Diversity, Health inequity, Health Care Disparities and Psychiatric Training

Mar 21, 2018

A 700-word blog post isn't going to do justice to the topic I have chosen. We have lots of work to do as a profession - we can, and should, get better at rectifying the inequities that exist in the delivery of health care. A commitment to diversity and structural and cultural competence in our training programs is vital to this effort. I'll argue for it as a significant enhancement to the quality of life for a residency director.

Too often being a training director means focusing on administrative minutiae - Web-ADS, evaluations that are delinquent, faculty who do not show up for lectures, a resident who offends the nursing staff. Such work often grinds a new training director down and leads her to abandon the position.

Diversity is one of the macro issues. Those macro issues are the reason I am in the business of training for the long haul. My way of changing a little piece of something. It gives my work meaning even when I am bean-counting.

Consider the following. The US has the worst health care outcomes of most developed countries in terms of infant mortality and life expectancy. We spend the most on health care. We also spend the least on social services. Not news to all of you, and certainly not news in mental health professions. Generally, the media and government blame the health system for the lack of bang for our health care buck.

Now consider that we may get worse outcomes because of social determinants of health and health inequality. There is an emerging body of research that supports this. Mc Ginnis et al (2001) cite education, employment, income, housing, crime and environment as having significant bearing on health status. And status it is - the richest 1% have greater longevity (Sklar 2018 ). Our patients may even be more affected by significant social and economic inequality, since psychiatry sits at the intersection between social justice and medicine.

That's where residency training comes into the picture. We can better health outcomes as training directors by recruiting a diverse health care work force, and by teaching our residents to understand the costs and remedies for health care disparities.

AADPRT formed a Committee on Diversity at this year's Annual Meeting. Chaired by Adrienne Adams, it has the following purpose statement:

Future psychiatrists will be best prepared to practice if they are trained in an environment embracing diversity. This committee will provide AADPRT with a venue for ongoing education regarding diversity, a clearinghouse for educational materials about diversity, and representation within the leadership of the organization to advocate for issues about diversity and health disparities. The committee may partner with similar committees already in existence in a number of our allied organizations, including the American Psychiatric Association. The committee may also work in concert with other AADPRT Committees (i.e., recruitment, curriculum) in order to accomplish its mission.

And tasks:

    • To develop trainings for the membership on issues regarding diversity for the annual meeting
    • To disseminate best practices regarding diversity in recruitment and retention
    • To develop, and/or solicit and evaluate curricular materials for training in cultural psychiatry to disseminate to the membership
    • To develop, solicit and evaluate best practices regarding teaching residents how to identify and address health care disparities and educate them about the social determinants of health
    • To assess the demographics of psychiatry residents and faculty in training programs vs. the general population
    • To advocate for issues regarding diversity on the executive council
    • To interface with the recruitment committee and the IMG caucus regarding common issues

I'd love to know your views, or what you are doing about this area. Email me.

Sklar, DP Academic Medicine 93, 1, 2-3 January 2018
Mc Ginnis, JM, Williams-Russo,P, Knickman SR. Health Affairs (Millwood) 2002; 21: 78-93.