Journal for Minority Medical Students by Spectrum Unlimited

速 F O R

M I N O R I T Y

M E D I C A L

S T U D E N T S

Charter Members 2011 American Academy of Family Physicians

Harvard Medical School Minority Faculty Development Program

U.S. Navy

American Academy of Orthopaedic Surgeons

Kaiser Permanente California

UAB School of Medicine

American Academy of Pediatrics

North Shore Long Island Jewish Medical Center

Vanderbilt School of Medicine Office of Diversity

Association of Accredited Naturopathic Medical Colleges

Mount Sinai School of Medicine/ Elmhurst Hospital Center

Wake Forest University School of Medicine

Office of Minority Health U.S. Department of Health and Human Services

These special friends of the Journal for Minority Medical Students have demonstrated their commitment to reach out to minority medical students by placing their recruitment messages in each quarterly issue. We salute them and encourage our readers to consider these programs as they continue their medical education.

111700b.indd 1

4/27/11 2:58 PM

North Shore Long Island Jewish Health System A Major Academic Health System Dedicated to Patient Care, Teaching and Research

Allergy & Immunology Colon & Rectal Surgery Diagnostic Radiology Emergency Medicine Family Practice General Practice Dentistry General Surgery Internal Medicine Neurology

Nuclear Medicine Obstetrics & Gynecology Ophthalmology Oral & Maxillofacial Pathology Oral & Maxillofacial Surgery Orthopaedic Surgery Osteopathic Family Practice Osteopathic Neurological Surgery Neuromusculoskeletal

Pathology Pediatric Dental Medicine Pediatrics Physical Medicine & Rehabilitation Podiatric Medicine Psychiatry Thoracic Surgery Urology Vascular Surgery

The nation’s third largest, non-profit, secular healthcare system, the North Shore-Long Island Jewish Health System provides care for people at all stages of illness throughout Long Island, Queens and Staten Island – a service area encompassing more than five million people. The health system includes 15 hospitals, four long-term care facilities, a medical research institute, three trauma centers, five home health agencies and dozens of out-patient centers. North Shore-LIJ facilities house more than 5,576 beds, and are staffed by over 7,000 physicians, 7,000 nurses and a total workforce of more than 35,000 – the largest employer on Long Island and the ninth largest in New York City.

For further information: Office of Academic Affairs Telephone: 516-465-3192 Fax: 516-465-3190 www.northshorelij.com

9773-11-05

47 Journal for Minority Medical Students

111700b.indd 2

4/27/11 2:58 PM

The Disparities issue Vol. 22, No. 4

Features 29 The Disparities Issue Intro 30 A Talk with Dr. John Ruffin, Director, NIMHD 33 New CDC Report Documents Important

on the cover Nivia Gonzalez “Accompanied Beneath Descending Light” A native of San Antonio, Nivia credits her family with forging the creative energies within her. In 1966 she left Texas to move to New York City, where Nivia attended Cooper Union on a full scholarship; she would eventually earn a Bachelor’s Degree in Studio Art at Trinity University in San Antonio and a Master’s Degree in Art at the University of Texas at Austin. Nivia has garnered national and international acclaim for her art work. She says that much of her inspiration comes from her family and her twin daughters. “Years ago, when my kids were younger, I used to have them underpaint, and it would leave impressions… I would then paint based on the smudges my kids had left.” Her career came to a tragic halt on a dark night when a tire blow-out caused Nivia to lose control of her vehicle and crash into a guard rail. Due to severe head trauma, the 59-year-old artist also suffers from memory loss and limited mobility on the left side. Nivia has had a long road to recovery and that her art has been an important part of her therapy. This recovery, Nivia says, was an awakening for her, and her art reflects her revelation.

Health Disparities 36 New National Healthcare Quality & Disparities Report 37 The National Partnership for Action 40 Health Disparities 2.0: An interview with George A. Kaplan, PhD 43 Health Disparities Roundup

Perspectives 6

Publisher’s Page

AAMC Perspective by Peggy Geigher, M.P.A

13 AMA Perspective by Keith Voogd 17 LMSA Perspective by Brenda Campos-Spitze 20 SNMA Perspective 23 Resident’s Perspective by Luther Adair II, MD 25 The Surgeon General’s Report by Regina M. Benjamin, MD, MBA, VADM, USPHS 45 Diary of a First-Year Med Student by Amber Robins, MSI

For more information:

http://nivialinda.com

111700b.indd 3

4/27/11 2:58 PM

PASSION:

public health and research

CALLING:

family medicine

My family medicine training gave me the skills I need to take research from the bench to the bedside for my patients.

BE THE DOCTOR

you always wanted to be.

fmignet.aafp.org 111700b.indd 4

4/27/11 2:58 PM

Myth Fact - JMMS:Myth Fact for JMMS

JOURNAL FOR MINORITY MEDICAL STUDENTS PUBLISHER Bill Bowers EDITOR-in-chief Laura L. Scholes laura@spectrumunlimited.com Contributing Writer John Dunn, MD SENIOR ACCOUNT EXECUTIVES Carolyn Kiarie, Dee Harris Campus Rep Liaison Nisha Branch, Howard University College of Medicine ART Director Kate Hunt copy editor Robert Blue Marketing Director Leea Royal PUBLISHER’S ADVISOR Michelle Perkins, MD EXECUTIVE ASSISTANT to the PUBLISHER Amy Harrison

1/31/11

5:06 PM

Page 1

MYTH: You have to “sign your life away” to be a successful orthopaedic surgeon. FACT: With effort, you can have both a rewarding career in orthopaedic surgery and a rewarding life. The truth is, while the program is intense, orthopaedic surgery has the same residency work hours as many other surgical specialties. And once you graduate and become certified, you’ll actually have more control over your schedule than you would with many other medical specialties. So, if you’re driven to deliver exceptional patient care, you can work hard and enjoy life too.

Choose a career in Orthopaedics – our one-on-one mentoring programs offer personalized guidance and support to help you maintain balance. For more information, visit aaos.org/diversity or email mentor@aaos.org

SPECTRUM HEALTHCARE DIVERSITY & INFORMATICS PRINCIPAL INVESTIGATOR Bill Bowers VICE PRESIDENT OF OPERATIONS Tamika Goins SENIOR DEVELOPER/DBA Robin Shriver TECHNICAL ADVISOR Naresh Kumar CONTRACT MANAGER Lorry Rome PROJECT COORDINATOR Amita Gavalas

111700b.indd 5

4/27/11 2:58 PM

PUBLISHER’S PAGE

Change is in the Air By Bill Bowers, Publisher, Journal for Minority Medical Students

s we all know, the last few years have meant a lot of changes in our country: a new president, a new health care law, and...a recession. The Journal has been able to keep publishing during these tough times, and we’re proud of the contribution we are able to make to inspiring and informing the next generation of URM physicians. But as media becomes ever more digital, we have decided that it is now the time to make the shift ourselves. Starting with the next issue of the Journal, we will now be publishing a print magazine two times a year: A Residency

Match Issue and A Career Guide. Of course, we’ll continue to publish our always popular annual Keepsake to inspire undergraduate students to pursue careers in the health professions, as well as The Young Scientist, which encourages college students to set their sights on research. This change in schedule gives us an opportunity to remain a valuable “in the hands” publication, while also allowing us to beef up the content we are making available on our website: www.spectrumpublishers. com. We look forward to becom-

ing the destination site for all things related to minority medical education and career information for minority physicians. We really appreciate all the support our readers have given us over our 23-year history in serving URM med students. And we look forward to sharing this next exciting chapter of the Journal with you.

Last summer, the Association of American Indian Physicians held a workshop to help American Indian and Alaska Native college students who plan to apply to medical school. The workshop was geared toward both undergraduate and graduate students and provided them with information on the application process into medical and other health profession schools. Spectrum was proud to donate copies of our annual Keepsake guide to all of the participants. Bill Bowers

6 Journal for Minority Medical Students

111700b.indd 6

4/27/11 2:58 PM

111700b.indd 7

4/27/11 2:58 PM

Medical Students: A Career In Pediatrics Can Open Up New Doors The American Academy of Pediatrics (AAP) has a membership opportunity for medical students. The AAP offers many benefits, both general and specific to medical students, including:  Affiliate membership in the Resident Section  Free admission to the AAP National Conference & Exhibition (NCE)  Discounts on all AAP products and services  Pediatrics 101—a resource guide from the AAP  Online Resources - An e-newsletter for medical students, - Medical Student Listserv®, - Access to the YoungPeds Network And much, much more!

For information please contact us at: pedscareer@aap.org or call Julie Raymond at (800) 433-9016 ext. 7137 or visit www.aap.org/ypn

michigan state university kalamazoo center for medical studies

Our MissiOn

At MSU/KCMS, we realize that being an exceptional physician means having a balance between the personal and professional areas of your life. Our mission is to help you achieve your clinical and academic goals in a truly supportive environment. More than 180 residents take part in our residency programs and have exposure to the broadest range of health care. Our partnership with awardwinning Level One Trauma Centers means that from newborns to the elderly, you will have patient diversity that will allow for you to develop your skills to their fullest.

Michigan State University Kalamazoo Center for Medical Studies is a university and community partnership driven by a team of dedicated professionals committed to provide excellence in graduate, undergraduate and continuing medical education, knowledgeable and caring service, and research.

At MSU/KCMS, you will have opportunities to participate in a variety of research projects. We are proud of our numerous awards and grants and our faculty that understands the correlation between great research and great patient care. At MSU/KCMS, with quality of education comes quality of life. Almost half our residents own their own homes in a region that has been ranked as one of the best places in America to live. The “Kalamazoo Promise”—which provides free college tuition for students completing K–12 in the Kalamazoo Public Schools—low cost of living, clean air and an abundance of recreation means your hours outside of MSU/KCMS will be as fulfilling as those inside.

www.kcms.msu.edu · (800) ASK-KCMS

Our VisiOn Michigan State University Kalamazoo Center for Medical Studies will excel in providing quality medical education. We will deliver expert, responsive patient care and pursue innovative research.

Our Values MSU/KCMS offers fully accredited programs in Internal Medicine, Pediatrics, General Surgery, Family Medicine, Psychiatry, Orthopaedic Surgery, Medicine-Pediatrics, Emergency Medicine, Primary Care Sports Medicine Fellowship, and Transitional Year. MSU/KCMS also offers an Osteopathic Traditional Internship and dually accredited AOA/ACGME Family Medicine and Internal Medicine residencies.

111700b.indd 8

Compassionate Service Leadership Lifelong Learning Teamwork Commitment to Excellence

4/27/11 2:58 PM

AAMC perspective

Secrets to Smart Money Management By Peggy Geigher, MPA.

et’s face it. We all incur some kind of debt and, as medical students, you’re probably more aware of this than many in your peer group. According to the Association of American Medical Colleges (AAMC) in 2009 the average debt at graduation for medical school is $157,990. Although a small percentage of medical school graduates manage to not borrow, the vast majority do. In fact, close to 50% of the 2009, medical school graduates borrowed $150,000 or more. Okay, now that we got those statistics out of the way, take a breath. Debt is, and always has been, an important tool for acquiring large investments, like businesses and homes. Education debt is a fact of life for most medical students and it is a good investment. However, debt can also be detrimental if it is poorly handled. Dr. Leon Johnson, Jr., president and CEO of EAS Group, LLC, an education finance specialty and consulting firm, is one of the creators of the Summer Medical and Dental Education Program (SMDEP) financial planning workshop sessions.

Peggy Geigher, M.P.A. In the winter 2004 column of the Journal for Minority Medical Students, Dr. Johnson likened debt to cholesterol— it’s good to an extent, but too much becomes hazardous! He recommends individuals keep their debt below 50% of their gross annual income. The key to managing debt is to be well informed about borrowing and choosing your actions carefully. Each year, over 900 undergraduate students from across the country participate in the SMDEP. The program is six weeks long and works on building science and math skills, learning and study strategies, and

financial awareness. To meet the latter objective, the SMDEP scholars participate in a two-day financial planning workshop presented by experienced student financial aid officers and financial planners. During this workshop, they learn how to manage finances with fewer worries while achieving their academic goals, and you can, too. Here are some tips shared by our advisors. For starters, keep in mind that SMALL decisions quickly become BIG ones. That daily $4.00 cup of latte will you cost you $1550 per year. If you saved that money each day, you’d be over $130,000 richer after 30 years! Have you ever thought about buying a previously owned car or shopping at consignment stores? Over the last few years, these stores have really become popular. What about getting with a group of friends and neighbors and buying groceries in bulk? Above all, avoid credit card debt. Try not to use a credit card unless you can pay it off in full each month. Living like a student is not so bad.

Journal for Minority Medical Students 9

111700b.indd 9

4/27/11 2:58 PM

Medical Student Programs at Harvard Medical School Boston, Massachusetts

VISITING RESEARCH INTERNSHIP PROGRAM (VRIP)

VISITING CLERKSHIP PROGRAM (VCP)

Sponsored by the Harvard Catalyst Program for Faculty Development and Diversity, VRIP is an 8-week mentored summer research program open to 1st and 2nd year U.S. medical students, particularly underrepresented minority and/or disadvantaged individuals from accredited U.S. medical schools. VRIP is designed to enrich medical studentsâ&#x20AC;&#x2122; interest in research and health-related careers, particularly clinical/translational research careers. VRIP offers students housing as well as a stipend and transportation reimbursement for travel to and from Boston. Applicants must be U.S. Citizens or U.S. Noncitizen Nationals or Permanent Residents of U.S.

Sponsored by the Harvard Medical School Minority Faculty Development Program, VCP is open to 4th-year and last quarter 3rd-year minority medical students in good standing at U.S. accredited medical schools who wish to participate in a clerkship in any discipline at Harvard Medical School (HMS) affiliated hospitals. Housing and financial assistance towards transportation expenses to and from Boston are available. Students are assigned a faculty advisor, provided the potential to network with HMS residency training programs and have access to the medical school library, seminars and workshops. Clerkships are offered year-round. Applications must be submitted 3-6 months in advance of the desired rotation.

For more information on Harvard Catalyst programs please contact: Vera Yanovsky, Program Coordinator Phone: 617-432-1892 E-mail: pfdd_dcp@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu/catalyst

For more information please contact: Jo Cole, Program Coordinator Phone: 617-432-4422 E-mail: jo_cole@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu

Program Director: Joan Y. Reede, MD, MPH, MBA Dean for Diversity and Community Partnership Associate Professor of Medicine Harvard Medical School

111700b.indd 10

4/27/11 2:58 PM

aamc perspective

Get a roommate. Live in an area where there are lots of transportation options. Ask you yourself, â&#x20AC;&#x153;Do I really need a car?â&#x20AC;? If you choose these options wisely, thereâ&#x20AC;&#x2122;s no guilt in splurging once in a while, as long as itâ&#x20AC;&#x2122;s done in moderation. By making smart decisions, you wonâ&#x20AC;&#x2122;t let your medical school debt get the better of you. Soon, youâ&#x20AC;&#x2122;ll be able to dig yourself out of the debt! The vast majority of medical school graduates go directly into residency programs, which run three to five years depending on specialty choice. The average income is approximately $46,000 for first-year residents. Once residency is completed, incomes increase dramatically, rising to six figures for most physicians; living below your means during your educational experience by keeping your debt in check will pay off later on. At the end of the day, you can easily manage your debt without it managing you!

NOTES 1. NIEHS News. Making More Minority Scientists. Environmental Health Perspectives. 1997;105(2). (http://www.ehponline.org/ docs/1997/105-2/niehsnews.html) Accessed April 28, 2010. 2. Powell K. Beyond the glass ceiling. Nature; 448:29-100.

Try not to use a credit card unless you can pay it off in full each month.

Hereâ&#x20AC;&#x2122;s a great resource location that will help with your financial planning: FIRST for Medical Education (Financial Information, Resources, Services and Tools) created by AAMC in collaboration with the medial school financial aid community and the Organization of Student Representatives. FIRST for Medical Education is designed to help members of the academic medicine community navigate the complexities of student debt. www.aamc.org/programs/first/start.htm

SMDEP is a free, six-week summer enrichment program for freshman and sophomore college students who are interested in a career in medicine or dentistry funded by the Robert Wood Johnson Foundation with technical assistance and direction provided by the AAMC and American Dental Education Association.

Journal for Minority Medical Students 11

111700b.indd 11

7Ă&#x160;

4/27/11 2:58 PM

With the diversity of our staff reflecting the diversity of the varied communities we serve, Continuum Health Partners can truly be seen as a microcosm of New York City. Across our four acclaimed hospitals, we provide award-winning clinical and compassionate care enhanced by cultural competency training for residents that allows patients, families and colleagues to feel most welcome. Here, you can work alongside some of the nation’s most renowned providers of healthcare, including attending physicians who hail from the prestigious Columbia University College of Physicians and the Albert Einstein School of Medicine. As part of our residency program, you’ll have the opportunity to thrive in an atmosphere that celebrates our differences, encourages your perspective and allows us to learn from — and flourish with — each other.

Continue your education with Continuum Health Partners. As distinguished as we are different.

Discover our innovation. Discover our diversity. Discover Continuum Health Partners. To learn more about our residency programs, visit • chpnyc.org/professionals/slr_gme • bethisraelgme.org/rprograms.html • nyee.edu/residency--fellowship-programs.html

Destination Diversity champions a diverse workforce and fosters an inclusive culture that delivers quality care to a diverse patient population. We support the creation of a multicultural environment that works for everyone and capitalizes on the diversity of all employees. Continuum Health Partners is committed to diversity and equal opportunity.

Make The Commitment To Medical School, And We’ll Make The Commitment To You.

The School of Medicine at the University of Alabama at Birmingham offers you more than a world-renowned medical curriculum. We also provide you with opportunities to succeed. Our Office of Minority Enhancement was created specifically to help students like you to make the most of your education and enjoy all of the advantages of medical school. Call us, and find out more about: our special programs, including combined M.D./Ph.D. and M.D./M.P.H. degrees, the Early Decision Plan, and the Summer Health Enrichment Program (UAB-SHEP), which prepare you to enter medical school. financial assistance, assistance in securing research and clinical opportunities, counseling and support for academic and personal concerns, tutorial programs, and liaison activities among the School of Medicine, minority students, and medical organizations. For more information about our minority programs, please call 1-800-707-3579, ext. 6 today. Or write: Office of Diversity and Multicultural Affairs The University of Alabama School of Medicine 1530 3rd Avenue South, VH 102K Birmingham, AL 35294-0019 Visit our web site: http://medicine.uab.edu Standing, from left: Sandrine Niyongere, MSII, Ezinne Okwandu, MSII, Alexis Mason, MSII, Whitney McNeil, MSII. Seated, Justin Jackson, MSII.

UAB is an equal education opportunity institution.

111700b.indd 12

4/27/11 2:58 PM

AMa perspective New Ways to Deal with the Age-Old Debt Problem by Keith Voogd, Department of Medical Student Services, American Medical Affairs Consortium

espite its eye-popping price tag, a medical education is a solid long-term investment that will pay out many times over throughout a physician’s career. Yet promises of future returns offer little solace to physicians dealing with crippling debt in the first years after medical school. According to the Association of American Medical Colleges, in 2009 the average indebted new medical school graduate carried more than $156,000 in medical education debt, a debt burden corresponding to a monthly loan payment as high as $1,800. While well established physicians may have no trouble making such payments, debt of this magnitude is anything but manageable for the average resident physician earning less than $3,000 per month after taxes, or even for some physicians practicing in the lower remunerating government or non-profit sectors. Fortunately, a recently enacted federal program allows new physicians to better manage their educational debt during the residency years and, through workrelated incentives, even reduce their debt burdens down the road.

Keith Voogd

Manage your debt

Now in its second year as an option for borrowers, the U.S. Department of Education’s Income Based Repayment (IBR) Plan seeks to make federal student loan repayment more affordable for borrowers who carry large debt loads relative to their incomes.

Unlike its predecessor, the economic hardship deferment option known popularly as the “20/220 pathway,” IBR is not an outright loan deferment program. Instead, IBR provides for reduced payments (i.e., partial deferment) for borrowers who demonstrate partial financial hardship. Only borrowers earning less than 150 percent of the federal poverty level (FPL, currently $10,830 per year for an individual) are eligible for full deferment. Consequently, under IBR nearly all residents with educational debt are required to make monthly payments beginning in the first year of residency. Monthly payments under IBR are based solely on the borrower’s income and family size, without respect to the amount owed. Minimum required payment amounts are capped at 15 percent of the amount by which the borrower’s income exceeds 150 percent FPL for his or her family size. In concrete terms, a first-year resident with no dependents and an average salary and debt burden would be required to make a monthly payment of approximately $380 under IBR,

Journal for Minority Medical Students 13

111700b.indd 13

4/27/11 2:58 PM

Ama perspective certainly a much more manageable amount than the nearly $1,800 for the same resident under a standard tenyear loan repayment plan. An additional benefit of IBR is the assurance that no matter how high a borrower’s future income rises, the required monthly payment under IBR will never be higher than it would have been under a standard 10-year repayment plan when the borrower first entered repayment. This unique feature of IBR is especially beneficial to borrowers who, like physicians finishing residency, anticipate substantial future increases in income but prefer to invest their resources somewhere other than in the expedited repayment of their relatively lowinterest student loans—say, for example, in a new medical practice.

Reduce your debt

Although IBR helps new physicians manage their debt and maximize discretionary income, reduced payments alone do little to reduce the total amount owed. In fact, as a result of the combination of reduced payments under IBR and everaccruing interest on unsubsidized loans, some physicians may even enter practice owing more than they owed upon graduating medical school, despite their having made sizable monthly loan payments throughout residency. Fortunately, Congress addressed this problem by

establishing two new loan forgiveness options as part of IBR. One option, available to all borrowers making reduced payments under IBR, provides for automatic forgiveness of remaining balances on eligible loans after 25 years of reduced payments. While this option may represent a boon to highly indebted borrowers with perpetually low incomes, relatively high incomes after residency will preclude most physicians from ever benefitting from this option, as most physicians will have paid off their loans in fewer than 25 years, even if only making the minimum monthly payments required under IBR. A second new loan forgiveness option, on the other hand, promises to benefit considerably more physicians and to a greater extent. The Public Service Loan Forgiveness (PSLF) Program provides for forgiveness of balances on eligible loans after just 120 reduced monthly payments for borrowers employed full-time by “public service organizations.” Eligible public service organizations include federal, state, and local governmental entities as well as non-profit [501(c)(3)] organizations and other private organizations that provide public health services. Nearly all hospitals with residency programs are considered public service organizations under PSLF, meaning that most physicians will enter medical practice having

already accrued three to six years of public service employment towards the ten-year requirement for loan forgiveness. Consequently, physicians who practice in the government or non-profit sectors for as little as four years will have their remaining loan balances forgiven. For a physician with $150,000 in educational debt, the combined lifetime savings due to IBR and PSLF could easily add up to more than $75,000.

Learn more about your repayment options

IBR and PSLF are excellent additions to the range of loan repayment options available to help physicians manage and reduce their medical education debt. Nevertheless, because the ultimate value of these programs depends on circumstances that vary widely from borrower to borrower (e.g., current and anticipated future income, length of residency, family size, etc.), you should carefully research and weigh these and all of other loan repayment options with your own unique situation in mind. Visit the AMA Web site (www. ama-assn.org/go/IBR) to learn more about IBR and PSLF, and for helpful tips about comparing loan repayment options. And be sure to always consult with a financial planning expert before making decisions about loan repayment.

14 Journal for Minority Medical Students

111700b.indd 14

4/27/11 2:58 PM

Major strength lies in the quality of our faculty, residents and students

OFFiCE FOR DiVERSiTy HOUSE STAFF AND FACUlTy AFFAiRS

Vanderbilt School of Medicine is seeking to bring the best residents, fellows and faculty from all ethnic, racial and gender groups into this great Medical Center. As we broaden our reach, you will enrich our environment and make Vanderbilt a leader in promoting people of diverse backgrounds. We invite you to visit Vanderbilt and learn more regarding our training programs or visit our website at www.mc.vanderbilt.edu/gmediversity.  U.S. News & World Report listed Vanderbilt Medical Center 16th on its 2009 “Honor Roll” of hospitals, a tribute reserved for a select group of institutions labeled the “best of the best.”  Vanderbilt is the third fastest growing health sciences center in the country in research funding

 The Monroe Carell Jr. Children’s Hospital at Vanderbilt has been ranked No. 15 on a listing of best children’s hospitals in the U.S. by Parents magazine, the third national accolade earned by the hospital this year.  Our office supports the Minority House Staff for Academic and Medical Advancement (MHAMA), an organization of Vanderbilt house staff and advisors www.mc.vanderbilt.edu/mhama. Contact us by e-mail at omecca.b.dale@vanderbilt.edu. or call 615-343-7958 André L. Churchwell, MD Associate Professor of Medicine (Cardiology) Associate Dean for Diversity in Graduate Medical Education and Faculty Affairs Vanderbilt University School of Medicine

www.mc.vanderbilt.edu/gmediversity 111700b.indd 15

4/27/11 2:58 PM

Naturopathic Medical Students Embrace Diversity - Globally and Locally The AANMC proudly recognizes the students of its member schools for honoring their commitment to multicultural diversity.

Carina Lopez, Class of 2012

Francisco Heredia, Class of 2011

UNIVERSITY OF BRIDGEPORT COLLEGE OF NATUROPATHIC MEDICINE

SOUTHWEST COLLEGE OF NATUROPATHIC MEDICINE “I saw that no one was addressing the many ailments that afflict Latino immigrant communities from a naturopathic perspective. Being Latino should not be a risk factor for diabetes, or for any other

“As a Puerto Rican woman who would be the first doctor in her family, there was a lot of pressure to just be the best.” Even as a child Carina Lopez knew her future was in the medical field. With an inclination to help people and an early understanding of the importance of health, Carina found herself in the pre-med program at New York University (NYU). But when she became disillusioned with her conventional medical education, her Puerto Rican heritage and upbringing around holistic remedies led her to the career path of naturopathic medicine. During her medical studies, Carina has been fortunate enough to travel to the Dominican Republic and Belize. During her time in Belize, she predominantly worked with diabetic patients teaching them the important role a proper diet plays in managing their disease and overall health. As a naturopathic medical (ND) student, listening to instructors lecture about the success of simplistic yet effective naturopathic treatments serves as daily inspiration to Carina. With an interest in teaching, she will be well prepared to provide the same inspiration to other ND students someday.

READ MORE Francisco.AANMC.org

Considering a career in naturopathic medicine? Find out more: the diverse ways of practicing naturopathic medicine.  Discover Students of AANMC schools go on to follow varied career paths

and lead extraordinarily influential lives Students.AANMC.org

information from the ND schools. Becoming a licensed  Request naturopathic physician begins with a strong education. Start by choosing the school that’s right for you Choose.AANMC.org

our PDF brochure offering a concise overview  Download of what it takes to become an ND Download.AANMC.org



111700b.indd 16

4/27/11 2:58 PM

LMSA perspective Reaching Back: The University of California, Irvine LMSA Mentorship Program By Brenda Campos-Spitze, MSII, UC Irvine

ecently, fifteen UC Irvine undergraduates shyly trickled into Gina’ s Pizza Parlor, anxious to meet the group of medical students selected and specially trained to become their mentors. Over the mouth-watering scent of pizza, the mentees and mentors chatted in between savory bites. The ambient volume rose as conversations became more fluid and apprehension dropped:

“So, what year are you in?” “Are you interested in medicine?” “Oh, you’ re a med student? I thought you were an undergrad!” Following the informal lunch mixer, the mentees and mentors headed a few blocks up the road to the UCI Activities and Recreational Center, where they were in for a treat. In hopes of devising an activity that would allow the group to bond and create a feeling of trust and community, the Latino Medical Student Association (LMSA) Mentorship Program (MP) Co-Chairs signed the 30 mentees and mentors up

“Don’t lose your balance!” During the low-ropes challenge, the mentees and mentors had to put their heads together to figure out how to get across the course without falling down. for a “Team Up” event. The Team Up program included creative icebreakers, low ropes and challenges, along with other fun-filled team-building activities. Through confronting and solving a series of challenges, the relationships

between the mentees and mentors began to grow before our very eyes. In the 1990s, we launched the LMSA Mentorship Program in partnership with Chicanos/Latinos for Community Medicine, a UCI undergraduate organization.

Journal for Minority Medical Students 17

111700b.indd 17

4/27/11 2:58 PM

A Mission to Care. A Mission to Cure.

As an academic medical center, Wake Forest University Baptist Medical Center brings together the best of patient care, research and education. With internationally recognized faculty who are pushing the frontiers of medicine and a focus on expert training, Wake Forest Baptist offers the benefit of the latest medical knowledge and subspecialty care. Wake Forest University School of Medicine provides an opportunity for a unique medical education. We offer: • MD Degree • Two five-year, joint-degree programs— MD/MBA and MD/MS, and flexibility to pursue other degrees • Seven-year, joint-degree program—MD/PhD • Physician Assistant studies—master’s degree • 57 accredited residency training programs • The Graduate School of Arts and Sciences offering master’s level and PhD degrees • Post–Baccalaureate Premedical Program— a one-year certificate program • Scholarship Clerkship Program for visiting senior medical students • Maya Angelou Center for Health Equity For more information about Wake Forest University School of Medicine, visit our website at www.wfubmc.edu/school.

111700b.indd 18

4/27/11 2:58 PM

LMSA perspective

Mentees Johanna Herrera and Zulmy Mancia cheer on fellow mentee Katherine Louis as she attempts her first intubation. The goal of the mentors in the program is to provide guidance and motivation to their mentees, pushing them to persevere through their rigorous studies and guiding them through the daunting medical school acceptance process. This year, in an effort to improve attendance at our less popular informational talks, the MP Co-chairs began pairing these talks with exciting hands-on workshops. So far, this strategy has been a success! We have planned several workshop-talk events throughout the school year to continue to motivate our mentees, all the while fostering stronger bonds amongst all program members. A few weeks following the mixer and Team Up event, the mentees had the opportunity to learn about venipuncture through a handson workshop organized with the Emergency Medicine Interest Group. Immediately following, the MP co-

Fourth-year Nick Sawyer leads mentee Alfonso Ortiz in practicing venipuncture on a mannequin arm.

chairs led a short talk on “ Scheduling for Success,” to give the mentees pointers on how to best arrange their science and non-science courses for academic success. Older mentees were also invited to share their own experiences, discussing their favorite science classes, professors, and GPA boosters. Our most recent event was an intubation workshop organized with the Anesthesiology Interest Group. The mentees split into three groups and rotated through three different stations—Anatomy of the Airway, Intubation 101, and Oxygen Mechanical Ventilation, a how-to on using an Ambu bag and face mask. It was so rewarding to see the smiles on their faces as they practiced techniques that even most second-year medical students falter with. Following the workshop, we had a panel of seven medical students give the mentees tips on how to obtain

clinical, research, and extracurricular experiences. Coming up ahead are more exciting events for our mentees and mentors. In January, we will be taking our mentees into the Anatomy Lab for our third annual Cadaver Day. Later in 2011, we will be holding our annual Bring Your Mentee to Medical School Month, in which our mentors take their mentees on medical school field trips to the UCSD School of Medicine and Western University of Health Sciences. In April, our LMSA chapter will be hosting the 27th Annual LMSA-National/West Conference 2011, which all of our mentees are encouraged to attend. Lastly, we will wrap up the bustling school year in June with a relaxing summertime barbeque. We cannot wait to see how the rest of the school year turns out for our mentees and mentors.

Journal for Minority Medical Students 19

111700b.indd 19

4/27/11 2:58 PM

snma perspective

SNMABranch Nisha Community Named Outreach President-Elect Roundupof SNMA Howard Med Student and Journal Campus Rep joins leadership ranks

UCSF SNMA Attends the ome people are called to serve. School’s Black Caucus Gala

Some people are called to lead. But Nisha Branch, a third-year and On February 19, 2011, student the SNMA Journal Rep, hasBlack beenHeritage called went toCampus the 21st Annual to both.Gala held by the UCSF Black Month Branch’s commitment to medicine Caucus. Several medical and nursing and the underserved was honored students dined with UCSF notablesat the recentAdams, SNMAUCSF Annual Medical Michael Affirmative Conference in Opportunity/Diversity Indianapolis when Action/Equal she was named President-Elect. “I Director; Chancellor Susan Desmondhad alwaysDr. thought national Hellman; Mark about Roach,a the leadership position, but wasn’t sureDr. UCSF Radiation-Oncology chair; if the timing was the going to beChair right,”of Talmadge King, UCSF Branch said. “But because I believe Medicine; and Medical School Deanso strongly everything does, I Dr. Sam in Hawgood, justSNMA to name a few. a way to make it work. I’m figured Theout event began with the recital really and excited to take of “Lifthonored Every Voice and Sing” to a this position so I can help promote the collage of notable African-Americans SNMA’s mission, other students, and events. Masterhelp of Ceremony and help Adams diversify medicine.” Michael then transitioned Branch, was set to graduate the crowd towho a fashion show called from Howard University College of “Beneath the Surface.” Various doctors, Medicine in 2012, will nowwore take a year students, and professionals off to do orthopaedic research before concepts like self-respect, dignity, and completing studies while she serves family pride,her and walked through the as SNMA President the 2012dining crowd as shortduring biographies 2013 year. these models’ were academic read chronicling Though Branch always knew she experiences. wanted be inCaucus health care, it wasn’t a ThetoBlack was founded straightafter paththe from her undergrad years shortly assassination of Dr. at University Virginia Martin LutherofKing, Jr., to in medical 1968. school. In fact, she took amost seven

“During that time, I also took master’s coursework for public health, was a bartender and a makeup artist along the way, too. But my heart was always with medicine and I was really thrilled that I got the opportunity to come to Howard.” Though this president-elect year will see Branch devoted to shadowing the current president and developing her own agenda, she already has very specific ideas about what she hopes to accomplish during her tenure. “I really want to enhance the brand of SNMA,” Branch said. “I want UCSF SNMA students students at UCSF’severywhere—white, Black Caucus Gala black, Asian, Hispanic, everyone—to know Nisha Branch, SNMA President-Elect “Basement” workers, African-Amerabout SNMA because I believe people icans who worked as janitors, nurses from all backgrounds are committed I reallyhelp, appreciate theUCSF, aids, kitchen and so on at to diversity in medicine, and that’s Journal. It provides great were being forced to use thearestwhat SNMA is all about. service to minority rooms that were located inmedical the base“I also really want to focus on students, and I look ment. These workers went forward on strike building our membership because to helping the magazine in to protest this policy and the substanhaving new members is what will anyconditions way I can. dard working with which reinvigorate the organization and give they had to deal. The Black Caucus, us new ideas,” she continues. “Finally, years between. “After became college, Ithe along off with other groups, I want to leave a legacy of helping the did sicklethat cellwould disease research change at St. impetus eventually organization grow for the benefit of Christopher’s Children the admissionsHospital policies for of the profesthe members of the future.” in Philadelphia, and italso wasfought there for, sional schools. They The Journal wishes Nisha much that my interest in working and won, reclassification of with their job success in her efforts and we look underserved patients wasoff, really piqued status, consecutive days access to forward to working with her over the andbathrooms, I became committed to helping all and equitable personnel next two years. end health disparities,” she says.

20 Journal for Minority Medical Students

111700b.indd 20

4/27/11 2:58 PM

FACULTY POSITION The Sidney Kimmel Comprehensive Cancer Center (SKCCC) at Johns Hopkins Leukemia Clinical Investigator

Why is this med student smiling?

recruiting a clinical investigator with expertise in leukemia/myelodysplaindividual will participate in an active clinical and research program in leukemia, should be board certi-

Photo courtesy of Vanderbilt University SOM

hematology, and eligible for licensure in the State of Maryland. Responsibilities will include: attending on inpatient leukemia service, attending and supervising fellows in outpatient clinic, and developing and supervising research protocols. commensurate with the individualâ&#x20AC;&#x2122;s University, an EEO/AA employer, is committed to increasing the representation of women and members of underrepresented groups on our faculty and encourages applications from such candidates. Applicants should provide a letter of interest, curriculum vitae/bibliography and the names of three references to:

Richard J. Jones, M.D. Co-Director, Hematological Malignancy Program The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins 1650 Orleans Street-Room 244 Baltimore, MD 21231 rjjones@jhmi.edu

111700b.indd 21

Because she just found out she can join our community of minority med students and premeds. So can you:

www.spectrumpublishers.com

4/27/11 2:58 PM

snma perspective Scenes from the 2011 SNMA Annual Convention personnel policies. To this day, and mentorship. UC Davis’ Imani April 20-24, 2011 inconsisting Indianapolis, IN the Black Caucus continues to work Five physicians, of a with the administration to build a cardiologist, internist, family physician, Clinic provides diverse UCSF campus. pediatrician and obstetrician/gynecologist, participated in the program’s free health care panel discussion. One of the physiBuffalo SNMA Helps cians, Dr. Kenneth Gayles, was one of year-round to Host Doctors to College the first African American students to be accepted at SUNY Buffalo School Recently the SNMA chapter at Sacramento of Medicine in the late 1960s SUNY Buffalo helped the student AMA chapter host its first Doctors residents. UC Davis SNMA Excels at Back to School Program (DBTS). .

DBTS is an AMA initiative targeted to help increase the number of minority physicians in the U.S. As many of you know, African Americans, Hispanic Americans, and Native Americans comprise nearly 1/4 of the U.S. population. In 30 years, these groups are expected to make up 1/3 of the U.S. population. Surprisingly, only 7% of physicians and 6% of medical school faculty come from these groups. The goal of the DBTS is to help address this issue, as well as encourage young minority students to pursue a careers in medicine and make them realize that this is a profession that is attainable with dedication, hard work,

Outreach

now looking to add another dimension The UC Davis SNMA Chapter to their outreach efforts: mentoring. has a long, strong tradition of commu- Their goal is to reach out and mentor nity service. SNMA is the nation’s young people so they may be inspired oldest and largest organization focused to pursue their career aspirations. on the needs and concerns of mediThey are in the process of establishcal students of color, and has invested ing a Minority Association of Premuch effort in promoting the status Health Students (MAPS) chapter for quo of minorities, particularly undergraduates. They’ll coordinate a SNMA Convention 2011 African Americans. Their Imani scholarship for high school students as Clinic provides free health care year-Top well a medical school workshop day. left:asResearch opportunities round to Sacramento residents, and abound at NHLBI. their annual Ulezi Family Health Faire provides free health screenings and Top right: It’s all in the family: representatives of the Jefferson Medical invaluable health care information to College’s Department of Familly the community of Oak Park. They are and Community Medicine. Bottom left: Mixing and mingling in honor of new SNMA President Nisha Branch.

for Minority Medical Students 2222 JournalJournal for Minority Medical Students

111700b.indd 22

4/27/11 2:58 PM

Resident’s perspective Can technology help maximize the clinician’s role? By Luther Adair II, MD Senior Radiology Resident Long Island College Hospital

s a physician, I recently I had the misfortune of having to explain to a patient why we were performing a nuclear medicine bone scan on her. She was admitted to the hospital with a presumptive diagnosis of ovarian cancer and we were performing this test to see if the cancer had invaded her bones. Her symptoms started when she noticed that her abdomen had grown over the course of the last two months at which point she had been told by her doctor to lose weight. Her current provider believed that she may have ovarian cancer because ovarian cancer causes a large amount of fluid to accumulate within the abdomen and pelvis. This is known as a peritoneal Luther Adair II, MD effusion, which can be sampled for cancer by drainage and sending it cancer is the third most deadly cancer for pathological diagnosis. Ovarian amongst female patients because of

this insidious pattern of presentation. This experience elucidated two points for me: First, I felt really good about being able explain a complex situation to her because she seemed very upset that she didn’t know what was going on with her body. When I asked her why she was so distraught, she said that it was because she had been looking information up on the computer and that none of her providers could explain why she was having this “big belly.” I call this situation mismanaged elements of patient interaction. An example of this is when a patient tells her doctor that she is having a headache and he then suggests an inapprorpiate diagnosis because he didn’t remember to ask her when the headache began. In this case her initial provider failed to

Journal for Minority Medical Students 23

111700b.indd 23

4/27/11 2:58 PM

The efficient use of technology along with a better understanding of patient’s concerns can likely lead to a more well informed, compliant patient.

identify her symptoms and later her providers failed to address her need for information. Secondly, this situation speaks to the need for better use of technology to provide patients with information. I couldn’t help but thinking, “ If only I had my iPad, I would easily have been able to provide her with a visual representation of her presumed diagnosis in addition to the verbal explanation.” The iPad and other mobile devices are able to provide access to an enormous amount of information quickly. When combined with the knowledge and expertise of a skilled professional such as a doctor these tools are amplified in their efficiency. For a starting price of around $500, every physician can have an iPad, and provided there is a

phone signal, it can become an instant library, theater, and in the case of this patient, assistant. Modern hospitals are currently under tremendous budgetary constraints and the future even more abysmal. However, with tools that increase the quality of interactions between patients and their providers, I believe we will save money and time in the long run. By helping patients to understand their bodies and illnesses better, physicians provide an invaluable service — one that the internet may not be able to do alone. The use of technology such as the iPad, conversely, can help physicians maximize their impact with visual aids and quick access to information. When combined, the efficient use of technology, along with

a better understanding of patient’s concerns, can likely lead to a more well informed, compliant patient. I believe that this will also lead to more rewarding patient encounters for providers. Luther Adair, II, MD is a former Campus Rep for the Journal. If you’d like to be a Campus Rep, get in touch: leea@spectrumunlimited.com

Journal for Minority Medical Students 24

111700b.indd 24

4/27/11 2:58 PM

The Surgeon General’s

Report

One Doctor, One Patient How You Can Help Eliminate Disparities in Health By Regina M. Benjamin, MD, MBA, VADM, USPHS

hen I was an intern, I went to the Medical Association of Georgia’s annual meeting. One of the intense issues that was being debated was whether sexually transmitted diseases needed to be taught in medical school. I stood up and said that I’d never seen syphilis or gonhorrhea except in a textbook, and I thought there was a need. The Georgia delegation passed that resolution. They sent me to the AMA to speak on the issue, and the resolution passed. Within six months, every medical school in this country was encouraged to include sexually transmitted diseases as part of their core curriculum. Whether it’s in medical policy or in medical practice, I learned that one person can make a difference. I learned that I could make a difference in medical practice when the National Health Service Corps sent me to Bayou La Batre, Alabama. It’s a pretty place, but it’s a poor place. And when I got there, I found a group of people who were too poor to afford medical care, but too rich to qualify for Medicaid. I liked the people. I liked the community. I wanted to practice medicine there. But I quickly learned that practicing medicine

wasn’t just about sewing up the shark bites. I had to deal with the land sharks, the regulators, the reviewers, the red tape dispensers and people I jokingly call the hammerheads—the lawyers. So I knew I needed to stay involved. I stayed involved with the state medical society, the AMA, our state academy of family physicians, the Red Cross, United Way, the Chamber of Commerce, the Girl Scouts—just like every other family physician, I was involved in my community. I learned that my patients had problems that my prescription pad alone couldn’t take care of things like lack of adequate housing (especially after Katrina), employment opportunities, and clean water. I had a number of adult patients who could not read.

Cultural Competency & Your Community

Let me give you an example of one of my patients. I’ll call her Mrs. Smith for HIPAA reasons. Mrs. Smith is a 40-something African American woman who has a slipped disk and is overweight. She called me on a Saturday, and said, “Dr. Benjamin,

Surgeon General Regina Benjamin my back is really hurting. That ibuprofen you prescribed for me just isn’t working. I went to that specialist you told me to go see and he said I needed to lose some weight. I’m trying, I really am, but I’m hurting.” I could hear the pain in her voice. I said I’d call something in for her, but I said she had to come in to see me the following week. She promised she would. On Tuesday, I walked in the exam room and there she was, leaning over the exam table. She was in so much pain, she couldn’t sit down. So I asked her if the medicine had not helped, and she told me she couldn’t afford it. And I said, “You couldn’t afford it? You work at the school in the janitorial department. You have Blue Cross.” And she said, “Well, I couldn’t afford the co-pay. But I get paid Friday and I promise I’ll get it then.” I stepped out of the room and

Journal for Minority Medical Students 25

111700b.indd 25

4/27/11 2:58 PM

got my nurse to go across the street to Jim, our pharmacist, and get the medicine for her. As I went back in the room to hand her her medicine, her eyes welled up with tears. She said, “Oh Dr. Benjamin, I’m so embarrassed. I didn’t want you to do that.” I realized at that moment I had taken her dignity away from her. I also realized at that moment that cultural competence doesn’t have to do with the color of your skin; it has to do with allowing a patient to keep her dignity. As I was walking out of the room, she said, “Oh by the way, can I have a work excuse?” And I said, sure, you take your medicine and you should be able to go back Thursday or Friday. And she said, “Oh no, we’re stripping those floors. I’ve got to go back to work tonight.” Here was a woman who was in so much pain that she couldn’t even sit down, but she’s willing to go strip the wax off the floors so our elementary kids can go to school in a clean environment. She is the kind of people that we advocate for. She’s the kind of people we’re here for.

An historic opportunity to end disparities I was so pleased when the Patient Protection and Affordable Care Act went into effect because it requires insurance companies to cover preventive services and they cannot require a copay or a deductible for these services. I am especially grateful to serve at this historic time as we make overdue changes in how we finance and deliver health care, changes that will eventually give all Americans access to the high-quality, affordable health care that they deserve. But giving all Americans health care coverage is only the first step in reducing the health disparities that

plague our country. We know that reducing and, ultimately, eliminating health disparities will require more than just giving Americans an insurance card. We have to address the social determinants of health, such as poverty. A study that was published in the December, 2009, issue of the Journal of Public Health showed that poverty and dropout rates are at least as important a problem as smoking in the United States. On average, poverty showed the greatest impact on health, smoking was second, followed by being a high school dropout, being a non-Hispanic black, obese, a binge drinker, and uninsured. The second step that in reducing disparities that is just as challenging is prevention. Prevention is the

foundation of our nation’s public health system. And prevention is the foundation of my work as Surgeon General. As Surgeon General, my priorities focus on wellness and prevention. As “America’s Doctor,” I want to provide Americans with the best scientific information available on how to live healthier lives. I’m also trying to bring some clarity and understanding to the overwhelmingly confusing conversation about health and health care. There are perhaps no more serious challenges to the nation’s health and well-being than those posed by obesity and overweight. Since 1980, obesity rates have doubled in adults and tripled in children. And the problem is even worse among black, Hispanic

26 Journal for Minority Medical Students

111700b.indd 26

4/27/11 2:58 PM

and Native American children. More than two-thirds of adults and more than one in three children are overweight or obese, and we see the sobering impact of these numbers in the high rates of diabetes, heart disease, and other chronic diseases that are starting to affect our children more and more. Recently, a study at the University of North Carolina School of Medicine reported that obese children as young as age 3 show signs of an inflammatory response that has been linked to heart disease later in life. So last January, I was joined by Secretary Sebelius and First Lady Michelle Obama to release my first paper, “The Surgeon General’s Vision for a Healthy and Fit Nation.”

I was very pleased subsequently to join the First Lady with her Let’s Move campaign. Both my Vision for a Healthy and Fit Nation and the Let’s Move campaign take a comprehensive approach that engages families and communities as well as the public and private sectors. But for people to do these things, they need to live and work in environments that support these efforts. There’s a growing consensus that we as a nation need to help create environments where the healthy choices are the easy choices and the affordable choices. For years we’ve encouraged Americans to eat nutritiously, exercise regularly and maintain a healthy lifestyle. But my Vision for a Healthy and Fit Nation is an attempt to change the national conversation from a negative one about obesity and illness to a positive conversation about being fit and healthy. We need to stop bombarding Americans about what they can’t have, what they can’t eat. We need to talk to them about what they can do to become healthy and fit. I’ve been trying to set a good example. Last summer, I went to the Grand Canyon for the first time and hiked it rim to rim. It meant the first day I went 14 miles straight down— 5,000 feet—and the next morning I went back up. The point is that I’m not an athlete or a big fitness guru; but if I can do it, anybody can—all you have to do is walk.

How physicians can play a part

A few months ago, I asked various health care organizations around the country to join in the Exercise is Medicine initiative. It’s a multinational, multi-organizational initiative that brings physical activity

to the forefront of disease prevention and treatment by making exercise part of every patient’s interaction with their clinician. I believe that exercise is the new medicine. There needs to be a connection between clinicians, fitness professionals, and the public, so that everyone can receive the guidance they need to stay healthy and active. But we need to have fun doing it, you need to have a good time— dance, play—enjoy being healthy no matter what size you are. We should remember that people are more likely to change their behavior if their meaningful reward is something more than attaining a dress size. That reward has to be something that each person can feel, that they can enjoy and that they can celebrate. The real reward is optimal health, which allows people to embrace each day and live their lives to the fullest without disease, disability, or loss of productivity.

An exciting time for health care

This really is an exciting time to be in health care. We have an opportunity to make our health system work better for our patients and for our doctors. As doctors, we often take care of everyone else and put ourselves last. We have to play, exercise, enjoy, have fun, and vacation. And as a family doctor and as “America’s Doctor,” I cannot end without saying one very important thing: First and foremost, you need to take care of yourself.

Ed. Note: This article taken from Dr. Benjamin’s opening remarks at the recent American Public Health Association’s annual conference.

Journal for Minority Medical Students 27

111700b.indd 27

4/27/11 2:58 PM

T HE M OUNT S INAI S CHOOL OF M EDICINE ’ S C ENTER FOR M ULTICULTURAL & C OMMUNITY A FFAIRS AND THE G RADUATE M EDICAL E DUCATION C ONSORTIUM 111700b.indd 28

VISITING ELECTIVES PROGRAM FOR STUDENTS UNDERREPRESENTED IN MEDICINE (VEPSUM) VEPSUM offers four-week electives at Mount Sinai School of Medicine (MSSM) and its affiliates in the Graduate Medical Education Consortium to qualified 3rd-year and 4th-year medical students who are from groups underrepresented in medicine1 and who attend U.S. accredited medical schools. In collaboration with the MSSM Center for Multicultural and Community Affairs, VEPSUM is designed to increase diversity in the house staff and subsequently the faculty of the Mount Sinai School of Medicine and its affiliated institutions.  Electives are available between July and February. Students must have completed their required core clerkships before starting the program.  Tuition is not charged.  Housing and travel expenses are subsidized for one month.  Students are provided the potential to network with residency program directors, residents, minority faculty, and students, and have access to the Office of Graduate Medical Education, Center for Multicultural and Community Affairs, medical school library, seminars, and workshops. To learn more about VEPSUM and the application process, please visit: http://www.mssm.edu/about-us/diversity/initiatives/visiting-electives-program We look forward to receiving your application and to having you visit with us! For more information please contact: Adam Aponte, MD, MS at adam.aponte@mssm.edu Monique Sylvester, MA at monique.sylvester@mssm.edu

1 The Association of American Medical Colleges (AAMC) defines groups underrepresented in medicine “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population."

4/27/11 2:58 PM

The Disparities Issue If there’s anything that’s become clear in the time that we’ve been publishing the Journal, it’s that health disparities are a persistent and troubling issue. We’ve read report after report that confirm disparities exist. But we’re wondering now: where’s the tipping point? When will the country realize we’ve got enough data and put our attention on erasing inequalities in health? This issue of the Journal looks at all sides: how we got here and what we can do to have a more healthy nation—for everyone.

Journal for Minority Medical Students 29

111700b.indd 29

4/27/11 2:58 PM

The Issue:

HEALTH DISPARITIES A Talk with Dr. John Ruffin, Director, NIMHD

Last fall, leaders from around the country gathered at the Fourth Annual National Conference on Health Disparities to discuss one of the most important health issues in our country. This year, the conference had

a particularly interesting focus: how things like literacy, public safety, and urban design can have an impact on health and health disparities. We got to talk with one of the nation’s foremost experts in this field, Dr. John Ruffin, Director of the National Institute on Minority Health and Health Disparities (NIMHD), about how the dialogue around disparities has changed and how students can help play a part in ending health disparities.

process than the next. It’s very exciting to see such passion and commitment from the nation’s next generation of health leaders. The conference was especially noteworthy because it focused on the non-medical determinants of health disparities. Adopting a broader perspective as we seek to understand the origins of health disparities is vital if we are to achieve health equity. The idea that our health is powerfully influenced by our social and economic arrangements, our environment, and our laws and policies, is beginning to be recognized at the level of national health policy, and the social determinants of health are the subject of growing scientific research. It was inspiring for me to be in the company of a diverse group of professionals who are committed to looking at health disparities from this broad perspective.

To start, we’d love to hear your thoughts about the recent Philadelphia conference—in general, or specifically: anything surprising, intriguing, inspiring you heard or saw? Dr. Ruffin: I was particularly inspired by the enthusiasm of the young people who attended the conference. I saw students from across the country, each of whom was more engaged in the

Can you comment on the Hon. James E. Clyburn’s comment at the conference that the health reform law is “the Civil Rights issue of the 21st century?” Dr. Ruffin: Congressman Clyburn captured an essential truth: access to the best available health care is a basic human right and the Affordable Care Act is a landmark piece of legislation that helps ensure access for everyone.

30 Journal for Minority Medical Students

111700b.indd 30

4/27/11 2:58 PM

Photos left to right: Dr. John Ruffin, Hon. Donna Christensen and Mr. Michael A. Rashid; Dr. John Ruffin, Dir., National Institute on Minority Health & Health Disparities, Washington, DC; Dr.David E. Rivers & Ms. Ingrid Saunders Jones;

Can you talk a bit more about how the health reform law will affect disparities? Dr. Ruffin: Today, low-income Americans, racial and ethnic minorities, and other underserved populations are burdened with higher rates of disease and worse health outcomes, in part because they are more likely to lack insurance and thus have fewer treatment options and reduced access to care and preventive interventions. Thanks to the tireless efforts of our various congressional leaders, including members of the Congressional TriCaucus Brain Trust, and thanks to the prior work of champions like Congressman Louis Stokes, we have passed historic legislation that will bring down health care costs, increase access to health care, invest in prevention and wellness, and give individuals and families more control over their own care. This will have a dramatic, positive impact on eliminating health disparities. How important is it to have dialogue and partnerships between disparate groups (i.e., urban planners who can design more walkable communities with better food choices, health professionals, insurance executives) in helping to end health disparities? Dr. Ruffin: It is vitally important because the

causes of health disparities are complex and multifactorial. We really need fundamental changes in our society if health disparities are to be eliminated, and this can only be accomplished through partnerships that cross traditional professional boundaries and disciplines. Through the health reform law and other initiatives, the administration is supporting such partnerships. For instance, we are supporting promising and proven community strategies around the country for promoting wellness and reducing chronic disease that bring together health professionals, educators, community activists, urban planners, and many others. Working together, we can take what works, build on that foundation, bring quality care to every American and achieve a vision of health equity. After this most recent conference in Philadelphia, can you comment on how you feel the â&#x20AC;&#x153;conversationâ&#x20AC;? around health disparities has changed since you took the helm of NIMHD? Dr. Ruffin: Though racial/ethnic minorities and other underserved populations continue to bear a disproportionate burden of morbidity and mortality, we believe that the recent attention to reforming health care has caused a sea of change in this area. Working together, we have

Journal for Minority Medical Students 31

111700b.indd 31

4/27/11 2:58 PM

“Adopting a broader perspective as we seek to understand the origins of health disparities is vital if we are to achieve health equality.” Ms. Melody Barnes, Pres. Obama’s Domestic Policy Adviser & the Dir. of the Domestic Policy Council, White House, Washington, DC.

made great progress in moving health disparities to center stage, and the new law reflects a growing societal conviction that access to the best health care is a fundamental human right. We now have an unprecedented opportunity to achieve a vision of health equity for future generations by eliminating health disparities. Can you discuss the interplay between local or community-based initiatives and federal initiatives to ending health disparities? Dr. Ruffin: Though we often talk about health disparities affecting different populations, we can never forget that health disparities really affect individuals and their families. At the federal level we recognize the importance of working with the community in order to effect the positive improvements in health that we need to advance our work towards eliminating health disparities. Given the complex nature of health disparities, our approach has to be multifaceted, and consequently, partnerships among federal agencies and organizations at the grassroots level are pivotal in improving a community’s

health. It’s an interdependent relationship that exists and must thrive if we are to be successful in eliminating health disparities. What would you advise our readers about specific steps they can take to be part of the solution? Dr. Ruffin: It doesn’t matter whether you start with yourself, your family, or at the local level, by making behavioral changes, helping organize a blood pressure clinic at your neighborhood barber shop, or on the national stage by heading to Washington to get involved with health policy. You are only limited by your motivation and your imagination. Remember that there are a lot of people who don’t realize how significant health disparities are, so do all you can to educate your peers and colleagues about the challenges we face. Please allow me to express my thanks to the Journal for allowing me to share with you the important work done at the conference. I hope it inspires you to get involved.

32 Journal for Minority Medical Students

111700b.indd 32

4/27/11 2:58 PM

New CDC Report Documents Important Health Disparities Need for better data highlights progress and challenges in achieving health equity A race/ethnicity, gender and other

mericans’ differences in income,

social attributes make a difference in how likely they are to be healthy, sick, or die prematurely, according to a new report by the Centers for Disease Control and Prevention. State-level estimates in 2007 indicate that low income residents report five to 11 fewer healthy days per month than do high income residents, the report says. It also says men are nearly four times more likely than women to commit suicide, that adolescent birth rates for Hispanics and non-Hispanic blacks are three and two-and-a-halftimes respectively those of whites, and that the prevalence of binge drinking is higher in people with higher incomes. The data are in the new “CDC Health Disparities and Inequalities Report — United States, 2011.” The report also underscores the need for more consistent, nationally representative data on disability status and sexual orientation.

“Better information about the health status of different groups is essential to improve health. This first-of-itskind analysis and reporting of recent trends is designed to spur action and accountability at the federal, tribal, state and local levels to achieve health equity in this country,” said CDC Director Thomas R. Frieden, MD, MPH The report, the first of a series of consolidated assessments, highlights health disparities by sex, race and ethnicity, income, education, disability status, and other social characteristics. Substantial progress in improving health for most U.S. residents has been made in recent years, yet persistent disparities continue. The report addresses disparities at the national level in health care access, exposure to environmental hazards, mortality, morbidity, behavioral risk factors, disability status, and social determinants of health, such as conditions in which people are born, grow, live, and work.

Findings from the report’s 22 essays: •In 2007, non-Hispanic white men (21.5 per 100,000 population) were two to three times more likely to die in motor vehicle crashes than were non-Hispanic white women (8.8 per 100,000). The gender difference was similar in other race/ethnic groups. •In 2007, men (18.4 per 100,000) of all ages and races/ethnicities were approximately four times more likely to die by suicide than females (4.8 per 100,000).

•In 2007, rates of drug-induced deaths were highest among

Journal for Minority Medical Students 33

111700b.indd 33

4/27/11 2:58 PM

non-Hispanic whites (15.1 per 100,000) and lowest among Asian/ Pacific Islanders (2.0 per 100,000). •Hypertension is by far most prevalent among non-Hispanic blacks (42 percent vs. 29 percent among whites), while levels of control are lowest for Mexican-Americans (31.8 percent versus 46.5 percent among non-Hispanic whites). •Rates of preventable hospitalizations increase as incomes decrease. Data from the Agency for Healthcare Research and Quality indicate that eliminating these disparities would prevent approximately 1 million hospitalizations and save $6.7 billion in health care costs each year. •Rates of adolescent pregnancy and childbirth have been falling or holding steady for all racial/

ethnic minorities in all age groups. However, in 2008, disparities persist as birth rates for Hispanic adolescents (77.4 per 1,000 females) and non-Hispanic black adolescents (62.9 per 1,000 females) were three and 2.5 times those of whites (26.7 per 1,000 females), respectively. •In 2009, the prevalence of binge drinking was higher in groups with incomes of $50,000 or above (18.5 percent) compared to those with incomes of $15,000 or less (12.1 percent); and in college graduates (17.4 percent), compared to those with less than high school education (12.5 percent). However, people who binge drink and have less than $15,000 income binge drink more frequently (4.9 versus 3.6 episodes) and, when they do binge drink, drink more heavily (7.1 versus 6.5 drinks).

The Journal talked with the recently appointed director of CDC’s Office of Minority Health and Health Equity, Leandris Liburd, Ph.D., M.P.H. about the report and how it contributes in the broader conversation about health disparities. JOURNAL: What was the most surprising thing for you in the report? LIBURD: Because I’ve been involved with eliminating health disparities for

my entire career at CDC, the data wasn’t necessarily surprising. But I will add an important caveat: It all is alarming. I was particularly alarmed by the reported rates of suicide among American Indian adolescents and young adults, as well as by the growing rates of HIV infection among African Americans. I was also alarmed that overdoses of prescription drugs now kill more Americans than overdoses of illegal drugs. More broadly, if we look at, for example, chronic diseases and things like tobacco use, it’s disheartening to see that the advances that have been made in medicine and health care that have benefitted our majority population have not benefitted communities of color and persons of lower socioeconomic status to the same extent. We continue to have issues of access. JOURNAL: This report chronicles disparities in 22 essays covering everything from HIV infection to coronary heart disease. How do you respond to those who would say we didn’t need more evidence of disparities? LIBURD: First off, I’d like to say that I’ve been with CDC and involved in this work for a very long time, and I’ve never seen in a single document a report that is as comprehensive at this level. And though many people think there is broad public awareness of these disparities, it’s really not true. We’re hopeful that the report will increase public awareness about health disparities among different populations. We’re also hopeful it will be a tool for action, and we look forward to it being used at all levels—federal, state, and

Dr. Leandris Liburd

34 Journal for Minority Medical Students

111700b.indd 34

4/27/11 2:58 PM

within local communities—to establish priorities and help marshall additional resources to eliminate health disparities. JOURNAL: Is CDC partnering with other agencies in the fight to end disparities? LIBURD: We’re hopeful that this report complements the release of the National Partnership for Action (NPA) to End Health Disparities, which is a national plan that’s been developed by the Office of Minority Health at HHS. The report also acts as a complement to the recent National Healthcare Disparities Report from the Agency for Healthcare Research and Quality. Finally, we believe that the information provided in the report is of vital importance in achieving the goals of Healthy People 2020. JOURNAL: How do you hope the report is used by people “on the ground” in the fight to end health disparities? LIBURD: I hope that the report will stimulate conversations within local communities, because at the end of the day, public health is local. And not only is this a big problem, it’s a very complex problem. I don’t like to dwell in the complexity because people get overwhelmed. But if we continue to confront it and keep it in the face of all of us, we’ll make progress. JOURNAL: What would you say to our readers about how they can get involved in helping eliminate disparities? LIBURD: I want to encourage physicians to become acquainted with the social environment from which their patients come. For example, if someone comes in with diabetes, and the physician may give that person a prescription and say, “Change

your diet and increase your physical activity.” The patient leaves and goes into a community and a family structure for which they have very little support to act on what they’ve been told to do. When they come back in three months for their followup visit, their hemoglobin A1c may be worse than the physician expected. I think a lot of times that happens because the physician is so focused on the exam room, they’re not paying to what’s going on outside in the community. I don’t expect them to change the social environment of their patients, but I’d like for them to be aware of what resources are there that can support the patient so they can make referrals.

I would also suggest that whenever possible, that they lend their expertise and their influence to arenas that are addressing health disparities. For example, if you get a physician to participate in a community event where there’s an opportunity to talk about health, it immediately gives the event more credibility. So the more community presence a physician has, the better. Both of these things will help move forward the agenda of eliminating health disparities. Note: The full “CDC Health Disparities and Inequalities Report — United States, 2011”, is available at www.cdc.gov/mmwr.

Health Disparities: It’s a local thing One group that lauded the release of the CDC report was the National Association of County and City Health Officials (NACCHO). “This report highlights a fundamental role of the local, state, and federal governmental public health system to gather and report data that describe the health status of the nation.” said Robert M. Pestronk, executive director of NACCHO. “Local health departments are increasingly engaged in community partnerships to address the root causes of health inequities, thereby keeping people healthier in the first place.” The nation’s local health departments lead efforts that protect the public by preventing disease, promoting health, and working to reduce health dispari-

ties and inequalities. They help create and maintain conditions in communities that support health and reduce inequities by promoting access to nutritious foods and exercise, and discouraging tobacco use, among others. Local health departments across the country that are devising innovative approaches to tackling health inequity on a variety of fronts include Louisville, Boston, and Milwaukee. Each has established a Center for Health Equity within their departments. For example, The Alameda County Department of Public Health (CA) published one of the first studies to demonstrate the relation between health and the housing foreclosure crisis.

Journal for Minority Medical Students 35

111700b.indd 35

4/27/11 2:58 PM

Disparities persist at “unacceptably high” levels according to the new National Healthcare Quality & Disparities Report

in health care quality conI mprovements tinue to progress at a slow rate—about

2.3 percent a year; however, disparities based on race and ethnicity, socioeconomic status, and other factors persist at unacceptably high levels, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued today by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ). The reports, which are mandated by Congress, show trends by measuring health care quality for the Nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patientcenteredness, care coordination, efficiency, health system infrastructure, and access. “All Americans should have access to highquality, appropriate, and safe health care that helps them achieve the best possible health, and these reports show that we are making very slow progress toward

that goal,” said AHRQ Director Carolyn M. Clancy, MD “We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement.” Gains in health care quality were seen in a number of areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42 percent in 2005 to 81 percent in 2008. Other very modest gains were seen in rates of screening for preventive services and child and adult immunizations. However, measures of lifestyle modifications such as preventing or reducing obesity, smoking cessation, and substance abuse saw no improvement. The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American

Indians, and Alaska Natives received worse care than whites for about 40 percent of core measures. Asians received worse care than whites for about 20 percent of core measures. And Hispanics received worse care than whites for about 60 percent of core measures. Poor people received worse care than high-income people for about 80 percent of core measures. Of the 22 measures of access to health care services tracked in the reports, about 60 percent did not show improvement, and 40 percent worsened. On average, Americans report barriers to care onefifth of the time, ranging from 3 percent of people saying they were unable to get or had to delay getting prescription medications to 60 percent of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.

36 Journal for Minority Medical Students

111700b.indd 36

4/27/11 2:58 PM

The National Partnership for Action

A bold mission,

a broad coalition T

he existence of health disparities among minority populations is undisputed. The question that confronts us is: What actions can be taken by private and public partners that would improve the effectiveness and efficiency of our collective efforts? That’s where the National Partnership for Action to End Health Disparities (NPA) comes in. The NPA focuses on health status and health outcomes among racial and ethnic minority populations and is intended to lead the Office of Minority Health (OMH) and its partners toward a shared destination: a nation free of health disparities, with quality health outcomes for all. The NPA was formed at the grass roots level. The OMH sponsored regional events to bring together local, state, Tribal, regional and federal experts and practitioners from the private and public sectors to lay the foundation for a comprehensive, community-driven, sustained strategy. What came out of these meetings was the core mission of NPA: to mobilize and connect individuals and organizations across the country to create a nation free of health disparities, with qual-

ity health outcomes for all people. One of the first NPA campaigns was, A Healthy Baby Begins with You, was launched in mid-2007 to educate young mothers and fathers in the African American community about infant mortality prevention, SIDS, and healthy living.

NPA Goals: •Illuminate the compelling issues that impact health outcomes. •Identify action steps that partners can adopt and adapt for their target audiences. •Seek out and highlight promising practices that help eliminate health disparities. •Promote tools, programs, and information sources for consumers, caregivers, and health providers.

The NPA will promote strategic actions in five key areas: •Increase awareness of health disparities. •Strengthen leadership at all levels. •Improve health and healthcare outcomes. •Improve cultural and linguistic competency in delivering health services. •Coordinate and utilize research and outcome evaluations more effectively.

Journal for Minority Medical Students 37

111700b.indd 37

4/27/11 2:59 PM

NPA

Program

Focus: Memphis Middle School Students Help Make Community Healthier

atonyann is one of the students from the Memphis Academy of Health Sciences (MAHS) who is making her Memphis community better. The seventh grader became involved with the infant mortality issue after her high school principal came to her because of her writing skills and willingness to become active in causes. The 13 year-old Latonyann said she felt compelled to spread the message in her community. “I don’t think it’s right that babies should die before the age of one, and I want to help other teenagers,” she said. “And I’ve had that situation with my aunt, and my mom had one of my baby brothers and me at a young age and we could’ve had a risk of that (infant mortality).” For a week last month, college and high school students from various parts

of the United States came together to raise awareness about babies dying prematurely in Memphis and Shelby County, Tenn., an area with one of the country’s highest infant mortality rates. Activities involved college students training middle- and high-school students to become peer educators so that they then could raise awareness of the infant mortality issue among people of their own age and in their community. One of the schools in the Memphis area that participated in the event was the Memphis Academy of Health and Sciences. Following the meeting with the peer counselors, Latonyann said she thought about some ideas of how to go about helping teenagers with the problems of infant mortality. “I talked to my grandpa about it and I told my neighbors, but I want to go out and tell more people. Put out a flyer and put it out in the community. Have young kids just come in, and we can talk about it, in a community place, where we can all meet up and it’s appropriate, where people feel comfortable,” she said. MAHS Executive Director Curtis Weathers said the school had been looking for a community outreach initiative

that would involve their students in the improvement of their community’s health. After looking at several options, including issues such as childhood obesity, and other childhood diseases, the school settled on the issues related to infant mortality. MAHS opened in 2003 and was one of the first charter schools in the state of Tennessee. Weathers said two of the school’s partners, Le Bonheur Children’s Hospital and the Regional Medical Center, are very much involved in the issue of infant mortality, and all agreed that this would be a worthwhile enterprise. “I visited the newborn’s center at ‘The MED’ where they have all the little ‘preemies’ and of course, once you enter that area, you are almost never the same once you see little kids fighting for their lives,” Weathers said. The school has been slowly educating kids and the community about infant mortality, and has sponsored a walkathon focused on the issue. During Memphis Week, MAHS launched its own two-part initiative called Project 38108 which will have students chronicling the stories of families going through, or that have gone through, some issue related to infant mortality. 38108 is one

38 Journal for Minority Medical Students

111700b.indd 38

4/27/11 2:59 PM

of the zip codes in Memphis where the infant mortality rates are highest. As part of the project, MAHS’s students who are good writers and are interested in the issue of infant mortality will interview families who have lost babies, with the hope of publishing the stories in a book. Another aspect of the project is the creation of “Message Teams,” that will work to keep the issue of infant mortality visible, especially among teenagers and young adults, by visiting schools, community centers, and churches, to perform skits, vignettes, and communication pieces that talk about infant mortality and train people on what they could do to prevent some of these deaths. Maaden Eshete, 26, a student at Morgan State University’s School of Community Health and Policy was one of the trainers at MAHS. “I am interested in maternal and child health; and as a full-time student who also works full-time, the flexibility to work on this during evenings and weekends was ideal,” Eshete said. “I signed up for the initial Preconception Peer Educators (PPE) training at Howard (University in Washington, DC) and

I have been involved ever since.” “I had a great team of PPEs to work with, and MAHS staff is committed to their students and made it as easy as possible for us to come in and do what we do,” continued Eshete. “The students, of course, were the best part – I couldn’t have asked for a better group of young people to interact with, teach and learn from.” Jamesia Durden, 21, a PPE and biology and Spanish premed major from Fisk University in Nashville, Tenn., became involved in the project because of her own experience: she was born as a premature baby. She says she sees her life as a way to reach out and help families that may be faced with similar situations, and she hopes to become a neonatologist. This project was a good experience: Durden says her experience with MAHS students was “phenomenal.” “The students were prepped very well for our arrival. They had prior knowledge of infant mortality and were able to engage in dialog with us, which not only allowed us to teach them but also allowed us to learn from them. “ She said students had creative ideas on how they were going to implement

projects in their school to raise awareness about infant mortality. “One idea that I especially liked was the idea of making a published story book that included stories of students who had personal accounts of infant mortality. I also viewed the photo album of young lady who lost a sister to infant mortality. This was very touching and even brought me to tears. This young lady made it to the health fair that was held on Saturday and I was able to exchange personal information with her in order to form a better relationship.” “This experience ignited a fire in me to not give up because the community is involved,” she said. “Most of all, the students were trained as PPEs and are now armed to go out into the community and spread positive health-related messages about helping to reduce infant mortality rates.”

Journal for Minority Medical Students 39

111700b.indd 39

4/27/11 2:59 PM

Health

Disparities An interview with disparities research pioneer

2.0

George A. Kaplan, PhD

fter looking at the CDC’s exhaustive report on health disparities, the Journal called George A. Kaplan, PhD, Chair of the new Network on Inequality, Complexity, and Health (NICH), which is part of the NIH’s Office of Behavioral and Social Sciences Research. NICH is an interdisciplinary leadership network of expert researchers who together will establish the feasibility, utility, and importance of applying complex systems approaches to health disparities and related aspects of population health. Kaplan, a social epidemiologist and professor emeritus at the University of Michigan’s Institute for Social Research, is one of the foremost researchers on the effects of socioeconomic status, neighbor-

hood, and community on health outcomes . JOURNAL: For years, we’ve had report after report on research confirming that health disparities don’t just exist, but are abundant. I know that this is a big question to start, but where do you think we need to go from here? KAPLAN: I think the basic problem now is that the study of health disparities—and by that I include lots of different kinds of disparities: race, ethnicity, socioeconomic position, geographical location, etc., which is why I actually prefer using the “inequalities” term—tries to reduce everything to single causes. And yet we know that inequalities in society are generated by a

Dr. George A. Kaplan

whole set of processes that have to do with landscapes of opportunity. People’s careers influence health outcomes. People’s education influences health outcomes. Discrimination influences health outcomes. So these things—and more— are critical to understanding health disparities. To the extent that we try and reduce it to one thing or another, which I think is the dominant strategy that most researchers use, we really miss the forest for the trees. What we’re doing is trying to move away from that sort of very reductionist view of health disparities. Our group is

40 Journal for Minority Medical Students

111700b.indd 40

4/27/11 2:59 PM

focused on trying to take a more realistic view of what generates health disparities and how we can reduce them by bringing in people from a lot of different disciplines: computer science, engineering, epidemiology, law, public policy, economics, child development, sociology, and biology. These are people who are used to thinking about complex systems. So we’re trying to take a systems approach, not just metaphorically, but actually building computer models of what generates inequality. JOURNAL: What does this type of approach bring to the field? KAPLAN: The truth is, we’ve been able to describe a lot about health disparities and health inequalities, but we know less about how all these factors come together, and whether intervening at point A or point B leads to the same consequences or better consequences in one case or the other. That’s what we’re going to do. JOURNAL: Why do you think this is important? KAPLAN: When people think about health, they basically think that health is either about going to the doctor or about individual behavior. Or of course now, they’ve been brainwashed into thinking it’s about genes. This leads to a very simplistic way of thinking about how you fix inequality. They don’t think about education. They don’t think about neighborhoods. They don’t think about taxpolicy, marketing, the agricultural bill. JOURNAL: So what are your goals with your new program? KAPLAN: Our goal isn’t to come up with any grand model that explains everything; I can assure you that we won’t. But we’re hoping that we can model the use of thinking more broadly and deeply about the causes of inequality and what can

be done about them, and then actually developing some tools people can use. For example, if somebody, either in academia or in the community, believed that there was going to be a change in school boundaries, maybe they could go to a website and get a sense about what that might mean in terms of health outcomes later on. In effect, what we’re doing is an academically based Simm City–like kind of modeling, where we’re creating a virtual world that has many of the great characteristics of the world we all live in, and trying to explore how inequality is produced. Now, for people who are saying, “We already know enough, we ought to do this and we ought to do that,” I think it’s fine. I’m not about to stop anybody from doing any of that. This is just an attempt to move the agenda forward in an additional, science-based direction. The nice thing about it is that there are lots and lots of opportunities, if get what we hope we get, for asking policy questions as well, “what if” questions. JOURNAL: How do you think the new health care reform law addresses—or is not addressing—the issue of health disparities? KAPLAN: Like many people, I think it does something, but not nearly enough. I just picked up the newspaper this morning and read that something like 35 governors from 35 states are comfortable with cutting Medicaid. And that’s already on top of cuts that are being made in education. The social safety net is being cut in many ways. JOURNAL: How have you seen the dialogue shift regarding health disparities? Are you more optimistic now than when you started? KAPLAN: I think in terms of the science and in terms of the translation of some

of the ideas in the scientific literature about how inequalities are produced and maintained, there’s actually been a lot of progress. If you look at the rate of publication on things like discrimination and poverty and health, it’s gone up exponentially. But the problem is that it’s still been difficult— often impossible—to introduce these issues into policy for a variety of reasons. One is that there are strong interest groups that are opposed to it. Two, there are political interests that are opposed to it, because of the legacy of the notion that everything that happens to you is based on your own actions. And three, studying social determinants of health and how they’re related to inequalities and disparities in health really involves breaking through institutional and academic silos that separate people studying one thing from another and in terms of funding programs. Finally, there’s just more education out there. People understand the factors involved hit when for example, people lose their homes or are laid off from work, or can’t find work, that contributes to immediate social and economic distress. They are contributing to generational costs, and some of those costs are likely to be health costs. JOURNAL: If the access issue could be solved through universal health care or something similar, do you think that would stop the bleeding, so we could look at these other things in a less charged environment? KAPLAN: I don’t think it should be “if, then.” There is absolutely no justification, in my mind, for the pathetic fact of people not having access and being underserved in so many ways. That just is not acceptable. In my belief, health care is something that ought to be a right that comes with participation in society. But,

Journal for Minority Medical Students 41

111700b.indd 41

4/27/11 2:59 PM

you know, the metaphor that you stop the bleeding is a good one because, for the most part, medicine is dealing with consequences, not causes. We always have to ask: What caused the bleeding in the place and whether it was literally bleeding that came from a knife, based on violence, or whether it was not being able to fully participate in society. We have to move upstream and ask what’s causing that, and then, what we can do about that. If we provide a high standard of quality of care to everyone, will it eliminate health inequalities? Certainly not. Would it reduce them? Yes. Would it also reduce some of the costs—personal and health-wise—of those inequalities and disparities.

JOURNAL: What advice would you give to our readers about how they can be a part of the solution? KAPLAN: The first thing I would say is that they don’t have to carry the whole load. They shouldn’t be the only ones that are responsible for reducing inequality, which is often the burden that people of color carry in professional venues. That’s certainly not fair, and it’s also not effective. It’s too small of a group. On the other hand, whether they grew up rich or poor, and whether they experienced extraordinary levels of discrimination or not, they will bring important perspectives to what have been predominantly white institutions, and that’s extremely important; those perspectives need to be heard.

Despite the founding of the U.S. on the backs of slaves, I actually believe that there really is a fundamental way in which people in this country really are interested in reducing inequality. Despite all the Tea Party/Glenn Beck nonsense, I don’t really think that’s where the core of our society lies. The struggle, in medical care and everywhere else, is to tap into the better aspects of people, rather than the meaner aspects. I think young people have more of a willingness to try that, rather than just dismissing everybody and having an “us versus them” society. I hope they’ll fight the good fight.

42 Journal for Minority Medical Students

111700b.indd 42

4/27/11 2:59 PM

Health Disparities

Roundup

Dr. Wayne J. Riley

Meharry President Heads National Panel on Health Dr. Wayne J. Riley, president and CEO of Meharry Medical College, has been named chairman of the National Advisory Council on Minority Health and Health Disparities of the National Institutes of Health. In the position, effective this month, Riley will serve as a liaison and national spokesman on issues of

minority health and health disparities. He will help Dr. John Ruffin, director of the National Institute on Minority Health and Health Disparities, in facilitating meetings of the advisory council and, when necessary, serve as a conduit between Ruffin and the council. The National Advisory Council on Minority Health and Health Disparities (NIMHD) is an advisory body appointed by the U.S. Secretary of Health and Human Services that advises the director of the NIMHD, the National Institutes of Health (NIH) director, and the Secretary on the nationâ&#x20AC;&#x2122;s minority health and health disparity research funding, priorities, and programs. Riley is the 10th president of Meharry Medical and is a recognized expert in health care management and health policy. He also chairs the Association of Minority Health Professions Schools.

problem of health disparities and lack of preventive and primary care in the U.S. are issues that must be addressed, former U.S. Surgeon General David Satcher said in February, 2011, while speaking at Georgia Health Sciences University as part of its commemoration of Black History Month. Now the head of Satcher Health Leadership Institute at Morehouse School of Medicine, Satcher pointed out that the U.S. spends more than any other country on health care yet fares worse in health outcomesâ&#x20AC;&#x201D;37th, according to the World Health Organization, and 49th in life

Former Surgeon General David Satcher on Health Disparities Regardless of your opinion on the current health care reform law, the Dr. David Satcher

Journal for Minority Medical Students 43

111700b.indd 43

4/27/11 2:59 PM

expectancy at birth in 2010, according to the CIA World Factbook. “It’s very clear that we have a problem,” he said. “Countries that focus on primary care have better health outcomes than we do.” “I think we all must agree that we need to make some major changes in our health system in terms of its access, in terms of its quality, in terms of its costs,” Satcher continued. “How we spend our dollars for health and health care in this country needs to be examined very closely.” The current system allows health disparities to persist such that a black baby is two-and-a-half times more likely than a white baby to die before turning one, and black men are twice as likely to die of prostate cancer and have a 30 percent higher death rate from cardiovascular disease, he said. “Disparities are real, and they show up in life-and-death statistics,” Satcher said. He also stated that system must be made more accessible and affordable, especially through an emphasis on primary and preventive care, and it must ensure a diversity of providers. As Surgeon General in 2001, Satcher declared there was an “epidemic of overweight and obesity in America” after seeing the rates since 1980 triple for children and double for adults. Those who are taking action and speaking out, such as First Lady Michelle Obama, should be applauded, he said. “To hear her talk about this from a parent’s perspective, it’s not easy for parents to deal with this issue, especially working parents,” Satcher said. He also commended companies such as Wal-Mart for working with

Obama by agreeing to make more affordable healthy food available at its stores. “We need industry,” Satcher said. “Industry has made a lot of money on the bad eating habits of the American people. But industry can also be a force for change. The good news is those companies are trying to find a way to be more responsible.”

Equal access may cut some health disparities, says recent study. Racial and economic disparities in the U.S. health care system may come down to access to medical care, hints a new report on appendicitis. “Our study showed that in a system with equal access to care, the previously shown socioeconomic disparities in appendicitis outcomes are eliminated,” Dr. Steven L. Lee and colleagues from Kaiser Permanente in Los Angeles write in the Archives of Surgery. “This report should be useful to health care policymakers in their work to close the existing racial/ethnic and socioeconomic health disparity gap.” During appendicitis, the inflamed appendix sometimes bursts when it isn’t removed in time, and so researchers have used ruptures as a proxy for how much access people have to surgical care. For their study, the researchers looked at data on more than 16,000 appendicitis patients at Kaiser Permanente hospitals in southern California.

All members of the managed care organization have the same access to medical care, which makes it possible to tease out the role of race and income level in appendix ruptures. Overall, whites had the highest rupture rates at 32 percent, while Hispanics had the lowest at 24 percent. After taking into account income and education, there was no difference between blacks, whites and Asians in rupture rates, however. Blacks did seem to stay at least half a day longer at the hospital than other groups, though , suggesting cultural differences that health policy won’t easily change, according to the researchers. People from neighborhoods with different income levels — less than $40,000, $40,000 to $65,000, and more than $65,000 — fared the same, both in terms of rupture rates and hospital stay. A commentary in the journal points out that those income brackets might not be sufficiently fine-grained to reveal potential disparities, and that people in southern California might not be representative of the whole country. Still, notes Dr. John H. T. Waldhausen, “If further study substantiates the findings, this will add evidence that universal coverage and health care reform are not only beneficial for society but may also be associated with health care cost savings by dealing with illness early in its course rather than later when it has become more difficult, complex, and costly to treat.”

44 Journal for Minority Medical Students

111700b.indd 44

4/27/11 2:59 PM

Diary of a First-Year Med Student by Amber Robins, MS1 University of Rochester School of Medicine May 8, 2010

August 9, 2010

My name is Amber Robins and I just graduated from Xavier University today! These last four years have just flown by. I can’t believe I actually did it! It’s bittersweet for me though. I know that my life is about to change forever. In just a few months, I will be moving to New York, to start medical school at University of Rochester School of Medicine. This is a big change for me. I cannot believe that I’m actually about to live my dreams. At just six years old, I knew being a physician was what I was made to do. Much of my inspiration came from my dad’s life-changing experiences with a spinal cord injury. Every step of the way he had very supportive, caring physicians with him. Seeing how doctors interacted with my dad truly made me think that being a physician was the greatest career ever. Oh my goodness, I’m actually going to be a doctor! There are so many things that need to be done before I start school. I have to find an apartment, ship my car from Louisiana to New York, pack all my clothes, and so many other things. Wait! Let me take a breath. I know that right now it’s very important to enjoy my time before medical school, and the fact that I actually just graduated. Although this summer may be busy, I will make sure I enjoy every moment.

Last night I woke up multiple times because I was very anxious about my first day of medical school. I am somewhat uncomfortable because I know I will be meeting people for the first time and will be with them for the next four years of my life. It’s really hard leaving college where I found incredible friends to go to a place where I basically know no one. I know my experience will be different

Dear Journal,

be my only challenge though. I already know that adjusting to New York will be very interesting as well. I am originally from Louisiana where it is fairly hot all the time. We’ve never really had snow. In New York, I’ve heard that they always have snow in the winter. I’ve never seen a huge amount of snow before or even thought about driving in it. I hope I like it. All in all, I just hope everything works out because I am really out of my comfort zone. I know the material in medical school will be challenging, and of course that’s a concern, but I can do little about that now. I’ll just have to adjust along the way like all the other medical students before me have done. I know I’m here in medical school and Rochester, New York, for a reason. Let medical school begin! August 22, 2010

Dear Journal,

than undergrad. It’s still hard for me to believe that undergrad is over and now I’m starting medical school a few months later. I know that coming from an HBCU (Historically Black College and University) to a majority school will truly be an adjustment. This won’t

Last week was very interesting for me. I took my first med school test. I didn’t do as well as I had thought. I expected to get a similar grade as I did in undergrad, but that definitely was not the case. I’m just used to making one of the highest grades in the class like I did in undergrad. Now, I am just glad that I passed the test! I have to keep remembering that I’m not in college anymore. Things will be different and more challenging now that I’m in medical school. I am so glad that I spoke with one of my closest friends today about my

Journal for Minority Medical Students 45

111700b.indd 45

4/27/11 2:59 PM

Diary of a First Year Med Student test. He told me that when he began graduate school he had the same issues. He didn’t score as high as he did in college, but after some time he did much better. He eventually adjusted to his new environment. I hope that’s the case for me. The great thing is that at least I know it’s not just me who has had issues with adjusting. I hope I can get things together. I keep trying to remember that P=MD (Pass=Medical Degree). September 6, 2010

Dear Journal, Yesterday one of my family members was having some issues. She called me and was crying. I didn’t know what to do. I felt so helpless because I couldn’t do anything because I was so far away. It wasn’t a good feeling at all. However, the situation made me think about some things. Prior to medical dchool, I was always the go-to person. Everyone knew that if they had a problem, I was just a phone call away. Unfortunately, I understand that may have to change now. I can’t always be there for people as I was before. It’s not that I don’t want to be supportive of friends and family. I just know that it has to happen in a different way. Most days, I’m at school from 8am-5pm, and when I come home I have to study until I go to bed. I’m realizing more and more that sleep is very valuable. So what do I do? How will I be able to still be there for others while balancing medical school as well? I actually asked a third year how she does it. She said that she had to just be able to study first and at the end

of the night make her personal calls and emails. However, if a call is very important she has to be able to be fine with sacrificing some study time. At first, this sounded so harsh, but I think it makes some sense. I’ll try it out and will see how it goes. March 6, 2011

Dear Journal,

I’ve heard when times get hard in medical school that it’s good to think about why I chose to be in medicine. I think that would especially be a good idea right now as I study tirelessly for my final in Genetics, Embryology, and Biochemistry. When I first dreamed about being part of the medical field as a little girl, I saw it as a way to intimately touch others’ lives. My view was untainted by politics, egos, or personal gain and would have no bearing on a patient’s treatment. It was simply based on the concept that a physician is given the privilege of having a detailed glimpse into someone’s life. This is done in order to help her reach her full potential regarding her mental and physical health. Even if a physician only sees a patient for one 15-minute session, both patient and doctor can learn lessons that could change their whole perception of life forever. Right now as a first year, I’m in a course where I see patients of all ages and conditions. I take their histories, do physical examinations, and present this information to a supervising physician. During this course, I regained my appreciation for medicine. This was true with all of my patients, no matter what

their socioeconomic status. In many instances, I was honored to be able to talk with individuals, learn their stories, see them as unique people, and try to assess what I could do for them as a future physician. I tried my best to put smiles on their faces knowing that all of them were struggling with very difficult situations. My patients included a woman who was a retired snow plower, a stay-at-home mom who took care of an ex-husband with dementia, a multi-million-dollar retired business owner, a young man who was a recovering heroin addict, and many others from various backgrounds. With all of these patients, I found something very inspirational to take away: each is a meaningful person and the world is more enriched because of his or her presence. I truly have learned to embrace, yet again, the importance of a doctorpatient relationship. My patients are healers for me, and I hope with the knowledge and experience I gain that I can be the same for them. This will lead to a continual growth in me as a person and will overflow into the treatment of my patients. I have learned much about myself and that my view of medicine as a young girl is still the true core of our medical field. Though at times individuals may try to taint its true meaning, medicine will forever be a field of healing through the hope that is grown in each and every physician-patient relationship. I’m glad I reflected on why I chose medicine as a career. It makes learning all of things in medical school much easier and more worthwhile.

-Amber 46 Journal for Minority Medical Students

111700b.indd 46

4/27/11 2:59 PM

ERAS Network

RESIDENCY TRAININg AND OPPORTuNITIES

PEDIATRICS

PHYSICAL MEDICINE AND REHABILITATION

CINCINNATI CHILDREN’S HOSPITAL MEDICAL CENTER

REHABILITATION INSTITuTE OF CHICAgO/NORTHWESTERN uNIVERSITY MEDICAL SCHOOL

Cincinnati, OH

Cincinnati Children’s is a national leader in pediatrics. As a major academic pediatric medical center, we attract patients from all over the world, conduct pioneering medical research and offer outstanding teaching programs. We work closely with community-based caregivers. Our vision is to be the leader in improving child health and in preparing tomorrow’s pediatricians. We’re proud to be ranked third in National Institutes of Health funding to children’s hospital and pediatric departments nationwide. In addition, US News & World Report consistently ranks the Department of Pediatrics as one of the top four pediatric departments in the country. Running the Numbers Number of beds 413 Annual admissions, including short stays 20,574 Radiologic procedures 151,595 Outpatient visits (includes satellites) 583,785 Emergency department visits 84,486 Surgical procedures (impatient and outpatients) 23,759 Critical care admissions (cardiac, ICU, NICU) 2,142 Interactive Team Care Each ward team is made up of four PL-1s, with primary responsibility for patients on their ward and a PL-2 or PL-3 supervisor. Each team also includes a faculty member who makes rounds and plays an integral role in teaching. These teams cover wards that admit primary pediatric and subspecialty patients of all ages. Please contact us or visit our website: Pediatric Residency Training Program Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue, ML 5018 Cincinnati, Ohio 45229 513-636-4315 • www.cincinnatichildrens.org INTERNAL MEDICINE

BRIgHAM & WOMEN’S HOSPITAL Boston, MA

The Internal Medicine program at Brigham & Women’s Hospital is a national leader in clinical training and research. As a major academic medical center, we are at the forefront of medical research and innovative curricular development. We draw patients from a large international referral base as well as our large local diverse population, and we are the second largest provider of free medical care in the state of Massachusetts. Our vision is to promote healthcare and health equality throughout the region, and we are dedicated to recruiting, training and retaining a housestaff and faculty that reflect the diversity of our patient population. We will be accepting applicants to our categorical medicine, primary care medicine, combined medicine/pediatrics and preliminary medicine programs. Key Hospital Information: Number of beds: 777 Inpatient Admissions: Over 45,600/annually Ambulatory Visits: 773,000/annually Emergency Department Visits: Approximately 58,000/annually Contact: Nora Y. Osman, MD Assistant Program Director Office of Minority Affairs bwhresinfo@partners.org 617/732-5775 www.brighamandwomens.org/residency

111700b.indd 47

Chicago, Il

Providing medical care to this nation’s estimated 40 million physically disabled citizens is a responsibility that often falls to the physiatrist—the physician specializing in the field of physical medicine and rehabilitation. Patients commonly seen by physiatrists include children and adults who have disabilities such as hemiplegia; paraplegia; quadriplegia; amputations; arthritis; fractures; pulmonary, vascular or neuromuscular diseases; and other less disabling conditions. The Department of Physical Medicine and Rehabilitation at Northwestern University Medical School offers a program of interdisciplinary studies centered at the Rehabilitation Institute of Chicago (RIC), with associations at Veterans Administration Westside Medical Center, Northwestern Memorial, Children’s Memorial, Evanston Hospital, Illinois Masonic Medical Center and Alexian Brothers Hospitals. With more than three decades of experience in the field, RIC is dedicated to excellence in research, education and providing comprehensive care programs to the physically disabled. A 176-bed private, nonprofit freestanding facility, RIC was named top rehabilitation hospital in the country by US News & World Report for fourteen years in a row.

Information: Office of GME Northwestern University Medical School 645 N. Michigan Avenue Suite 1058-A Chicago, IL 60611 312-503-7975 kku935@northwestern.edu Contact: James Sliwa, DO Residency Program Director Rehabilitation Institute of Chicago 345 E. Superior St. Chicago, IL 60611 www.northwestern.edu/pmr rbailey@ric.org Applications: Electronic Residency Application System (ERAS) erashelp@aamc.org www.aamc.org/eras 202-828-0413 202-828-1125

Journal for Minority Medical Students 47 Journal for Minority Medical Students 53

4/27/11 2:59 PM

A dv e rt i s e r ’ s Ind e x

American Academy of Family Physicians . . . . . . . . . 4 American Academy of Orthopaedic Surgeons . . . . . 5

he UCLA Intercampus postdoctoral research and clinical training programs in Medical Genetics utilize the resources of its affiliated campuses and teaching hospitals to train academically oriented applicants with M. D., Ph.D., D.D.S. or equivalent degrees in a wide variety of clinical and/ or research opportunities in molecular, biochemical, immuno-, cancer, cyto-, somatic cell, and population genetics. Five-year combined Pediatric/ Medical Genetics residencies are also available at each of the affiliated hospitals and applications are accepted through ERAS. These programs meet all the requirements of the American Board of Medical Genetics and Accreditation Council for Graduate Medical Education (RRC).

Application forms are available from: Patricia Kearney Coord. Academic Affairs Medical Genetics Institute Cedars-Sinai Med Ctr 8700 Beverly Blvd West Tower 665 Los Angeles, CA 90048 www.uclamedgeneticspostdoc.org

111700b.indd 48

American Academy of Pediatrics . . . . . . . . . . . . . . 8 Association of Accredited Naturopathic Medical Colleges 16 Cedars-Sinai Medical Center . . . . . . . . . . . . . . . . 48 Continuum Health Partners . . . . . . . . . . . . . . . . . . 12 Harvard Medical School . . . . . . . . . . . . . . . . . . . 10 Johns Hopkins Medicine . . . . . . . . . . . . . . . . . . . 21 Kaiser Permanente . . . . . . . . . . . . . . . . . . . . . . . CV2 Michigan State University Kalamazoo . . . . . . . . . . . 8 Mount Sinai School of Medicine . . . . . . . . . . . . . . 28 National Health Service Corps . . . . . . . . . . . . . . CV4 North Shore Long Island Jewish Health System . . . . . 2 U.S. Navy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 UAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 University of Tennessee . . . . . . . . . . . . . . . . . . . CV3 Vanderbilt University . . . . . . . . . . . . . . . . . . . . . . 15 Wake Forest University School of Medicine . . . . . . . 18 R ESI D E N C Y Ind e x

Pediatrics Cincinnati Children’s Hospital Medical Center . . . . . . . . . 47 PHYSICAL MEDICINE & REHABILITATION Rehabilitation Institute of Chicago . . . . . . . . . . . . . . . . . . 47 internal medicine Brigham & Women’s Hospital . . . . . . . . . . . . . . . . . . . . 47

The Journal for Minority Medical Students is published quarterly by Spectrum Unlimited. Subscription rates: $20 per year. Back issues: $5. Copyright 2011 Spectrum Unlimited. No part of this publication may be reproduced without the consent of the publisher. The opinions expressed in this publication are those of the authors and do not necessarily reflect the view of the magazine managers or owners. The appearance of advertisements in the publication does not constitute endorsement of the product or company. SPECTRUM UNLIMITED • 1194-A Buckhead Crossing • Woodstock, GA 30189 • (770) 852-2671 • fax: (770) 924-4327 • JMMSmag@aol.com • www.minoritymedicalstudents.com

4/27/11 2:59 PM