NCCL Preconference Puts Focus on Health Equity
May 2, 2024, David Mitchell, Kansas City, Mo. — An April 17 preconference to the 2024 National Conference of Constituency Leaders focused on family medicine’s role in advancing health equity and social justice. The half-day event offered breakout sessions related to health equity and the social determinants of health; implicit bias training; anti-racism and social justice.
AAFP News talked with three participants — all delegates to the NCCL, the Academy’s leadership development conference for women, minorities, new physicians, international medical graduates, and LGBTQ+ physicians or physician allies — for their insights on these topics and this new event.
AAFP News: Diversity, equity and inclusion programs and initiatives across the country are under scrutiny. Why is it important for health care organizations, including the AAFP, to continue this work?
Bernard Richard, M.D., minority constituency delegate: It’s necessary in order for us to foster an inclusive environment where we can improve our communications and tailor treatments that can be respectful of cultural, racial and socioeconomic backgrounds. People need to feel respected, regardless of their background.
Victoria Otano, M.D., minority delegate: The patients we serve are diverse. Minority physicians are tired and burned out from fighting inequalities in the workplace and for our patients. When organizations like the AAFP talk about these challenges, it validates our feelings and those of our patients. It creates opportunities for safe conversations to understand how racism impacts health care. It is important to continue to talk about these issues and send a consistent message that our experiences as minorities matter and our patients are at the center of the conversation.
Katharina de Klerk, D.O., LGBTQ+ constituency delegate: We don’t know what we don’t know. We all have big blind spots when we make decisions and come up with new ideas, and it’s only by bringing together many perspectives that we can be our most creative, responsive and thoughtful in our leadership decisions.
Further, we all know that health outcomes are better when patients receive care from people who look like them and who understand where they’re coming from. And in order to continue to recruit a diverse pool of people into medicine, and specifically family medicine, it’s important for people to see people who look like them as family doctors and in leadership within our profession. It’s through intentional programming — educational programming, mentorship programs, and special advocacy programs like NCCL — that we create space for diverse voices to be heard and for people underrepresented in medicine to feel supported and championed so that they may become leaders in our field. I think this kind of programming also helps more people understand the importance of DEI work.
AAFP News: How do these issues affect you and your patients?
De Klerk: I work at a federally qualified health center in Rhode Island, and I work with a lot of trans and gender-diverse patients. The importance of investing in DEI work is really visible where I work. The leadership decided to put significant resources toward a program for gender-affirming care about 10 years ago and did so by hiring trans and gender-diverse people to work in almost every level of the organization, from front desk to medical director level, and as a result there is a much more robust culture of affirmation and understanding. They also invested in hiring staff to work on state level policy initiatives and are now a state-wide policy leader on many important issues that affect our patients. It really highlights the importance of hiring people who are a reflection of the communities that you serve, to help realign institutional priorities, and in order to provide the highest standard of care and make patients feel safe when receiving their care. The same principle is, of course, generalizable to all communities that face systemic oppression in our society.
Katharina de Klerk, D.O.
Victoria Otano, M.D.
Otano: I serve a predominantly African American and Hispanic patient population. I also serve a population living in poverty and having poor access to health care. Equity applies to all of them, regardless of race. The main obstacle for my patients is access to affordable care. Many are uninsured or underinsured and cannot afford a simple copay for a visit or medications. Regardless of my efforts as a physician, if they cannot access the medications and care they need, their health is, and will continue to be, compromised.
Richard: I cannot help but notice that there are not enough family doctors in my community while simultaneously noticing that there are many non-English speaking citizens in my area. So, if I’m not their doctor, who is? I’m nervous that there are individuals who are not being served. They are just as much a part of my community as anyone else. They belong. Therefore, there is work to be done because there are people who are in my community who are not receiving care. I ask the other doctors in town, ‘Are you the doctors for these groups of people?’ And they say, no, so that suggests that there is a care gap somewhere and that we haven’t done our part to reach out to these communities. That is a major concern.
Also, I have lots of patients who come from quite a distance who say, “Wow, I’m so glad that I was able to find a Black doctor like you.” Or, “Wow, I’m so glad I was able to find a gay doctor like you.” Then you think to yourself, there must be a gap somewhere. You would think that it shouldn’t be so hard just to find someone whom you can have a relationship with that you feel you can trust.
But it works both ways. There must be numerous individuals in our community that must not trust me because I can see that there are people who don’t look like me in the community who speak languages that I don’t speak who don’t come to me because there must be an issue of trust. So there’s work for me to do, as well. There's work for all of us to do. That’s why we have to continue to study and learn together. We can do better.
AAFP News: How far are people traveling to see you?
Richard: An hour and a half to two hours is not uncommon.
Bernard Richard, M.D.
AAFP News: What did you hear at the preconference that you plan to implement in your own practice and/or share with your peers?
De Klerk: The preconference really highlighted all of the work that the AAFP is putting into promoting health equity, and the programs that they have in place to promote diversity, equity and inclusion within our profession and to address health care disparities in the community. The session I attended highlighted the tangible impact that implicit bias has on health outcomes, as well as the impact that implicit bias has on the health and well-being of a professional team. We talked through various scenarios where bias creeps up in medical training and clinical practice and explored ways to interrupt those deep-seated ideas and cultural norms.
Otano: I learned how to intervene when there is an act of racism happening in the moment and that we need to continue to check our own biases regardless of how much we think we don’t have them.
I would like to implement training for staff and peers in our workplace that goes over implicit bias, equity and inclusion in health care. I do not believe staff are properly trained to work with diverse populations. In my eyes, the patient experience with the health care system starts the moment they call to make an appointment. Every interaction matters.
Richard: The things that I learned that I think were new to me were that the social determinants of health perhaps should be thought of as social drivers of health. I also learned that structural racism is what creates these drivers. And these drivers are in turn what lead to disparities.
We’ve always talked about social determinants of health at the hospital network system that I’m employed by. We’ve done our best to take action when we discover those. It’s true that there has been lack of resources to address some of these social drivers of health, but I think there hasn’t been an open conversation regarding the role that structural racism has played in creating those drivers. That is something that perhaps I will do more openly so that maybe we all can have a better understanding of what the true source was for the cause of these drivers and the subsequent disparities.
AAFP News: What are your takeaways from the NCCL reference committees and business sessions where these preconference topics were also discussed?
De Klerk: I found the constituency caucuses and the formal resolution debates to be really powerful. These sessions are an opportunity for people to share ideas and solutions to address some of the biggest issues in our organization, our profession and in health care more broadly. I’m reminded how powerful it is to bring people together who have shared lived experiences, and to create an environment to nurture those connections and that sense of community. The resolution debates this year have me thinking a lot about topics like the accessibility of resources and spaces for people with disabilities, and the daily stresses associated with your visa status being tied to your employment.
Richard: I did help pen a resolution that would help our Academy stand against legislation against diversity, equity and inclusion. You cannot mandate that you’d not teach diversity, equity inclusion to family doctors. We will not be able to care for our patients in a respectful way. We have to have physicians who have some level of cultural competence and be aware of the socioeconomic backgrounds of the patients we serve. That has to be mandated in order to turn out good family doctors.
Otano: NCCL is a great platform to discuss equity and social justice at a national level. It is crucial to interact and discuss the level in which different state policies affect patient care. As more states are moving toward restricting DEI initiatives, NCCL provides a platform for shared discussion and innovation while exposing physicians to different challenges and perspectives. My involvement in NCCL has been eye-opening and formative. I am looking forward to continuing to advocate for underrepresented physicians and patients.