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Fourth National Conference on
Quality Health Care for Culturally Diverse Populations:
Integrating Community Needs into the National Health Agenda

September 28-October 1, 2004, Washington, DC
Hilton Washington, Washington DC

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Workshop A-5: Improving the diversity of the healthcare workforce: from supply to demand

Health Care’s Compelling Interest: Ensuring Diversity In Its Workforce

The United States is rapidly becoming a more diverse nation, as demonstrated by the fact that non-white racial and ethnic groups will constitute a majority of the American population later in this century. The representation of many of these groups (e.g., African Americans, Hispanics, and Native Americans) within health professions, however, is far below their representation in the general population. Increasing racial and ethnic diversity among health professionals is important because evidence indicates that diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health professions students, among many other benefits.
Many groups--including health professions educational institutions (HPEIs), private foundations, and state and federal government agencies--have worked to increase the preparation and motivation of underrepresented minority (URM) students to enter health professions careers. Less attention, however, has been focused on strategies to reduce institutional- and policy-level barriers to URM participation in health professions training.

HPEIs can improve admissions policies and reduce barriers to URM admission by developing a clear statement of mission that recognizes the value of diversity in health professions education. Admissions policies should be based on a comprehensive review of each applicant, including an assessment of applicants’ attributes that best support the mission of the institution (e.g., background, experience, multi-lingual abilities). Admissions models should balance quantitative data (i.e., prior grades and standardized test scores) with these qualitative characteristics.

The federal Health Resources and Services Administration (HRSA) is a major funder of health professions training that seeks to improve the quality and availability of diverse health professionals through an array of programs. These health professions programs should be evaluated to assess their effectiveness in increasing the numbers of URM students enrolling and graduating from HPEIs, and Congress should provide increased funding for programs shown to be effective in enhancing diversity. State and local entities should increase support for diversity efforts through programs such as loan forgiveness, tuition reimbursement, loan repayment, and other efforts. In addition, private entities should be encouraged to collaborate through business partnerships with HPEIs to support the goal of developing a more diverse health-care workforce.

The U.S. Department of Education should strongly encourage accreditation bodies to be more aggressive in formulating and enforcing standards that result in a critical mass of URMs throughout the health professions. In addition, health professions education accreditation bodies should develop explicit policies articulating the value and importance of diversity among health professionals, and monitor the progress of member institutions toward achieving these goals.
HPEIs should develop and regularly evaluate comprehensive strategies to improve the institutional climate for diversity. As part of this process, HPEIs should proactively and regularly engage and train students, house staff, and faculty regarding institutional diversity-related policies and expectations and the importance of diversity to the long-term institutional mission. HPEI governing bodies should develop institutional objectives consistent with community benefit principles that support the goal of increasing health-care workforce diversity, including efforts to ease financial and non-financial obstacles to URM participation, increase involvement of diverse local stakeholders in key decision-making processes, and undertake initiatives that are responsive to local, regional and societal imperatives. These objectives are best assessed and enforced via the accreditation process.

Brian D. Smedley, PhD is Project Director, The Opportunity Agenda, a think tank devoted to improving public debate on issues of opportunity and human rights. Formerly, Smedley served as Senior Program Officer in the Division of Health Sciences Policy of the Institute of Medicine (IOM), where served as Study Director for the IOM reports, In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce and Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Previously, Smedley served as Study Director for the IOM reports, Promoting Health: Intervention Strategies from Social and Behavioral Research; The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions; and The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. Smedley came to the IOM from the American Psychological Association, where he worked on a wide range of social, health, and education policy topics in his capacity as Director for Public Interest Policy. Prior to working at the APA, Smedley served as a Congressional Science Fellow in the office of Rep. Robert C. Scott (D-VA), sponsored by the American Association for the Advancement of Science, and as a postdoctoral research fellow in the Education Policy Division of the Educational Testing Service in Princeton, N.J. Among his awards and distinctions, in 2004 Smedley was honored by the Rainbow/PUSH coalition as a “Health Trailblazer” award winner; in 2003 and 2000 he was awarded the National Academy of Sciences’ Individual Staff Award for Distinguished Service; he was awarded the Congressional Black Caucus “Healthcare Hero” award in April, 2002; and in August, 2002, was awarded the Early Career Award for Distinguished Contributions to Psychology in the Public Interest by the American Psychological Association.

 

The White Memorial Medical Center Family Practice Residency Pipeline: Preparing Physicians for Underserved Communities

This presentation will describe the unique Family Practice Residency Program at White Memorial Medical Center in East Los Angeles, which emphasizes training excellent physicians to provide culturally responsive care to underserved patients. We will begin with an overview of the history of our program, emphasizing our initial needs assessment conducted in East L. A. over 13 years ago. Our presentation will emphasize how recruitment of future physicians begins with community links between our physicians and school children, and we will underscore our notable success in recruiting minority physicians generally, and Latino/a physicians more specifically. The presentation will emphasize the importance of this work in light of racial disparities in health access and outcomes in this country, as well as the IOM Report cited need for health providers from underrepresented minority groups.

Biographical Sketches

Born in Mexico, Dr. Flores was raised in southern California since the age of eight years old. He attended Sierra High School in Whittier, California and graduated from Stanford University with a B.A. in History in June 1977. He is Co-Director of the Family Practice Residency Program at White Memorial Medical Center in Los Angeles.

Dr. Flores graduated with honors from the UC Davis School of Medicine in 1981 and completed his internship and residency in Family Practice at the Kaiser Permanente Medical Center, Los Angeles. Dr. Flores has previously served on the Clinton Health Care Task Force Hispanic Advisory Committee and was a member of the National Advisory Council (NAC) of the National Health Service Corps. He also has served on the University of California (UC) Medical Student Diversity Task Force advising the UC on effective ways to recruit and retain students from disadvantaged backgrounds and from ethnic groups known to be under-represented in medicine.

Dr. Jeffrey Ring is a bilingual (Spanish and English) clinical psychologist and serves as the Director of Behavioral Sciences at the Family Practice Residency Program at White Memorial Medical Center in East L.A. He completed his undergraduate education at U.C. Berkeley and went on to complete a doctorate degree in clinical and community psychology at Boston University. In addition, Dr. Ring completed a fellowship in minority and community psychology with an emphasis on Latino/a mental health at the School of Medicine at the University of California at San Francisco.

Dr Ring has been working in the area of culturally responsive health and mental health for over a decade, with a number of published articles and international lectures and presentations. Most recently, he published a self-reflective article on the provision of culturally responsive care from a white, male perspective in the American Journal of Orthopsychiatry. Dr. Ring also serves as co-chair of the Group on Minority Health and Multicultural Education in the Society of Teachers of Family Medicine, and is a Fellow of the American Psychological Association. He lives in Burbank, California with his wife and twin sons.

Hector Flores, M.D.
Residency Co-Director
&
Jeffrey M. Ring, Ph.D.

Director of Behavioral Sciences
White Memorial Medical Center
Family Practice Residency Program
1720 East Cesar E. Chavez Avenue
Los Angeles, CA 90033
(323) 260-5789
(323) 881-8641 fax

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    Fourth National Conference is presented by
State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations
    As with the rest of Diversity Rx, this section is a work in progress and we welcome information on other efforts, programs, and reports that will expand upon the information offered here. Please let us know if you have other examples to include here.
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