Surgery News - November 2008 - (Page 12)

12 SURGERY NEWS • N O V E M B E R 2 0 0 8 THE VISION Evolutionary Changes in Surgical Practice Med School Diversity Sways Health Care Concepts BY DAMIAN MCNAMARA 20/20 Else vier Global Medical Ne ws hite students attending more racially diverse medical schools consider themselves better prepared to care for patients of racial and ethnic minority groups than are students at less diverse medical schools, according to a study of more than 20,000 graduates. Attitudes about providing equivalent access to health care for everyone also were stronger among students at more diverse schools. Their responses were 50% more favorable toward equitable access to care, compared with students at the least diverse schools. The associations were quite strong at medical schools that foster positive interactions and sharing of opinions among students from different backgrounds, Dr. Somnath Saha and colleagues reported ( JAMA 2008;300:1135-45). The investigators also found a “threshold effect” regarding minority student enrollment. Specifically, diversity outcomes were positive among the 118 medical schools in the study if the proportion of underrepresented minority graduates (URMs) exceeded 10%, or the total nonwhite student population was more than 36%. The authors had no disclosures. Affirmative action and addressing prior injustices are the justification for most programs to increase URM student diversity. However, Dr. Olveen Carrasquillo and Dr. Elizabeth T. Lee-Rey wrote in an editorial in the same issue of W JAMA, “the well-documented history of widespread racism within organized medicine and the American Medical Association’s apology is a reminder of how pervasive and tolerated such practices were only a few decades ago” (2008;300:1203-4). In the current study, Dr. Saha, an internist at the Portland VA Medical Center and Oregon Health and Science University, and colleagues assessed results of the online graduation questionnaires administered by the Association of American Medical Colleges in 2003 and 2004. There were anonymous responses from 20,112 individuals, representing 64% of all graduates during those 2 years. Race and ethnicity were self-reported. The 9% of URM respondents included black, American Indian, Alaska Native, Mexican American/Chicano, mainland Puerto Rican, and Native Hawaiian students. Minorities not considered to be underrepresented in the physician workforce, primarily Asians and non-URM Hispanic or Latino students, comprised the 23% nonwhite/non-URM group. The remaining 68% were white students. A total of 21% of the 13,764 graduates in 2003 and 22% of the 7,472 graduates in 2004 strongly agreed that “everyone is entitled to adequate care.” Also, 42% of the 2003 graduates and 44% of the 2004 graduates strongly agreed that “access to care is a major problem.” A total of 59% of the 2003 cohort and 60% of the 2004 cohort indicated they felt prepared to serve diverse populations. Interestingly, white students at more diverse medical schools did not indicate they were more likely to care for underserved populations. “This may reflect confounding by the urban versus rural location of schools,” the authors wrote. “Rural schools are likely to have both fewer nonwhite students and more students who plan to practice in rural, underserved locations.” In contrast, a total of 49% of URMs planned to work with underserved patient populations, significantly more than both white (19%) and nonwhite/nonURM students (16%). “Findings from this methodologically rigorous study can inform efforts to elicit continued support by the Supreme Court for admissions policies favorable to URM diversity,” wrote Dr. Carrasquillo, director of the Center for the Health of Urban Minorities at Columbia University Medical Center, and Dr. LeeRey, codirector of the Hispanic Center for Excellence, Albert Einstein College of Medicine, both in New York. “As with all cross-sectional studies, there are important limitations, the most important of which is the inability to address causality,” Dr. Carrasquillo and Dr. Lee-Rey wrote. Dr. Saha and colleagues noted that they had no measures of student attitude, experience, or plans to practice medicine prior to entering medical school. In addition, schools that actively recruit a diverse student body might be more committed to improving diversityrelated outcomes, another possible confounder of the study. “Acknowledging these limitations, we believe our findings have potential policy implications,” the authors wrote. ■ Oversight of Joint Commission Expanded Under New Law Commission, provides Medicare and Medicaid Services the standard in accreditation in in The Joint States,hospitalwhichsubjected fororder for itstoaccredited hospitals the United will soon be to be deemed have met the conto greater federal oversight. Congress has eliminated the Joint Commission’s “unique deeming authority” for hospitals as part of the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), enacted in July. Like other accrediting bodies, the Joint Commission will need to apply to the Centers ditions of participation in Medicare. Previously, the Joint Commission’s deeming authority was automatic and not subject to CMS oversight. Joint Commission officials supported the intention of the change, and plan to apply to CMS for hospital deeming authority. The Joint Commission and other accrediting bodies already apply to CMS for deeming authority in areas such as home care, laboratory, and ambulatory surgery accreditation programs. Under the new law, the Joint Commission will have 24 months to apply to CMS for deeming authority and to be recognized. During the transition period, accredited hospitals will not be affected by this change, according to the Joint Commission. Over the past few years, some members of Congress have tried unsuccessfully to eliminate the Joint Commission’s unique deeming authority. In 2004, the U.S. Government Accountability Office (GAO) issued a report calling on Congress to consider giving the CMS greater authority over the Joint Commission’s hospital accreditation program. GAO investigators examined state agency validation surveys for 500 hospitals accredited by the Joint Commission and found that the Joint Commission had missed most of the serious deficiencies picked up during the state reviews. —Mary Ellen Schneider http://www.NashvilleSurg.com

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Surgery News - November 2008

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