Anesthesiologist William McDade, MD, PhD, the first-ever Chief Diversity and Inclusion Officer of the Accreditation Council for Graduate Medical Education (ACGME) delivered a stirring Grand Rounds talk on October 21, urging the virtual audience to recognize that healthcare disparities can be eliminated only when we start to view them as quality deficiencies.
“We have become comfortable with health disparities because they are not our problem,” he said. “We live in hyper-segregated communities.” Dr. McDade pointed out that life expectancy can vary by 30 years between communities only 10 miles apart because distribution of physicians isn’t homogeneous, and isn’t related to disease burden. When physicians locate closer to underserved populations, health outcomes can improve. Dr. McDade cited the disproportionate impact of COVID-19 on minority individuals, noting that of the first 100 Americans who died from the novel coronavirus, 70 were African-American. Many minority individuals work in healthcare and in jobs where they can’t work from home, increasing their risk of infection.Principles of health equity
There are four foundational principles involved in achieving health equity, Dr. McDade said:
• Health disparities exist because we lack the societal will to view them as a form of unacceptable healthcare quality deficiencies and apply an equity lens
• Health equity is the means to achieve elimination of healthcare disparities
• The goal of increasing workforce diversity is to achieve health equity
• Inclusion is the tool to ensure that diversity is successful.
“Educating physicians who are more likely to serve underserved patients and locate in minority communities increases healthcare access and improves trust, communication and outcomes for those most at risk,” Dr. McDade said. Having a biomedical faculty that resembles the population can improve healthcare, he explained, as they tend to study problems that affect minority communities and to serve as role models, mentors, and advocates for minority students.
However, it’s vitally important to educate all physicians in principles of diversity and inclusion, Dr. McDade argued, otherwise matriculation of residents from underrepresented groups may produce “resistance and resentment” in the work environment. There needs to be “social adaptation of the learning environment” in order to address uncivil behavior, reduce “imposter syndrome”, and increase the residents’ chances for success. Without these adaptations, students from racial and ethnic minorities are at higher risk for depression symptoms.
Dr. McDade presented data showing that the rate of dismissal of anesthesiology residents nationwide in 2015-16 was only 0.4% for residents self-identifying as “White, non-Hispanic”, while it was 2.0% for residents self-identifying as “Hispanic” and rose to 4.1% for residents self-identifying as “Black, non-Hispanic”.
The use of USMLE performance to predict physician quality is “neither structured, coherent, nor evidence-based,” Dr. McDade said, and scores are “not associated with measures of clinical skill acquisition.” They are, however, highly associated with parental income. Instead, “new work beginning with medical schools and ACGME will combine medical school parameters with milestones data from resident performance to begin to identify patterns that may be more correlative with actual practice,” Dr. McDade said. “As augmented intelligence permits associations to be discovered, prediction of performance may be more accurate.”
Dr. McDade said he supports the conversion of Step 1 scores from a three-digit number to pass-fail, and the evaluation of residency programs by eventual board pass rate rather than by first-time board pass rate.
In a press release about Dr. McDade’s appointment as Chief Diversity and Inclusion Officer the ACGME said, “He will focus on national initiatives to diversify and include underrepresented groups throughout the medical education continuum with the goal of providing physicians with the knowledge and skills required to serve the American public in humanistic environments where clinician and patient well-being is promoted.”
Dr. McDade received his undergraduate degree in chemistry from DePaul University, his PhD in biophysics and theoretical biology from the University of Chicago, and his medical degree from Chicago’s Pritzker School of Medicine Medical Scientist Training Program. He completed his internship in internal medicine at the University of Chicago and residency training in anesthesiology at the Massachusetts General Hospital-Harvard Medical School.