Mon August 19, 2013
Obamacare Raises Concerns About Doctor Deficit
Originally published on Mon August 19, 2013 1:24 pm
CELESTE HEADLEE, HOST:
This is TELL ME MORE from NPR News. I'm Celeste Headlee. Michel Martin is away. Coming up, sticklers might complain that social media is actually ruining the English language, but we'll talk to a professor who says just the opposite. He says platforms like Twitter can be used to increase literacy - more in a moment.
First, though, major parts of the Affordable Care Act - many people call it Obamacare - will go into effect over the next few months. By early next year, more people are expected to have access to health insurance and healthcare. But along with that access, some are concerned there won't be enough doctors to treat everyone, especially in communities that might need those doctors the most. Here to talk to us about this is Dr. Wayne Frederick. He's provost and chief academic officer at Howard University, a historically black college here in D.C., and Dr. Wayne Frederick joins me now in our D.C. studios. Dr. Frederick, welcome.
WAYNE FREDERICK: Thanks for having me.
HEADLEE: You're from Howard. Obviously, you're focused on training African-American doctors, and we're going to talk about what that means in a moment. But do you think there's actually enough doctors of any race at all to cover all the people who'll be making appointments once they get covered by the Affordable Care Act?
FREDERICK: Yeah, you know, that's an excellent place to start. If you look at the landscape of physicians and you look at the population growth, there aren't enough physicians to cover all of the citizens of the U.S., especially when you look at the urban centers versus the rural areas.
And that's one of the things that Howard has always been focused on. So recently, there was a study that was put out where Howard was one of the top three schools that really was speaking to the social mission of medicine and was basically lauded for that attempt of getting physicians to go into areas of greatest needs, which is part of our mission at the university.
HEADLEE: And in fact, according to the latest census figures, around 5 percent of U.S. doctors are black compared to the total African-American population of the country, which is 13 percent. Why is this?
FREDERICK: A lot of it has to do with pipelining as one issue, in terms of, are we getting them into math and science early enough? And then, are we putting them into certain areas of exposure where they would have an interest in medicine? Second part of it is mentorship. Are they seeing role models that look like themselves, and see that as a viable option, to get to that of opportunity, as well. And then the third issue is that, overall, it's very costly, in general, when you look at higher education and the entire stream.
HEADLEE: It's costly to get your medical license and get a medical degree.
FREDERICK: It's costly to get a medical degree. It's costly to get an undergraduate degree...
FREDERICK: ...Both of which, obviously, are very important for you to become a physician. And when you look at that 13 percent of the population and you look at the socioeconomics of that 13 percent represent, you also are going to see a very difficult path, financially, to getting that degree as well.
HEADLEE: But as a nation, why - this may sound cold - but why should we care? Does it matter what color our doctors are?
FREDERICK: I don't think it matters what color our doctors are, but it matters what they do in terms of mission, and it matters how they go about fulfilling the mission of medicine and fulfilling the social mission that we have as a country to provide healthcare and provide opportunities for all.
The physicians of color that - who we train at Howard University and in general, all of our students really are tied to the mission. We want them to have a technical competence, but we also want them to go out and change the society around them. And part of that is to provide healthcare to those that are underrepresented, underinsured and uninsured.
HEADLEE: If you're just joining us, we're talking about the lack of African-American doctors in the United States. Our guest is Dr. Wayne Frederick of Howard University. You know, I read where one of the reasons why the race of a doctor matters is because of the patients themselves, that sometimes a patient is much more likely to be honest, forthcoming and even to go visit the doctor if they feel like that doctor understands them, which would argue that we really need a cross-section of doctors that look much more like the demographics of the U.S., right?
FREDERICK: I think that's one solution. But another solution, as well is to make sure that the cultural competency of all physicians is such that they are equipped to deal with the entire society as a whole, because some of the black physicians are going to work in predominately Caucasian environments, where they have to provide care for people who don't look like them.
So you certainly would like to believe that the black physicians that we train are also competent to provide the appropriate care and to get those patients to relate to them, etc. Same thing with gender issues. If you have male physicians seeing female patients etc., all of those things are all part of the competencies that we have to teach and instruct all the physicians to have as part of the opportunity to provide care.
HEADLEE: I mean, people may not realize what this actually means in practice, so I'm hoping you'll tell us the story of when you went to Houston. You'd been at Howard, right, that's where you got your education?
FREDERICK: That's correct.
HEADLEE: And at Howard, obviously, you're surrounded by a lot of brown and black faces.
FREDERICK: That's absolutely right.
HEADLEE: And then you went to Texas, and what happened?
FREDERICK: Yeah. And so my first day in the operating room - they had not had a lot of black surgical oncology fellows - and I, you know, sat in the operating room and while I was sitting there, you know, at the computer waiting for the operation to start, everyone in the room started asking, where is the new surgical oncology fellow - you know, not recognizing that the brown face in the room was actually the fellow and not an orderly.
HEADLEE: They thought you were an orderly?
FREDERICK: Correct. And again, nothing, you know, to take away from that, I think - against the institution, but I think there's a lot of unconscious bias that we participate in around those issues. And it's unfortunate, but a lot of it has to do with lack of exposure, and we certainly have to make sure that we see more brown faces, as you describe it. And we also see them in a very competent manner, as well. I think that is also a very important part of this discussion.
It's not just about filling quotas and numbers, but these are excellent physicians that we are producing, who are very competent and I think people need to see more of that as we go along. And that's a big part of the mission of Howard University.
HEADLEE: You know, the Affordable Care Act, Obamacare, is - a big portion of that is focused on getting some of the, you know, historically underserved populations served. So I'm assuming that suddenly we're going to see hundreds, thousands of people who maybe have never have gone to the doctor just for an annual checkup suddenly having regular care for checkups. What are the issues that maybe are specific to communities that are maybe low-income communities or urban communities? Are there particular healthcare issues that relate to those neighborhoods?
FREDERICK: Yeah, absolutely. The first issue is preventative care, and providing wellness type programs and interest in just maintaining general good health. The interaction of the low-income populations in America with the healthcare environment is often in an acute setting. When there's an emergency, that's why people go to the physician.
Turning that around to have people recognize that seeing a physician annually and getting an annual checkup, doing screenings for things like diabetes, cancer, etc. is all part of preventive healthcare and maintaining appropriate wellness is a big part of what we need to do. That will be a challenge in the low-income population, to get people out of the mindset of seeking physician care only when they have an acute problem and not seeking it as part of maintaining good health. I think that will be very, very key.
HEADLEE: And to a certain extent, some of the issues in just related to being a part of this lower socioeconomic status tend to lead one to a different lifestyle. I remember speaking with one doctor in New York who said, you know, oftentimes you have to have conversations about eating habits and diabetes, for example, with your patients on a regular basis.
FREDERICK: Yeah. That's absolutely right. I mean, when you look at what they can afford in terms of meals, etc., a lot of times what they're exposed to, especially in an urban environment where they may not have fresh food, fresh vegetables, etc., would lead them to higher fat content type meals etc., and sometimes, as well, less exercise.
So those things have to be constantly consulted with the physicians, the families. We really have to get that environment very, very tight around, you know, that preventative and wellness and participating in good lifestyle habits, as well. Not smoking - all of those things constitute areas that we will have to really target some of those populations around.
HEADLEE: So maybe I'm making an incorrect assumption, and please correct me if I am, but I would assume that one of the reasons you'd want people who were brown or black and maybe have grown up in these neighborhoods is they're more likely to be willing to serve in those neighborhoods, right?
FREDERICK: That's exactly right, and that has been the experience at Howard University. A lot of our students are committed to serving an underserved populations, underrepresented minority-dominated populations, and those are the populations that our students tend to go back to.
And so you're absolutely right, getting them back into the neighborhoods where they understand the culture, they understand the lifestyle, they understand some of the driving factors which may lead someone to participate in a certain type of behavior certainly will help in terms of their ability to combat that.
HEADLEE: And then all those little kids growing up, going to their preventive care visits with their black or brown doctor will then have a role model in their physician.
FREDERICK: Absolutely, and a lot of our students, during the application process, they often say that that was their inspiration for why they came to Howard Medical School, because they interacted with a physician who looked like them at some point in their lifetime. Whether through an illness or injury that they actually had, or through some type of a mentoring process, and that was the inspiration to go on to get into medical school.
HEADLEE: OK, so you've convinced me, absolutely, we need more black doctors, but how do we do that? I mean, if there's a problem in terms of getting funding, and that's true for any student in the U.S., no matter what color that you are, and if there's a problem of role models, if there's a problem of message, sometimes in terms of finding African-American role models, they're not in sports or entertainment, right? How do we solve it?
FREDERICK: Well, I think the first thing we have to do is to ignite that passion and ignite that possible - what I call the possibilities in them. And the way we have to do that is to get to them very early - exposing them to math and science as early as possible. So Howard has a middle school on its campus...
HEADLEE: ...A middle school?
FREDERICK: ...That's right, we have a middle school on our campus which is a charter school that is concentrated around math and science. Those students come in, they represent a broad performance, academic performance of the district area, and those kids come in, they come in performing at or below the level of the average for the D.C. public school system and the charter system. And we are seeing that just by having them focus on math and science, their interest in the area as well as their academic performance has been increasing.
So that they are close to matching and definitely closing the gap on their Caucasian counterparts throughout the city. That type of focused motivation around math and science, we think, will lead significantly to them participating in college and again, the opportunity for them to become physicians. So I think getting them in that environment very early is key.
HEADLEE: That's Dr. Wayne Frederick, he's provost and chief academic officer at Howard University. Thank you so much for coming in.
FREDERICK: My pleasure, thanks for having me. Transcript provided by NPR, Copyright NPR.