July 16, 2021 (ACP) -- In moves aligned with the American College of Physicians positions on systemic racism, the American Medical Association (AMA) doubled down on its efforts to foster diversity and inclusion in health care during a special virtual meeting of the House of Delegates, the group's policy-making body, held June 12 to 16, 2021.
The House of Delegates adopted guidelines to help health care organizations establish the type of new policies and organizational culture needed to prevent and address systemic racism, explicit and implicit bias, and microaggressions. These guidelines include creating clear definitions of discrimination and systemic racism, making sure policy is prominently displayed, establishing training requirements for systemic racism and explicit and implicit bias, and establishing protocols for reporting and corrective actions.
“ACP was pleased to be able to support the AMA's Board of Trustees in efforts to work on this difficult issue and establish a clear consensus to move the AMA forward,” said Dr. William Golden, who heads ACP's AMA delegation. Still, he added, a vocal minority have concerns that may still cause issues during future meetings.
The AMA Board of Trustees also unveiled its roadmap for continued progress toward such health equity. Going forward, the AMA will work with appropriate stakeholders to reimagine the future of health equity and racial justice in medical education, improve the diversity of the health care workforce and ameliorate inequitable outcomes among affected populations.
Moreover, the group plans to fund the creation and sustainability of medical schools and residency programs affiliated with historically Black colleges and universities, Hispanic-serving institutions and tribal colleges and universities toward a goal of achieving a physician workforce that better represents the racial, ethnic and gender composition of the United States. The AMA also plans to establish a task force to guide such transformation.
The House of Delegates also moved to improve access to telehealth services in historically marginalized and minoritized communities. These efforts should help to shore up the digital divide that was revealed during the COVID-19 pandemic as telehealth services became the main way to access medical care. The House of Delegates adopted policy to encourage initiatives that strengthen digital literacy; encourage telehealth solution and service providers to implement functionality, content and service access best practices for historically minoritized and marginalized communities; and encourage health systems to invest in initiatives that design access to care via telehealth for these communities.
In a policy paper in the January 2021 issue of the Annals of Internal Medicine, ACP outlined a similar framework for addressing racism and discrimination in health care. ACP published three companion papers on how to end disparities in general education, medical education and health care organizations; in law enforcement and criminal justice; and for populations at greatest risk. These policies dovetail with the ACP commitment to become an “antiracist, diverse, equitable and inclusive organization. “
Similar to the recent AMA actions, ACP called for more funding for equitable early education and experience for disadvantaged students and the creation of health care career pathways to better engage and connect students affected by discrimination. ACP is also asking medical schools to implement programs and policies to attract, recruit, retain and graduate such students.
“ACP looks forward to partnering with the AMA and our sister state and specialty societies to advance our shared commitments to ending racism, bias, and discrimination,” ACP President Dr. George M. Abraham said in a statement. “As physicians we know the harm that racism and discrimination bring to the well-being of our patients, and we have a moral imperative to combat that harm. It is time for organized medicine and all physicians to work together to confront this issue and work toward greater health equity.”
These macro-level societal changes will take time, and for now, the onus is on individual physicians to help undo some of the historical harms caused by systemic racism, said Golden. “Members should have open conversations and team huddles with staff members about language,” he said. “Even casual language can cause all sorts of issues that you are not aware of. It doesn't have to be overt to cause barriers to care and to limit impact of the interventions.”
In a further nod to the growing synergy between ACP and the AMA, the ACP delegate is now one of the largest in the AMA and is still growing, Golden said. “We are now a major delegation, and we are hoping that ACP policy will have a greater impact on AMA actions in the future.”
To that end, Dr. Sandra Adamson Fryhofer, an internist from Atlanta, is now the AMA Board of Trustees chair-elect. She served as the 2000-2001 president of ACP. Dr. Noel N. Deep is the chair-elect on the Council on Science & Public Health at the AMA. Deep is also the governor of the ACP Wisconsin Chapter. Dr. Susan T. Hingle serves on the AMA Women Physicians Section Governing Council. She served as the chair of ACP's Board of Regents from 2017 to 2018.