The issues around race and how it plays out in modern day American society are numerous, deeply personal to many and utterly complex to most. The incidents in Ferguson, Mo., which began in August and erupted late November in nationwide protests, are an example of the many problems with race relations that persist in our country. While I believe we have made significant progress since the civil rights movement began, we clearly have a long way to go.
In PA school, I was taught to avoid using the phrase “I know what you are going through” when counseling a patient. As a medical provider, and more importantly a fellow human being, it is a phrase that accurately represents my desire to connect with patients.Unfortunately, most of the time, it is a meaningless expression. Rarely do I have intimate knowledge of what my patients and their families are going through. It is in this same manner that I so badly want to relate to the people of Ferguson. I want to say I understand. But that would be a lie.
I want to understand what happened on that fateful day in August. I want to understand the grand jury deliberations, and the violence and destruction that followed. I am in no position to judge the events in Ferguson, but with all that I lack in understanding, there is one clear fact I wholeheartedly appreciate — racial inequality continues to tear at the moral fabric of our country. That inequality exists in every aspect of our nation. Sadly, this holds true in patient care, and the demographics of the clinicians who provide it.
We lack diversity at the institutions where we teach the art of medicine, and health care disparities are rampant in communities where we have the privilege of practicing. Just over 13 percent of the population in the United States is black. But only 4.5 percent of PA graduates were black in 2012. Therefore, not surprisingly, only 5.6 percent of faculty is black. (For comparison, 6.9 percent of medical school students were black in 2013 — still unacceptably low.)
A 2008 study published in JAMA found that medical students who trained within diverse student bodies were significantly more prepared to care for patients in racial and ethnic groups other than their own. The same report implores medical schools to not only recruit diverse students, but to also imbed diversity into the curriculum. There are numerous AAPA and Physician Assistant Education Association (PAEA) programs and projects underway to address the latter. But are we doing enough to address the main problem — the overall small number of black PA students?
While efforts by AAPA to increase diversity among the workforce are important, it is somewhat pointless without PA programs doing their part to vigorously recruit and select black students. Holistic admissions may hold an answer, but its use is determined by each PA programs’ admissions faculty.
Not only does our profession as a whole benefit from increasing the number of black PAs, so do underserved communities. A Commonwealth Fund report from 2004 showed that minority medical providers are more likely to practice in underserved areas than non-minorities. These communities experience a disproportionately higher incidence and prevalence of serious disease, while at the same time often lacking access to adequate medical care.
I am in no way implying that PAs have intentionally contributed to health care disparities. But I would argue that few, myself included, actively participate in our health care community to improve racial disparities. We make a committee or an association and shift the responsibility to them. Diversity has all too often become a buzzword, a sexy topic for meeting room agendas at a time when the harmful effect of its absence is seemingly infinite.
We took an oath to provide just care, and promote diversity. We are obligated, as medical professionals, to make a contribution towards a solution. Conversations are happening all over the country. It’s time for us to join the dialog.
Author’s note: The concepts and implications of racial inequality are undoubtedly complicated. For the purpose of this article, and in reflecting on the recent events in Ferguson and other parts of the country, I have chosen to focus specifically on disparities relating to the black community. This is not meant to marginalize the issues facing other minority groups.
Author’s addendum: After this article was posted, a lively discussion occurred on social media and over email. To clarify, affirmative action often refers to quota systems based on single factors. This is quite different from the holistic admissions approach I mention in the article. The latter is a varying point-based system for selection based on merit, and dozens of other factors. Race having a place as one of those many factors could be part of the conversation among stakeholders as the health professions continue to search for meaningful ways to address this. Regardless, it is important to increase the diversity within our applicant pools. This can be accomplished through activities such as expanding Project Access, and therefore, the “recruitment” I referenced in the article.
Rich Bottner is a physician assistant. This article originally appeared in PAsConnect.