Minority providers

“Importance of and Unique Role of
Providers of Color in Addressing
Disparities, Health Equity, and
Delivering Quality Care”
Luther A. Virgil, Jr., MD
Chief Executive Officer,
Chief Medical Officer,
National Minority Clinical Research Association (NMCRA)
Atlanta, GA

Objectives
• At the completion of this presentation, the participants
should be able to:
2.Describe the current state of the HIV workforce and
specifically the state of minority providers and HIV
3.Discuss the factors motivating and restricting providers
of color in addressing the needs of their respective
communities of color
4.Describe the critical importance of providers of color in
terms of access, stigma, and quality of care

Objectives
• At the completion of this presentation, the participants
should be able to:
2.Describe strategies and recommendations for addressing
health disparities and health equity as they pertain to
providers of color.
3.Propose strategies by which providers can SYNC their
efforts, practices, organizations, and professional groups
to address disparities and health equity for communities
of color and other disproportionately affected groups
(gay men of color, women, transgender, etc.)

The Current State of the HIV Workforce

State of the HIV Primary Care Provider
Workforce
• The HIV workforce is not well defined
• The current HIV medical workforce is largely composed
of the first generation of HIV medical providers who
entered the field more than 20 years ago.1
• One-third of current HIV providers are in the last
quarter of their careers and plan to retire within 10
years1

1. HIV Medicine Association. Averting a Crisis in HIV Care. The Body.com. June 2009. http://www.thebody.com/content/art52526.html

State of the HIV Primary Care
Provider Workforce

The Current State of the Minority HIV
Primary Care Provider Workforce

State of the Minority HIV Primary Care
Provider Workforce
• A 2004 report on health disparities, found that although
25 percent of the nation's population is minority, only 6
percent of its physicians are minority. That's the same
percentage found in the Flexner report, which was
published in 1910.1
• African-American and Hispanic medical school
graduates represent just one-tenth the number of White
graduates, according to the Association of American
Medical Colleges.2
1. Regina Benjamin. Surgeon general calls for more minority health professionals. The Chart. December 5th, 2009.
http://pagingdrgupta.blogs.cnn.com/2009/12/05/surgeon-general-calls-for-more-minority-health-professionals/
2. HRSA CARE Action Newsletter. Workforce Capacity in HIV. April 2010. pg. 6,
http://hab.hrsa.gov/newspublications/careactionnewsletter/april2010.pdf

Provider Workforce
• In 2007, African Americans comprised 48 percent of
reported AIDS cases in the U.S., and Latinos comprised
19 percent, However, among the HIVMA membership
only 4 percent are African American and 6 percent are
Latino1
• In 2007, among the AAHIVM membership only 8
percent are African American and 7 percent are Latino.1


Provider Workforce
• Summer of 2008, HIVMA and Forum for Collaborative
Research survey revealed that nearly 70 percent of Ryan
White Part C-funded HIV programs reported difficulty
recruiting HIV clinicians, with particular difficulty in
recruiting African American and Latino clinicians1


Provider Workforce
• The shortage of health care providers in HIV/AIDS care
is part of the larger primary care crisis in this country1
• Supply of providers will not meet the demand for
services over time (due to population growth, aging, and
other factors)1
• Failure to promptly address HIV medical workforce
issues could lead to the collapse of the HIV care system2

1. 2008 Health Resources and Services Administration HIV/AIDS Workforce Meeting. http://hab.hrsa.gov/care/keythemesworkforce.htm

Factors Restricting and Motivating
Providers of Color

Causes of the Current Status
 The number of patients has increased but the
number of providers is decreasing or remaining
stable (depending on location)1
 Stigma remains a concern in treating HIV/AIDS
especially for providers in rural and remote areas


Causes of the Current Status
 The health care workforce is aging and retiring at
rates higher than new providers are entering the
workforce. (Some HIV experts claim this situation is
even more pronounced with clinicians serving HIV/
AIDS patients)1
 A lack of qualified HIV clinicians and
reimbursement were identified as the major barriers
to recruiting and retaining HIV clinicians2


What Motivates Providers of Color?
Common reasons shared by minority doctors:
•Helping Others
- The most common reason given by applicants to med school
•Easing Suffering
•Improving Care
- 77% of African American physicians and 52% of Latino physicians say
unfair treatment based on race or ethnicity happens in minority
communities1
•Making Medical Miracles
•Giving to the Community
•Gaining Respect
•Making Money
•Continuing the Family Tradition
1. The Kaiser Family Foundation. “National Survey of Physicians Part I: Doctors on Disparities in Medical Care”. March 2002.
http://www.kff.org/minorityhealth/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13955

The Critical Importance of Providers of
Color

Role of Minority Providers in Addressing
Health Disparities
• Studies document improved outcomes when patients see physicians
of the same race, including for those with HIV1,2
• Data suggests that in general, more effective care is provided when
clinicians and patients have similar cultural backgrounds and speak
the same language1
• Minority health providers "are significantly more likely than their
white peers to serve minority and medically underserved
communities,“3
• In 2010, Minorities comprised approximately 70 percent of reported
AIDS cases in the U.S.4
1. Cooper LA et al. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med, 139(11):907-15.
2. King W et al. Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors? J Gen
Intern Med, 19(11):1146-1153.
3. Kaiser Network.U.S. Medical Profession Does Not Reflect Growing Minority Population. February 6, 2004.
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=22076
4. CDC. HIV Surveillance by Race/Ethnicity (through 2010). http://www.cdc.gov/hiv/topics/surveillance/resources/slides/race-ethnicity/index.htm

Role of Minority Providers in Addressing
Health Disparities

Therefore:

• The availability of Minority health
providers is a necessary component to
provide quality healthcare to underserved
health related populations

Strategies for Addressing Health
Disparities Related to Providers of Color

Increasing the Number of Minority
HIV Primary Care Providers
• Policy makers, professional societies, social
organizations, medical providers, community groups,
patient’s rights groups, advocates, and others must work
together to address the medical workforce issues:
1. Secure National Data on the State of the HIV Medical
Workforce
federally funded major national study of the HIV
medical workforce


Increasing the Number of Minority
1. Attract and Recruit new HIV Clinicians with a
special focus on recruiting Minority HIV Medical
Providers
incentives which improve reimbursement and
reduced administrative burden
Support full funding of the Health Professions Title
VII and VIII programs.


Increasing the Number of Minority HIV
Primary Care Providers
1. Build a strong HIV Medical Workforce Training
Pipeline1
 provide students, residents, and post graduate
clinicians with opportunities to provide HIV care in
both inpatient and outpatient settings
 provide supportive learning through teleconferences,
live and web-based programs to increase
competence and confidence
2. Ensure that the reformed health care system
provides support for HIV physicians1

Effective Strategies in Retaining Minority
1. Establish a comprehensive data collection system
which identifies the needs of Minority HIV primary
care providers1
2. Policy makers, professional societies, social
organizations, medical providers, community groups,
patient’s rights groups, advocates, and others must
work together to address the identified needs
3. Incentives which improve reimbursement and reduce
administrative burden must be continuous and flexible1


Effective Strategies in Retaining Minority
1. To reduce burnout, define productivity standards,
including defining norms for staffing and use of inter-
and multi-disciplinary teams1
2. In the context of coordinating patient care, link
supportive services directly to clinical teams to avoid
burnout and enhance retention1
3. Employ a multi-faceted approach to retain those who
are currently in the field.


SYNC’ing Efforts to Address Disparities
for Communities of Color

SYNC’ing Efforts to Address Disparities
• Establish a harmonious relationship between:

Summary
• The HIV workforce is not well defined
• Those providing care to the HIV-infected need
additional expertise in HIV medicine
• Those providing care to the HIV-infected must have
sensitivity to the particular issues of stigma and concerns
of special populations
• Racial and ethnic minorities are a necessary component
to provide quality healthcare to the HIV population

Summary
• Racial and ethnic minorities are still underrepresented
in health care professions
• Supply of providers will not meet the demand for
services over time
• Failure to promptly address HIV medical workforce
issues could lead to the collapse of the HIV care system

Summary
• To address HIV medical workforce issues:
1. Secure National Data on the State of the HIV Medical
Workforce
2. Attract and Recruit new HIV Clinicians
3. Build a strong HIV Medical Workforce Training
Pipeline
4. Ensure that health reform measures provide support
for HIV physicians
5. Ensure that a comprehensive coalition of
organizations work together to address the medical
workforce issues
6. Employ a multi-faceted approach to retain those
serving in and those who enter the HIV field

Minority providers

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