Medical organizations attack disparities on many fronts

Working independently on some projects and collaboratively on others, organized medicine is putting its full force behind eliminating health care disparities among racial and ethnic minorities in the United States.

At both the leadership and grassroots levels, programs and studies are being undertaken to publicize the issue of disparities while seeking the best way to reduce and eventually eliminate them.

In one of the most recent efforts to highlight the issue, the American College of Physicians published a position paper on disparities this month in Annals of Internal Medicine.

Some of the paper's tenets: All patients deserve high-quality care; providing Americans with affordable insurance is a key to eliminating disparities; quality improvement projects should use race, ethnicity and language measures; a diverse work force is an important part of eliminating disparities; and public education is needed to target products that have a negative impact on minority health.

ACP activities aimed at eliminating disparities include publishing materials designed to help physician-patient communication, signing on to an amicus brief in support of the University of Michigan's consideration of an applicant's race in deciding admissions, and lobbying the Centers for Disease Control and Prevention to maintain its commitment to minority health issues.

ACP Health Policy Associate Rachel Groman said the ACP programs are a mix of leadership-directed activities originating from the Washington, D.C., office and grassroots movements coming out of state chapters in California and Texas.

Reducing disparities is now one of the ACP's top priorities, she said, adding that the group's new president, Charles Francis, MD, is paying much attention to the issue. The same is true of the AMA's new president, John C. Nelson, MD.

"My real interest is in quality improvement in health care," said Dr. Nelson, a Salt Lake City obstetrician-gynecologist. "It breaks my heart to know that people are not getting the quality of health care that they need."

These disparities are also contributing to the decline of the doctor-patient relationship, and Dr. Nelson said that needs to be addressed. "The cornerstone of American medicine is the patient-physician relationship," he said. "Any barriers that get in the way of this, I'm opposed to."

The AMA is engaged is several disparities-reducing activities. Dr. Nelson said that, in the short term, the most significant are those that draw attention to the existence of disparities and those that lead to evidence-based solutions to eliminate them.

He predicted that, in the long term, the AMA's efforts to bring minorities into the work force will have the most impact. These efforts include the Doctors Back to School program, in which minority physicians visit schools encouraging children to consider careers in medicine, and the Minority Scholars Awards, which recently issued its first round of 10 $10,000 medical school scholarships.

The ACP is also trying to help physicians better handle the expense of reducing language-based disparities by working to reform Medicare rules that require doctors to pay for translation services.

"We're trying to bring that to the nation's attention from a physician's standpoint," Groman said.

She added that research remains a key component of the ACP's efforts.

"Data collection is our biggest concern because we don't have enough, and the public needs to know why we're concerned," Groman said.

Much of the AMA's efforts will be connected to a 38-organization coalition that it is leading along with the National Medical Assn. and the National Hispanic Medical Assn.

"We need to understand what others are doing and see if, by working collaboratively with two or five or 10 groups, we can do more than one group," Dr. Nelson said.

Although this group will initially deal with clinical aspects of disparities, Dr. Nelson said it must eventually address poverty and illiteracy. In so doing, he predicted the group will expand. "We hope this will be a magnet to attract all sorts of groups. We're riding the crest of a big wave, and we hope that it will crash down and eliminate disparities."