May 13, 2021 — The American Medical Association has released a 3-year strategic plan to counter longstanding health inequities that hurt marginalized communities and to improve the AMA’s own performance in this regard.
The 82-page report, which was created by the association’s Center for Health Equity, argues for both internal changes at the AMA and changes in how the association addresses race-based inequities in general.
The report was released just 2 months after WebMD reported that a podcast hosted by AMA’s top journal was lambasted as racist and out of touch. In the podcast, entitled “Stuctural Racism for Doctors – What Is It?”, one JAMA editor argued that structural racism doesn’t exist. He eventually resigned and the journal’s top editor was placed on administration leave.
The new AMA report’s strategic framework “is driven by the immense need for equity-centered solutions to confront harms produced by systemic racism and other forms of oppression for Black, Latinx, Indigenous, Asian, and other people of color, as well as people who identify as LGBTQ+ and people with disabilities,” the AMA said in a news release. “Its urgency is underscored by ongoing circumstances including inequities exacerbated by the COVID-19 pandemic, ongoing police brutality, and hate crimes targeting Asian, Black, and Brown communities.”
The plan includes five main approaches to addressing inequities in health care and the AMA:
- Implement anti-racist equity strategies through AMA practices, programming, policies, and culture.
- Build alliances with marginalized doctors and other stakeholders to elevate the experiences and ideas of historically marginalized and minority health care leaders.
- Strengthen, empower, and equip doctors with the knowledge and tools to dismantle structural and social health inequities.
- Ensure equitable opportunities in innovation.
- Foster truth, racial healing, reconciliation, and transformation for AMA’s past by accounting for how policies and processes excluded, discriminated, and harmed communities.
As the report acknowledges, the AMA has a long history of exclusion of and discrimination against Black physicians, for which the association publicly apologized in 2008. Within the past year, the AMA has reaffirmed its commitment to addressing this legacy and to be proactive on health equity.
Among other things, the association has described racism as a public health crisis, stated that race has nothing to do with biology, said police brutality is a product of structural racism, and called on the federal government to collect and release COVID-19 race/ethnicity data. It also removed the name of AMA founder Nathan Davis, MD, from an annual award and display because of his contribution to explicit racist practices.
The AMA launched its Center for Health Equity in 2019 with a mandate “to embed health equity across the organization.” Aletha Maybank, MD, was named the AMA’s chief health equity officer to lead the center.
In the report that Maybank helped write, the AMA discusses the consequences of individual and systemic injustice toward minorities. Among these consequences, the report says, is “segregated and inequitable healthcare systems.”
The “equity-centered solutions” listed in the report include:
- End segregated health care.
- Establish national health care equity and racial justice standards.
- End the use of race-based clinical decision models.
- Eliminate all forms of discrimination, exclusion and oppression in medical and physician education, training, hiring, and promotion.
- Prevent exclusion of and ensure equal representation of Black, Indigenous and Latino people in medical school admissions as well as medical school and hospital leadership ranks
- Ensure equity in innovation, including design, development, implementation along with support for equitable innovation opportunities and entrepreneurship.
- Solidify connections and coordination between health care and public health.
- Acknowledge and repair past harms committed by institutions.
Changing medical education
In an exclusive interview with WebMD, Gerald E. Harmon, MD, president-elect of the AMA, singled out medical education as an area that is ripe for change. “One of the most threatened phenotypes on the planet is the Black male physician,” he said. “Their numbers among medical school applicants continue to drop. We have increasing numbers of women in medical schools — over 50% of trainees are women — and more Black women are entering medical school, but Black men in medical school are an endangered species.
“We’re trying to get the physician workforce to look like the patient workforce.”
Harmon cited the “pipeline program” at the Morehouse School of Medicine in Atlanta and the AMA’s “doctors back to school” program as examples of efforts to attract minority high school students to health care careers. Much more needs to be done, he added. “We have to put equity and representation into our medical workforce so we can provide better high quality, more reliable care for underrepresented patients.”
Putting the AMA’s house in order
In its report, the AMA also makes recommendations about how it can improve equity within its own organization. Over the next 3 years, among other things, the association plans to improve the diversity of leadership at the AMA and its journal, JAMA; train all staff on equity requirements; and develop a plan to recruit more racial and ethnic minorities, LGBTQ+ people, and disabled people.
Maybank, the AMA’s chief health equity officer, told WebMD that she wouldn’t describe these efforts as affirmative action. “This is beyond affirmative action. It’s about intentional activity and action to ensure equity and justice within the AMA.”
The AMA has to thoroughly examine its own processes and determine “how inequity shows up on a day-to-day basis,” she said. “Whether it’s through hiring, innovation, publishing or communications, everybody needs to know how inequity shows up and how their own mental models can exacerbate inequities. People need tools to challenge themselves and ask themselves critical questions about racism in their processes and what they can do to mitigate those.”