Like the nation as a whole and many other industries, health care systems reached an inflection point in recognizing and working to reverse racial injustice. Disparities in COVID-19 infections and deaths and vaccine hesitancy among marginalized communities are shedding light on a long history of systemic racism that has disproportionally affected care delivery for patients of color. At Penn Medicine, the effort of the organization as a whole to unify to eliminate structural injustice — known as the Action for Cultural Transformation — depends on this important work happening at every level. The inception of a new award — which aims to recognize a group with a demonstrated commitment to inclusion, diversity, and equity — was announced in October 2020 by Eve Higginbotham, SM, MD, ML vice dean for the Office of Inclusion, Diversity, and Equity in the Perelman School of Medicine at the University of Pennsylvania, and Dwaine Duckett, senior vice president and chief human resources officer, for the University of Pennsylvania Health System (UPHS). Higginbotham and Duckett are leading the Action for Cultural Transformation effort on behalf of the organization.
Last month, the department of Family Medicine and Community Health’s Anti-Racism Task Force (DFMCH ARTF) was named the winner of Penn Medicine’s inaugural Champion in Inclusion, Diversity, and Equity Award: An Award of Excellence. This team is confronting racial inequities head on within five key areas of focus: employee engagement, education, patient care, service, and research. UPHS CEO Kevin Mahoney presented the award to the task force during the 2021 Martin Luther King, Jr. Health Equity Symposium. Mahoney recognized the task force’s many achievements, including the development of educational opportunities and recruitment interventions, and actions to address health disparities and serve the local community.
Ayiti-Carmel Maharaj-Best, MD, an assistant professor of Family Medicine and Community Health and director of the Family Medicine Underrepresented in Medicine Visiting Clerk Scholarship Program, co-leads the department’s anti-racism task force with Renée Betancourt, MD, an assistant professor and vice chair of Diversity, Equity, and Inclusion in the department. The two doctors work alongside 64 registered task force members.
“I am extremely proud of the collaborative action of the group,” Betancourt said. “The true leadership within the task force comes from the individual task force members who propose initiatives and move our efforts forward. What we’ve been working for is incredibly important and special.”
To share their efforts and lessons learned through the task force’s anti-racism efforts, Maharaj-Best and Betancourt discuss some of their experiences in the Q&A below.
What was the catalyst for developing an anti-racism task force within the Department of Family Medicine and Community Health?
Renée Betancourt: Prior to the formal development of the anti-racism task force, there was already a lot of momentum within our department to address issues of equity and racism. In particular, we had made several gains in the area of residency recruitment. Then, in the spring of 2019, a group of residents and faculty attended a Society of Teachers of Family Medicine conference, where we learned about other institutions that had implemented theoretical frameworks to help them move towards becoming antiracist and multicultural. We emerged from that conference very inspired to weave the initiatives we had already been working on into a broader organization with a clear mission.
What type of success has the task force had with recruitment of residents?
Betancourt: For several years, our faculty and residents have been working together to refine our recruitment process in order to identify areas where racism and inequality manifests. As a result, we are continuously revising the residency application process. For example, we’ve developed a Holistic Review Rubric that operationalizes the department’s residency program values, recognizes a candidate’s distance traveled in overcoming racism and other structural barriers to academic advancement, minimizes the influence of race and wealth privileges on the recruitment processes, and increases transparency. Since we’ve implemented these changes, we have seen a significant increase in the number of underrepresented in medicine (UIM) candidates. We have also worked to recruit residents with a racial concordance to our West Philadelphia patient population [i.e. helping the majority-Black community see more Black and other UIM physicians] by implementing a Visiting Student Elective which provides scholarships and mentoring for UIM medical students as they rotate within our department.
How have you engaged DFMCH employees within the work?
Ayiti-Carmel Maharaj-Best: In addition to implementing department town halls and resident-led workshops on structural racism, we’re building a more inclusive environment that helps our employees use their voices, contributions, and life experiences to make this department a better place. To support this, we founded a mentorship program for UIM residents to provide extra support and institutional knowledge for trainees who are more likely to be face structural barriers in their training.
We are also examining the experience of our clinical support staff, which is an area that is often overlooked. Our support staff has strong ties to the community we serve, so we need to make sure that these employees feel welcomed, included, and respected, while also providing them opportunities to develop and advance professionally. Lastly, there is a focus on the systems we have in place to allow employees to report incidents of discrimination or microaggressions. If we don’t provide a place for employees to share their experiences, we will always be able to plead ignorance. It is our responsibility to provide structures that make people more comfortable within our department. These efforts are in the early stages, but they are a big part our vision for the future.
How has the anti-racism task force been involved within the community?
Betancourt: Our vaccine clinics are a fantastic example of community engagement. Members of the ARTF collaborated to secure funding from the Bach Fund Grant to secure flu vaccination supplies. During the fall 2020 influenza season, our staff and providers came together to set up pop-up vaccine clinics at two local churches and two domestic violence shelters to improve vaccination access and provide education about vaccines.
How does patient care drive the work of the ARTF?
Maharaj-Best: Patient care — and any associated health disparities or outcomes — is one of our biggest drivers for doing this work. We encourage our employees within the department to speak up whenever they recognize disparities in their work. In doing so, we have been able to identify and address several race-based health care guidelines.
For example, the management of anemia in pregnant Black women presented an opportunity for structural change. A subcommittee of our department’s task force found that there was not reliable data to support an existing guideline that recommended different treatment of anemia for patients who were Black, compared to other races. We collaborated with Penn Medicine Maternal Fetal Medicine and Obstetrics and Gynecology to remove this guideline from Penn practices. This disparate guideline is based on a national guideline from the American College of Obstetrics and Gynecology, which has yet to eliminate this disparate recommendation. Through this work, we are able to recognize this is not something that happens by accident — it is an impact of systemic racism, that can only be undone by creating counter-structures to reverse the harm the medical field has perpetuated for generations.
How is your work informing the way you educate health professionals?
Maharaj-Best: Because Penn is an academic institution, a big part of our mission is to train our residents to be leaders for tomorrow who are able to provide the care that our community needs. This academic year, we created a new social justice curriculum that is embedded into our Community Medicine rotation. This formalized curriculum covers structural racism, white privilege, housing discrimination, disparities in education, and the criminal justice system. The curriculum helps residents apply this content to the Philadelphia community and Penn so they can better understand how historical factors still play out today.