Doctors share the future of the healthcare workforce and how to better support women and people of color
The COVID-19 pandemic has amplified the deep inequalities of the health workforce and the awareness of these. Women and Blacks, Aboriginals and other people of color are particularly affected by these disparities. Now, as the pandemic eases, many in the medical community are working to make sure problems don’t go underground.
As the new Dean of Medical Education at the University of Chicago’s Pritzker School of Medicine, Vineet Arora is an academic hospitalist, researcher, and strong advocate for improving the future of healthcare and a safe working environment. His academic research has focused on trainee abuse, burnout, sleep deprivation, and avenues for promotion in academics. More recently, she has focused on the best ways to bring diverse teams together to provide care.
Recently, Arora met Resa E. Lewiss, emergency physician at Thomas Jefferson University, creator and facilitator of Visible voices, a podcast dedicated to these questions and more. They talked about what awaits the health workers. The interview has been edited for clarity and brevity.
It was bad already, and it got worse. Sadly, the pandemic has “exposed” those inequalities that women, marginalized identities, individuals at BIPOC, especially our black colleagues, have faced and have only been magnified by the coronavirus pandemic, but also by problems of structural racism and police violence. The deaths of George Floyd, Breonna Taylor and others have really signaled Americans that we need change, and we need it now. We can’t relax, we need it now.
Sometimes people put health care on a pedestal: the idea that we are professionals, that we don’t treat people differently. We take an oath to treat everyone the same. Unfortunately, the data does not confirm this. And so, with a racial calculus that responds to healthcare, we know that our black patients, for example, have poorer health outcomes and face skewed treatment as well.
Decades ago, when I was in school, people took for granted that an underserved area was a code for “the hospital can’t fix this”. Now, we better recognize that it is really the structural oppression of populations that has limited their health and the accumulation of generational wealth. So how do we in the health field go upstream to help do that? This is how we close the gap. We’re not going to close the gap with the same old routine tricks that we tried.
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This is a really interesting question. I think one thing to think about is: Do we have a shortage of health professionals? Historically, there have been a lot of labor force projections that were wrong. We are fairly certain that we have an aging health care workforce, particularly in nursing. We have a lot of people who are exhausted after the pandemic, people who are planning to retire, people who move out and take on itinerant jobs or other types of jobs.
So when it comes to frontline healthcare, things have gone so badly that I am concerned that we are bleeding our workforce to the point where we will have critical workforce shortages, especially in the area. regions that are already suffering from it.
The real challenge is that we are going to face not only a shortage, but more specifically a shortage in already underserved areas. How do you fix the mismatch and misaligned incentives so that we can get the health workforce where it’s needed? It will really be the challenge of the future.
In the New York Times, there was an article profiling a friend of mine. She’s a doctor here in Chicago. She is an internist in the suburbs, who has stopped working. Similar to many medical moms, who are in dual career marriages, she faces incredible challenges. Women may be in lower paying specialties, like primary care, and they won’t have the support they needed during the pandemic, and there is a partner or spouse who is under a lot of stress. higher.
In fact, research shows that female physicians with young children are leaving the workforce. I have seen a lot of pivot points anecdotally. Sadly, we’ve seen a lot of black women leave academia. I shudder to use the phrase by choice, because generally if you peel that onion it’s usually due to decades of micro-aggression … and so I think for intersectional identities, especially black women, that ‘ is much worse.
Although the pandemic has sparked interest in the careers of health professionals, in medicine, all the places are filled… and we are not creating new places. In fact, we have hospitals that are closing their residency programs due to the emergence of private buyout hospitals.
International medical graduates (IMGs) are actually filling the gap in many medically underserved areas and in rural areas and in primary care areas, and so what people don’t understand is that without IMGs , we just wouldn’t do it. About half of the residency places in internal medicine are IMGs. Family medicine also has huge numbers largely because that is where they are wanted. … We are seeing strong growth in the use of physician assistants and nurse practitioners, which will certainly impact the demand for physicians. Either way, it’s hard to say that anyone is thinking strategically about the labor needs of the future population.
This is such a difficult question. These are health care issues that we need to recognize. Take, for example, our issue of sexual harassment. Our first step on the road to recovery is recognition. It is so disturbing for me to see these cases of sexual harassment, and in particular what has been described as the networked silence around the survivor. We have to accept that we have a problem. It must be accepted by the leaders… and in all the teaching hospitals.
It is no longer a woman’s problem although it affects women more often. It’s everyone’s problem. If women leave the workforce, men suffer, male patients suffer, male colleagues suffer. It is therefore no good for women to leave the labor market. And there is very good data to point out that the work environments where women are happy and women are present are diverse and better. They have better [patient] results, they perform better, they retain better, and therefore it is not beneficial for anyone to leave the labor market.
Anytime you have really steep hierarchies you’re going to end up with bad results and a bad environment. We know that for patient safety, steep hierarchies suppress information and interfere with communication. And so we have to flatten the hierarchy, and allow the vulnerable people down there to speak up when things don’t go their way, in a non-punitive way.
We can learn from other industries that have actually made these changes. Medicine is often slow to change.
I believe a lot in defender training and I really go from being a spectator to a defender. To really have a good workforce, we have to take this approach where we are all in the same boat. And so the allies really have to take it upon themselves to have this honest training, and to call it right when they see it, to help interfere, to be a partner or a co-conspirator.
The real challenge is how to get people to overcome inertia to have activating energy. This is where leadership comes in. Leaders need to be courageous to tackle these issues.
I am really inspired by young people. They weren’t cluttered by the way it was. They rule with their hearts and as things should be. And sometimes when we are in leadership positions, we can feel limited by the shackles in our organization and what we can say, because that is what our organizations value.
But at the same time, looking at young people gives me hope, because I was one of those people, and I will always want to say, “How can I keep this? How can I keep talking to make it clear that we need to change, and that change is coming from many, many people calling and asking for the same.
I look at the American Medical Association as an example where the House of Delegates approved the report which recognizes the historic legacy of racism in medical education. This effort was student led… so we could make these changes.
We can leverage our learners to help lead us and they can mentor us, they can be our reverse mentors. I often see a lot of people who feel very strongly inside that they are allies, but they are too afraid to say anything. These are especially men in power because they fear saying the wrong thing or being jumped on.
And for the allies, I would say we have to create a psychological space for people to get it wrong and redeem themselves anyway, because people are going to be wrong. Because now their fear drives them to silence. And then the cost of this silence is really, really deafening.
The “Visible Voices” podcast covers topics such as healthcare, equity and current trends. The episodes drop weekly and can be found anywhere you listen to podcasts.
Tune in on July 8 at 4:15 p.m. for an Inquirer Live-Health conversation on the future of work for women in healthcare, moderated by Health Editor Charlotte Sutton, and featuring Lewiss and Amie Archibald-Varley, RN, Quality and Patient Specialist at Niagara Health and co-creator / co-host of “Gritty nurse ” Podcast; Suzanne Chong, PhD, personnel psychologist, Ursinus College, founder of Clarity and Insight Counseling Services; and Natalia Ortiz-Torrent, MD, medical director, consultation and liaison psychiatry, Temple University Hospital. Register on Inquirer.com/HealthReport.