Executive Summary

Thank you for this invitation to testify regarding the importance of workforce diversity in healthcare. My name is Anne Beal. I am a physician and a Senior Program Officer for the Commonwealth Fund. I commend Dr Sullivan for convening this special commission, and for bringing attention to the issue of diversity in the healthcare workforce. This is a critical time to develop a healthcare system that is responsive to, and reflects, the reality of American racial and ethnic diversity.

Racial disparities in clinical care and health outcomes are a well-described public health problem in the United States. While diversity in the health care workforce is a crucial mechanism for improving the health system's ability to care for minority patients, we should also pay attention to diversity among physician leaders.

Physician leaders develop health policies that influence regulation, financing and delivery of health care. In addition, those who serve as medical school faculty set research agendas, influence medical education, and serve as role models for the recruitment and retention of both minority and majority students. These physician leaders do more to address disparities than individually care for patients; they are in positions to address disparities by influencing healthcare training and health systems as a whole.

Academic Medicine

The Commonwealth Fund's commitment to eliminating disparities in health and healthcare is demonstrated through our program work, much of which is being conducted by minority medical faculty. The Fund recognizes that they contribute work that addresses disparities, while we contribute to the advancement of their careers.

For example:

• Nawal Nour, director of the African Women's Health Practice at Brigham and Women's Hospital in Boston, expert in treating women for conditions related to female circumcision, and recent recipient of a MacArthur "genius award".
• Dr. Lisa Cooper at Johns Hopkins works in the area of patient-physician communication and the role of racial concordance in those interactions. Her work was cited in the IOM's Unequal Treatment report, and served as a basis for recommendations to diversify the workforce.
• Dr. Leo Morales, who is based at UCLA and RAND, is studying the impact that access to interpreter services has on the health care experiences of Latino and Asian patients.
• Dr. Glenn Flores of the Medical College of Wisconsin was recently funded to conduct a randomized controlled trial to implement and evaluate a community-based intervention that could become a national model for improving the quality of asthma care for minority children.

All of these projects are being led by minority medical faculty, and they provide valuable contributions to our understanding of the prevalence of disparities and, more importantly, to the mechanisms by which they may be eliminated.

Health Policy

The Commonwealth Fund's single greatest contribution to promoting minority physician leadership is the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy. Several years ago, our president, Karen Davis, decided that she no longer wanted to attend high-level health policy meetings at which no minorities were "sitting at the table." Recognizing that there were no training programs to prepare healthcare professionals to enter public health and health policy leadership positions, the Fund's board of directors approved the establishment of the fellowship. Under the leadership of Dr. Joan Reede, Dean for Diversity and Community Partnership at Harvard Medical School, the fellowship was initiated in 1996.

The fellowship combines an intensive year of training in health policy, public health, and management with special programs focused on minority health issues. In addition, our fellows must also complete a practicum. Some of the topics have included

• creating legislative agendas to eliminate racial disparities in healthcare,
• evaluating services for minority victims of domestic violence, and
• defining and identifying medical translation errors.

At present, 35 alumni physician fellows are actively engaged as leaders in health policy, research, and service delivery to minority communities. Among our alumni are:

• Joseph Betancourt, senior scientist at the Institute for Health Policy at Massachusetts General Hospital;
• Dora Hughes, staff member of the Senate Committee on Health, Education, Labor and Pensions;
• Roderick King, director of the HRSA Boston Field Office;
• Yvette Roubideaux, assistant professor at the University of Arizona College of Public Health, and a current Commonwealth Fund grantee who recently convened a conference to discuss methods to assess quality-of-care among American Indians and Alaskan Natives.

As can be seen from the work of the physicians we have mentioned, they are addressing disparities in care at a level that can impact more patients than any one physician can serve. The potential contributions of future minority physician leaders will be critical to our ability to address disparities, and we must do all that is possible to support and promote their careers. Therefore, I would make the following recommendations:

• Establish enrichment programs for young students that start as early as elementary and middle school to attract minority students to the field of medicine.
• Leaders in academic medicine need to determine if they are asking young minority faculty to assume too many administrative responsibilities. The school's or hospitals' thirst for input from minority faculty undermines the faculty members' ability to advance as leaders.
• Academic medical centers need to launch a comprehensive strategic plan to increase the institution's emphasis on racial and ethnic minorities. The onus should not be placed on minority faculty to address cultural competency, workforce diversity, curriculum development, research in disparities and culturally sensitive communication skills. Instead, medical schools, hospitals and majority faculty need to take a proactive, leadership role to ensure the inclusion of minority health issues in all aspects of research and education.
• We need continued and adequate support for federal programs that encourage workforce diversity. While the "pipeline issues" are important, professional mentorship does not end with residency training. Continued and adequate funding of faculty development programs is important to help expand the number of minority students, physicians and physician leaders.

My remarks today have focused on physician leaders, however, diversification of the health care workforce must occur across the all health professions. Development of physician leadership is critical, but is only one important step toward providing more appropriate care to the US population. The Fund has a longstanding history of supporting projects to improve the health of minority Americans. We stand ready to partner with others to make a difference in eliminating racial and ethnic health disparities.

Related Resources
The Commonwealth Fund/Harvard University Fellowship in Minority Health Policy
Cultural Competence in Health Care Website
Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches, Joseph R. Betancourt et al., October 2002.
Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans, Karen Scott Collins, et al., March 2002.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, Institute of Medicine, 2002