Questions and Answers

2007 Champions of Health Professions Diversity Award Honorees

Michael V. Drake, MD: Q & A

Q: What are some of the challenges in diversifying the health care workforce?

A: The main challenge is really derived from the nature of the United States at large. We do not have equal opportunity or equal access for many segments of our population or society. The adage is: “It's not rocket science” or “it's not brain surgery.” Well, sometimes it is brain surgery. And that is a big challenge. If you start with people who do not have equal opportunity, then their chances of coming to the enterprise with equal ability to impact the enterprise is not equal. And so we start with this unequal playing field and try to create opportunity, but we have the entire weight and history of the country where opportunities are not equal.

Q: What is the role of higher education in diversifying the health care workforce?

A: Higher education is a really important part of our efforts to improve the quality of life for people in California and nationwide. Higher education is a gateway to full participation in many of the most exciting and forward-looking things that we do in our society. Our higher education system does not reach and is not available to all segments of our society. I think of higher education as a lever. It is not a be-all; it is not an end-all. But it is one method of helping to make our society more inclusive and more excellent.

Q: What do you think have been some of the best responses to this era of backlash to affirmative action?

A: The concept that affirmative action is one of the only effective ways to deal with disparity is something that we have to move beyond. Affirmative action was effective, but it also was a bit of a shortcut. What it allowed us to do was to assume a whole series of things about individuals and then apply remedies that helped a whole group of individuals move forward. We now have to be more specific about the circumstances of the individuals that we are addressing. We can use life history, life experience, evidence of leadership – all of the things that we really were looking for but were kind of lumped together under affirmative action. We must identify those characteristics and then celebrate and encourage those characteristics.

Hector Flores, MD: Q & A

Q: What have you done to help increase the diversity in the health professions?

A:My own contribution to diversity in the health professions is built on the efforts of our predecessors in the civil rights movement and in affirmative action, who gave people like me the opportunity to become a physician.

Similarly, my own focus on building a pipeline to the health professions is modeled after the successful efforts of others. In 1992, we established Jovenes por La Salud, a high school initiative with the Multi-Cultural Area Health Education Center. This program has assisted more than 400 disadvantaged students with over 90 percent attending college. And here is the fun part: This March we matched our fifth former Jovenes student in our residency program!

Q: Why are there health disparities among minority groups?

A: The major reason for the health disparities in minority groups is that they are disproportionately affected by poverty. Financial barriers limit immediate access to certain services, including health and well-being services. It is clear from my 25 years of experience as a physician (no matter what your race or ethnicity is) that if you are poor, you are going to have poor health status. Poverty is also a barrier to achieving higher education and professional training, which perpetuates socioeconomic disparities. At the same time, there are issues related to culture and language that also present major barriers. It would be disingenuous to ignore the fact that bigotry, racism, sexism and intolerance continue to affect the health of vulnerable populations.

Q: Can cultural competence be taught?

A: I do believe that cultural competence can be taught and that clinicians will be motivated to learn as soon as they understand that it is fundamentally based on the humanistic traditions of medicine. We call it “cultural competence” because we are trying to define something in a novel way and to mold it into a set of scientifically based metrics that can help us determine whether it makes a difference in the care of patients. But, ultimately, it is about humanism in medicine. I believe that it is possible to emphasize the importance of compassion and respect for others. If we are open-minded about medicine being a lifelong learning endeavor, we can embrace the idea that taking time to learn the cultural identities of our patients is also a lifelong endeavor. Usually our best teachers are our patients themselves.

Ernest C. Levister, Jr., MD, FACP: Q & A

Q: What have you observed about disparities in health outcomes?

A: The most compelling observation is the stagnation in minority representation in the physician workforce resulting in unwelcome consequences for the health of the nation. Evidence points to biases on the part of health care providers and institutions as greatly contributing to unequal medical treatment. For example, studies indicate that African-Americans and Hispanics are less likely to receive bypass surgery when medically indicated, are less likely to receive adequate pain management, and are less likely to be treated with state-of-the-art modalities for HIV infection, diabetes and hypertension. Minorities are also more likely to undergo procedures such as bilateral orchiectomy (removal of the testicles) and amputations, which is generally avoidable with optimal care.

Q: What needs to be done to diversify the health professions?

A: Putting aside issues of equity and fairness, at least five practical objectives can be put forth for attaining greater diversity in the health care workforce: 1) increase the number of minority physicians and health care professionals; 2) advance empathetic cultural competency; 3) increase access to high-quality health care services for all of our citizens; 4) strengthen the medical-disparity research agenda; and 5) ensure optimal management of the health care system.

Q: What do you think can be done, on a policy or institutional level, to diversify the health professions?

A: “Leveling the playing field” to permit massive upgrading of the health care workforce will require a fundamental shift in public policy that holds all levels of health delivery accountable for race-based inequities. Concurrent with efforts to change public policy, robust partnership programs that link health professional schools and teaching hospitals with local schools and communities will help to expand health care access for the underserved, foster research in areas of disparity, and enrich the pool of managers and policymakers to meet the needs of a diverse populace. Increasing the racial and ethnic diversity of the health workforce is essential to America’s fiduciary and moral obligation to protect, restore and improve the health of all Americans.