Leaderboard Ad

Segregation’s Impact on Parity in Healthcare

John M. Conley, MD Lecture on Medical Ethics
2:30 pm, Today
New Orleans Theater B

Historically, segregation has prevented equal access to healthcare, said Dana M. Thompson, MD, MS, Professor and Chair of Pediatric Otolaryngology at the Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine.

Dr. Thompson is delivering this year’s John Conley, MD Lecture on Medical Ethics on parity in otolaryngology. She took the time to answer some questions ahead of her speech, which is titled “Achieving Parity in Otolaryngology Care: Our Ethical Obligation beyond Care Access.”

What is health equity, and how has it been impacted by historically segregated healthcare?

Health equity is the attainment of the highest level of health for all people. To have health equity, people need full and equal access to opportunities that enable them to lead healthy lives. This means access to care, resources to maintain health, and culturally sensitive education on how to do so. Segregation, dating back to Jim Crow laws, prevented equal access to care and limited educational opportunities to train racially concordant physicians to care for segregated populations. The 1946 Hill-Burton Act, the 1964 Civil Rights Act, and the passage of Medicaid in 1965 have subsequently helped to lessen the gap in care access; however, other socioeconomic barriers to equitable access keep us from achieving full health equity. The 2010 Affordable Care Act is an effort to bring us closer to closing the gap.

Despite five decades of integration in medical education, the number of underrepresented minority (URM) physicians does not match their demographic share of the total population, and otolaryngology has one of the lowest representations of all specialties. This is important, as racially concordant physicians are more likely to care for minority patients, and minority patients are more likely to seek care from and trust a racially concordant physician. Increasing the number of URM physicians is an important effort toward health equity. Educating all physicians in culturally sensitive healthcare delivery is even more important in specialties such as otolaryngology, where achieving demographic parity of URM physicians to match the population is well into our future.

How do individual biases impact care?

Biases can subconsciously keep us from working with people who we perceive to be different than ourselves; because we have biases, we risk being insular and segregated in our mindset and approach to how we practice medicine, care for our patients, advance the science of otolaryngology, and educate the next generation of physicians. Our biases get in the way of our awareness of the need to study how diseases affect different groups of people, limiting how we advance science. Our biases get in the way of seeing the strength in a medical student or resident different than ourselves, thereby causing us to miss an opportunity to appropriately educate the next generation of diverse physicians.

Our biases get it the way of creating an integrated and functional diverse workforce. Diverse health teams are necessary given the challenges we face in twenty-first century healthcare delivery.

What’s the relationship between value-based medicine and health equity?

In value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives. The outcome requires a partnership between the physician and the patient. If we are anthro-culturally different than our patients and see our patients through the lens of our biases , we risk not understanding their values, expectations of their care, and their needs. This partnership is our ethical responsibility to our patients to help them live healthier lives and achieve health equity.