When it comes to the hard work of narrowing health disparities in the United States, the heavy lifting is most often done by those at the front lines of medicine. Clinics that treat underserved populations, researchers with ideas about how to improve health care access, or hospitals that support such programs are the primary forces in the battle against disparities in cancer, HIV, diabetes and other diseases. But one potential heavyweight in addressing racial and ethnic health gaps has gone largely unnoticed: national physician organizations.
Groups such as the American Medical Association (AMA) and the American College of Physicians (ACP) boast tens of thousands of physicians on their membership rolls, and have the power to drive the agenda of the health care industry. Through position papers, political advocacy and continuing medical education courses, these organizations are well positioned to both draw attention to health disparities and organize efforts to narrow these gaps.
“There are a lot of things that physician organizations can do that individual physicians or patients or health systems can’t,” said Monica Peek, assistant professor of medicine. “Historically, national physician organizations have been able to harness their size and infrastructure to affect health policy and legislation, and to set national health agendas. For example, the American College of Physicians frequently comes out with position papers on a variety of health issues. These papers create a buzz within medicine and get physicians and other health professionals talking about the issue.”
However, nobody had ever done a comprehensive study of what these organizations are doing to address health disparities in the United States. Peek herself sits on the health disparities sub-committee of the Society for General Internal Medicine, which decided to look at the activities and efforts of their peer organizations. A simple idea soon bloomed into a complicated analysis, with more than six hundred organizations identified during the research team’s initial source.
“I was open-mouthed shocked at the number and variety of the organizations that we found,” Peek said. “I would never have guessed that even very sub-specialized medical fields would have national organizations from which to have a national voice about health and health care in this country.”
By limiting their study, published last month in Academic Medicine, to national organizations and groups that are predominantly made up of physicians instead of a mix of health care workers, the researchers cut that number to 167. From there, they looked at the websites of those organizations for information about activities addressing disparities, and interviewed representatives from a subset of those organizations. They found a wide range of activities, ranging from scholarships supporting minority physicians-in-training to patient education programs to political advocacy. But participation was not equal: while 22 percent of the organizations had at least five different disparities-related activities in progress, 32 percent had no efforts in place at all.
“We were surprised by a couple of things,” Peek said. “The first is that a third of the organizations aren’t doing anything at all. So that was sort of shocking. But the second thing we were surprised by is that some organizations are doing an awful lot, some of whom are unlikely characters. Some sub-specialties — like orthopedic medicine, for example — aren’t ones that you might imagine are committed to reducing health disparities, but they were just doing an amazing job. Which means that somebody in that organization decided it was important and provided leadership to make things happen.”
Generally, certain types of organizations — primary care groups, large organizations, or those with high minority membership — were more likely demonstrate a high number of health disparities activities. Unsurprisingly, organizations that had formed subcomittees on health disparities were also more likely to be actively involved in a broad range of efforts. But however obvious, Peek said those are the organizations that can best serve as models for less-engaged groups looking to begin their own health disparities programs.
“We view this study as being the first step in understanding the big picture about where we are nationally as physician organizations in addressing health disparities,” Peek said. “One important next step will be to drill down a bit and learn more about the external factors and environmental circumstances that facilitate organizational change to address health disparities.”
“Another important step down the road is to see where we are 5 to 10 years from now, and see if we’ve made any progress at increasing the depth and breadth of physician organizations committed to reducing disparities. We’re hoping that the paper stimulates national conversation and interest, and provides linkages and information for organizations who want to do the right thing but just haven’t known how to get started.”
Indeed, the study was accompanied in Academic Medicine by three editorials, including one authored by James Madara, CEO of the American Medical Association and former Dean of the University of Chicago Medical Center. In his article, Madara compares the fight against racial and ethnic health care disparities to other massive, collaborative scientific achievements, such as the race to the moon and the Large Hadron Collider.
“What was clear in those past examples, and what is clear in health care today, is that the status quo is not solving our big problems,” Madara writes. “It is equally clear that, even should we wish to (which we do not), we cannot rely on central regulatory action to solve them, given the persistent state of impasse in our government. Perhaps this impasse, although unfortunate, is the opportunity that will force us to act in the private sectors of health care to address our big problems.”