Dr. Shani Muhammad is a board-certified family medicine physician who travels around the country speaking to residency programs about the importance of workforce diversity in healthcare. Below she discusses why this is essential in order to offer equitable, quality care for all.
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A diverse workforce in healthcare brings together people from a variety of different backgrounds to manage the changing landscape of the population of the United States. Diversity can and should be sought in gender and sexual identity, as well as sexual orientation, disabilities/abilities, geographical representation, age, language, and ethnic and racial makeup to accurately reflect the population being served.
A 2018 study published by the National Bureau for Economic Research showed that Black male patients are significantly more likely to agree to recommended health screenings and preventive services when offered by a Black male physician over one who is white or Asian. The significance of this study cannot be ignored. Black male patients have the lowest life expectancy of any other demographic.
Across a multitude of statistics – heart disease, colon cancer, breast cancer, infant mortality and peri-partum mortality, even when incidence of disease is lower – mortality rate is higher for Black patients. If the results of that study were to be seen in the clinical practice, it could reflect a 20 percent or more reduction in the gap in cardiovascular mortality between Black men and the rest of the population. It is reasonable to believe that the results of the Oakland study can be extrapolated to other marginalized groups.
Representation Matters
It’s not enough to just work towards cultural competence (one can never be fully competent, but can be working on moving towards it). It is important because representation matters. People have the right to feel that their health care provider understands and relates to them, their background and their unique life conditions that color their health. Being “othered” in a health care setting is another form of systemic racism, sexism, and homophobia/transphobia, etc.
There is an inherent stress that goes with being different, separate and stigmatized. Not to mention the not very distant and very real past history of the unlawful and unethical experimentation on black bodies for the advancement of science. Think Henrietta Lacks, Tuskegee and many more.
Given the history of mistrust and the sense of being othered, the very real data shows that black patients experience:
- Less pain medication
- Longer door to Cath lab times
- Less frequent DM surveillance (a1c, podiatry and ophthalmology referral)
- Less frequent screening for breast and cervical cancer
- Feeling not listened to
- Increased peri-partum mortality for Black women
…there is no wonder there is often a mistrust of the health care system by black patients.
Additional barriers to care for Black Americans
- Under 6% of physicians and surgeons are Black
- Black Neighborhoods are 67% LESS likely to have a primary care physician
- 2009 study showed that more African Americans living in a county correlated with fewer colorectal surgeons, gastroenterologists, and radiation oncologists
- Studies also show a connection between racial segregation and the quality of care a patient receives
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Building a diverse workforce means that patients with unique experiences related to their own social determinants of health are more likely to interact with a primary care physician who can relate to, understand or validate those experiences, which fosters a more trusting and collaborative partnership.
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