Initiatives by organized medicine to reduce health disparities lacking, study says

Public and private entities nationwide are tackling the complex challenge of reducing health disparities among racial and ethnic minorities, but many national physician associations and societies have little or no programs to address them.

A study of 167 such organizations found that 32% have no programs that target health disparities, and 21% have just one activity. The study did not list the specific groups included in the research, but said that most organizations evaluated had 1,000 or more members. Those most likely to have disparities-related efforts include primary care and minority physician organizations and those that have formed committees to address the issue, says a study in the June issue of Academic Medicine.

“The data suggest that although physician organizations are well positioned to work toward the reduction of disparities, they could be doing much more,” American Medical Association Executive Vice President and CEO James L. Madara, MD, wrote in an accompanying commentary.

Various factors contribute to health disparities, such as unequal access to quality care, poor communication and other aspects of the physician-patient relationship.

Monica Peek, MD, MPH, lead study author and assistant professor of medicine at the University of Chicago Pritzker School of Medicine, said she hopes the study will serve as a tool to measure future progress. "It's hard to move forward without having a pulse on where you are starting from," she says. "We're hoping that people use this as an opportunity to reflect not only on their own organization but where we are as a country." Photo courtesy of Dr. Peek

“It’s a pernicious problem that is plaguing our country,” said Monica Peek, MD, MPH, lead study author and assistant professor of medicine at the University of Chicago Pritzker School of Medicine. “It is unfortunate that half of physician organizations don’t have this on their radar. We know there is room at the table for all stakeholders to tackle this problem.”

Doctor organizations are uniquely positioned to compel change because they work with many of those stakeholders, including health professionals, policymakers, health systems and patients, she said.

How much a group is doing depends a lot on how much of a priority health disparities is to its leadership. For smaller organizations, it may be a matter of resources, while larger groups have more staff and money to invest, Dr. Peek said.

“There are a lot of important issues for organizations to think about. Unless you have someone championing [health disparities], it might not be” on their agenda, she said.

The study was prompted by the work of the Society of General Internal Medicine’s Disparities Task Force, which wanted to investigate what other physician organizations were doing on the issue, said Dr. Peek, who co-chairs the task force.

The study said only 24% had health disparities committees. Twenty-five percent had two to five disparities-related activities, and 22% had six or more.

Some issues most commonly addressed by such activities included access to care, work force disparities and language barriers.

Apologizing for the past

The study said organized medicine historically contributed to the problem by fostering racial and ethnic bias in medical care. The American Medical Association, for example, excluded black physicians from becoming members for many years, noted National Medical Assn. President Cedric M. Bright, MD, in a commentary accompanying the study.

“The AMA failed, across the span of a century, to live up to the high standards that define the noble profession of medicine,” wrote AMA Past President Ronald M. Davis, MD, in a July 16, 2008 article in The Journal of the American Medical Association. The AMA selectively enforced membership standards to exclude black physicians, and — as recently as the 1960s — failed to take action against affiliated state medical associations that openly excluded doctors on the basis of their race or ethnicity, Dr. Davis wrote.

The AMA has since adopted multiple policies related to nondiscrimination and has several initiatives aimed at eliminating disparities, including its Minority Affairs Section. In 2004, the AMA, NMA and National Hispanic Medical Assn. formed the Commission to End Health Care Disparities, which has since expanded to a coalition of more than 60 professional organizations working to eliminate disparities in health care, Dr. Bright said.

“I believe that physician organizations have a golden opportunity to flex our muscles to address social injustice,” he wrote. “We have the opportunity to change the paradigm of medicine from being a reactive industry to becoming a proactive industry.”

The study provides a baseline for physician organizations to measure future progress, the Assn. of American Medical Colleges said in its accompanying commentary. Stakeholders need to work together toward a collective solution. “We can magnify the influence of our efforts by evaluating what works and sharing best practices,” the AAMC said.

Dr. Peek said she hopes the study serves as a rallying cry for physician organizations, which have an important role to play in addressing health disparities.

“We have a past where physicians and physician organizations have actually done things to contribute to health disparities, but that is behind us,” she said. “It is time to move forward.”