NATIONAL HARBOR, Md. — Half of healthcare organizations surveyed have eliminated or are working to eliminate race-based clinical algorithms and decision-making tools that incorrectly use race as a proxy for genetic or biological ancestry, a survey by the American Medical Association (AMA) found.
“This is critically important,” Aletha Maybank, MD, the AMA’s chief health equity officer, said Sunday during a special session on health equity at the interim meeting here of the AMA’s House of Delegates. The AMA will be publishing a peer-reviewed article that will explore the issue in more depth, she said.
One example highlighted in the survey was the Medical Society of Delaware, which took steps to eliminate the use of the race correction factor in estimated glomerular filtration rate (eGFR) calculations throughout the state by contacting all known labs.
The association surveyed 84 organizations, including 29 state and territorial health associations, 39 specialty societies, and 16 city/county health organizations. The rate of responses varied by organization type, explained Blair Aikens, MPH, senior data analyst at the AMA; although 58% of the 54 state and territorial health associations that the AMA reached out to responded to the survey, only 6% of the city/county health organizations did, as did 26% of specialty societies.
One possible reason for the lack of response from city and county organizations is that, unlike specialty societies and state associations, the cities and counties don’t have a field representative who communicates regularly with the AMA, Maybank said during a question-and-answer session. “That’s something that we’re working on,” she said. “And the capacity of those organizations might be smaller — you might only have one employee with a lot of work to do, so finding other ways to reach out and connect with them, and maybe even survey them in a different form” might be valuable.
The survey also found that 74% of organizations have taken at least one action to get grounded in history and their local context, and 72% have taken one action to make equity a strategic priority.
During the question-and-answer session, House of Delegates members voiced their frustration with the slow progress of efforts to embed diversity, equity, and inclusion (DEI). “Our state medical society is doing a lot,” said Lynn Parry, MD, a delegate from Littleton, Colorado. “We have a DEI committee. Our medical society is changing its language, its approach. We’re looking through our bylaws and policies and acknowledging what we haven’t done in the past.”
“But there’s still a huge disconnect,” she continued. “We’ve done tons of presentations, but most of the time we’re speaking to the choir. We still have a Mile High Medical Society of African American colleagues who really don’t feel, with their history, that they want to be part of our medical society.”
On the other hand, Parry said, “we have people who live mostly in rural areas — physicians who don’t even want us to collect demographic data on them because the ‘woke’ people will use it against them. How do we bridge the gap?”
Maybank advised her to “recognize the progress of being at this point … There are cultures that have to evolve, and organizational cultures that have to evolve, to get to this point of talking to equity.” People working in this area “need to always continually figure out how to push, to advance — have the courageous conversations that get us to this point.”
She added that “I’m really speaking to myself, truthfully, sometimes, so that I can be patient and stick with it.”
Several delegates asked about getting more medical students and residents involved in DEI issues. “My class is very diverse,” said Jade Cook, a medical student at the University of California Los Angeles and a regional medical student delegate for the Washington State Medical Association. “But most of my colleagues are very averse to joining the American Medical Association because of [its] history of harms and discounting the voice of diversity.”
“I know that this is not what the association stands for any more, and I’m a proud member of the AMA,” she said. “But I’m wondering if there’s anything that we can do to try and recruit students into the AMA because we are future physicians and we will hopefully be in this organization for a long time, and there is a lot of room for diversifying the membership rolls.”
Sanjay Desai, MD, the AMA’s chief academic officer, said that the AMA was working to “demonstrate the value of membership in AMA and engagement with the AMA … The medical education group is engaging [with] over 70 schools; we actually provide [financial] support to universities and go there and engage with students on the ground about the work we’re funding.”
The AMA is now collecting information from House of Delegates members in a Strategic Planning Survey. The results of the survey, which closes Nov. 21, “will be reviewed … to inform elements of the updated external-facing strategic plan for 2024 and 2025,” according to the association.