younger than I was — between that and skin color, I had an amazing affinity for patients and they for me. I could get them to open up and to listen to me and to entertain with some seriousness the advice I gave them. I felt like a buddy, a sister — I could tease them, and they didn’t feel judged.”
Dr. Kaplan offered four reasons why we need more minority doctors. Here she is, paraphrased:
- To serve those who need it most: “Underrepresented minorities are more likely to go back and serve in their communities. This means more physicians are treating populations that are traditionally underserved in medicine. Our country has a discouraging history of not being able to make care accessible to minority groups — whether it’s because of lack of insurance, limited physical access (such as not having a clinic nearby, inadequate transportation, limited time), or even racism. It’s important to put physicians into communities who need care.”
- To encourage a sense of affinity: “There’s research on how patients respond to physicians with whom they feel some concordance — whether it’s culture, race, language, gender. Conversations are more patient-centered; the patients ask more questions, and more data about what’s actually bothering them can be extracted, leading to better outcomes.”
- To offer cultural understanding: “We know that different cultures have different belief systems around health. While it’s not necessarily true that all people from one culture think the same thing, it’s reasonable to assume that, if you as the patient feel affinity with your doctor and you feel safe and you don’t feel judged, there might be more connection.”
- To enhance the field of medicine overall: “Imagine you have a room with five people who are exactly the same — conversation is limited. But if you have five people who are entirely different, you’re going to encourage much greater learning. All five will leave the room with a much broader understanding. The population we serve is diverse. In order for all of us to leave our education, our grand rounds, our office, with a broader understanding of how to approach our patients, we need our colleagues to reflect our population.”
Dr. Kaplan’s points are backed up by a number of studies. For instance, research has shown that minority doctors are more likely to work with underserved and indigent populations (for a summary table, see pages 2-3 of the Commonwealth Fund’s report on disparities). These are the same populations who bear disproportionate rates of disease and who have the most limited access to care. (For more, see the CDC Health Disparities & Inequalities Report.)
The sense of affinity and understanding that Dr. Kaplan spoke of is captured in studies focusing on patient-physician concordance. Time and time again, it’s been shown that feeling a sense of familiarity enhances communication and patient satisfaction. Here’s the conclusion from just one of the studies:
The physician-patient relationship is strengthened when patients see themselves as similar to their physicians in personal beliefs, values, and communication. Perceived personal similarity is associated with higher ratings of trust, satisfaction, and intention to adhere. Race concordance is the primary predictor of perceived ethnic similarity, but several factors affect perceived personal similarity, including physicians’ use of patient-centered communication.
Finally, a study published in JAMA found that the more underrepresented minorities there are in a medical school’s student body, the more likely it is that students from that medical school (regardless of their own race) will “rate themselves as highly prepared to care for minority populations.”
What The Future Holds
Fast forward to 2050 — that’s only two generations away. According to projections by The Pew Research Center, the U.S. will look much different by that time: more than half of Americans will be people of color. As our population increasingly diversifies, so too should our medical workforce.
“We need to make sure there’s equity in care,” Dr. Landry explained. “You want to make sure patients don’t feel overlooked in the health care system. Unfortunately there’s an unconscious bias that may exist; there are systems that are in place that may disenfranchise one group of patients over the other. We want to level the playing field for all patients.”