Cultural competency now law in New Jersey

Physicians who want to obtain a medical license or be relicensed in New Jersey must take cultural competency training under a new law intended to help reduce health care disparities among racial and ethnic minorities.

Legislators and medical leaders say they believe New Jersey is the first state to pass a law requiring physicians to learn how to be culturally attuned to patients to be licensed to practice medicine.

But Arizona, California, Illinois and New York are considering similar bills that call for physicians and medical students to take courses to raise cultural awareness and sensitivity toward minority patients, according to the Federation of State Medical Boards.

Leaders in both medicine and licensure say that the measures signal a trend that states want to take greater steps to reduce health care disparities and ensure that physicians are more responsive to both cultural and language differences among their patients.

"What all of this says is there is an appreciation that the population in our country is changing and evolving, and that means, as health care [practitioners], we have to change also to meet the needs of that population," said Dale Austin, chief operating officer and senior vice president of the Texas-based federation.

Cultural competency efforts

New Jersey Sen. Wayne R. Bryant said he had proposed legislation for cultural competency training as a first step in eliminating disparities in medical care among minority groups.

Under the new law, signed by Acting Gov. Richard J. Codey March 23, doctors must take cultural competency training before they can get medical licenses from the State Board of Medical Examiners. The approximately 30,000 physicians who already have a license will have to complete the training to renew their licenses.

The board will determine how much training the state will require and when doctors must begin complying with the law. At press time, the board was scheduled to meet this month to discuss details. Board spokesman Jeff Lamm said New Jersey physicians are relicensed every two years, and the law likely will not be enforced before the June 30 licensing deadline. He said the law likely would apply to the next licensing deadline, which is June 30, 2007.

"[The new law] has the potential of truly working. If nothing else, it will acutely raise the level of awareness that is needed for all of us," said Maria Soto-Greene, MD, chief of staff and vice president of the University of Medicine and Dentistry of New Jersey. "It has to be an entire system changing, not just a physician."

Arizona and New York have proposals to require medical schools to teach a course in cultural competency as a graduation requirement. Doctors in both states also would need to complete cultural competency course work as a condition of licensure.

"I'm not naïve enough to think it's going to cure the problem. I do think it is a beginning. The first step needs to be to show in a formal setting that these disparities do exist," said New York Assemblyman William Scarborough, who is sponsoring the bill there.

California addressed the issue through a voluntary program when it passed the Cultural and Linguistic Competency of Physicians Act of 2003. That law set up a program for physicians to learn a foreign language and cultural beliefs. But now, proposed legislation would make doctors complete a continuing education course in cultural and linguistic competency.

Anmol S. Mahal, MD, California Medical Assn. president-elect, said the CMA opposes the bill. "We feel continuing medical education is best left to the choice of the physician," said Dr. Mahal, a gastroenterologist in Fremont, Calif.

Physician leaders expect to see lawmakers in other states propose cultural competency bills. In the meantime, they say part of the problem with the current proposals is that they don't spell out completely what is required under the plans. For example, an Illinois Senate bill would create a voluntary program to teach foreign languages and cultural understanding to physicians, but it doesn't say how much the program would cost.

"[Cultural competency] is certainly something that we favor as a medical society," said William Kobler, MD, immediate past president of the Illinois State Medical Society and a family physician in Rockford, Ill. "But there is no source of funding for this."

Voluntary vs. mandatory training

Various medical groups have worked to promote culturally competent care as the population changes, and many reports highlight disparities in the health care of minorities.

The American Medical Association and National Medical Assn. are among the groups who teamed up to form the Commission to End Health Care Disparities. AMA policy supports enhancing the cultural competence of physicians, including assisting doctors in getting information on training opportunities.

Many medical society leaders approve of efforts to make physicians more culturally competent -- but they are more supportive of voluntary programs than mandatory ones. If some bills now being considered are passed, physicians will have no choice.

"You really don't teach people cultural competency in a classroom. You learn it in the lap of your grandmother," said S. Manzoor Abidi, MD, Medical Society of New Jersey president and a neurologist in Maple Shade, N.J. "We really oppose any mandatory-requirement bill."