Recruitment and retention of underrepresented minorities in cardiovascular medicine

1
Recruitment and retention of underrepresented
minorities in cardiovascular medicine

• Michelle A. Albert MD, MPH
• Assistant Professor of Medicine
• Harvard Medical School
• Brigham and Womens Hospital,
• Divisions of Cardiovascular and
• Preventive Medicine
• Boston MA

2
Underrepresented minority URM
Population projections for the united states by
race and ethnicity

• The AAMC defines URM as
• Blacks
• Mexican Americans
• Mainland Puerto Ricans
• Native American / American Indians
• Native Hawaiians

Percent of US Population
Acosta and Olsen, Academic Medicine 2006
3
CVD Mortality, Race/Ethnicity and Gender
Mortality Rate (No./100,000)
For Whites and Blacks Data presented is overall
CVD death rates for 2003. For Hispanics, American
Indian/Alaska Natives and Asian Pacific Islander
data presented is age adjusted death rate from
heart disease, for 2002.
American Heart Association. 2006. Heart Disease
and Stroke Statistical Update.
4
CVD Mortality Rates, Race/Ethnicity and
GenderUNITED STATES, 1980-2001
Mensah et al, Circulation 20051111233-1241
5
IMPORTANCE

• Provide highest quality of care to all patients
• Ensure comprehensive research agenda
• Just and equitable access to rewarding careers
• Use of the rich and diverse pool of the nations
  talent to better manage the health care system
• Significant race/ethnic disparities in morbidity
  and mortality in USA
• URM will comprise a significant component of US
  population

Adapted from Newman et al, Cancer 2003
6
(No Transcript)
7
Urm enrollment in medical schools
Medical school matriculants, 1980-2000 (expressed
as a percentage of 1980 matriculants)
Acceptance rates for URM and non-URM applicants
to medical school, 1974-2001
Francis et al, JACC 2004
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
Cardiologists in Training (2002)2223
Source Cardiologys Workforce Crisis A
Pragmatic Approach 35th Bethesda Conference-2003
13
Distribution of Cardiologists 21, 726 TOTAL
21,726
Source Cardiologys Workforce Crisis A
Pragmatic Approach 35th Bethesda Conference-2003
14
Developing Immediate Use Strategies for
Increasing URM Cardiovascular Candidates

• Recruitment
• Retention
• Screening
• Barriers for specialty choice and sustainability

15
Barriers to urm entering into subspecialty
(cardiology)

• Lack of encouragement
• Lack of role models
• Lack of traditional training path (e.g. research
  experience)
• Lack of preparation (e.g. poor mentoring and
  feedback in residency, steps for corrective
  action)
• Debt
• Discrimination

16
Developing Immediate Use Strategies for
Increasing URM Cardiovascular Candidates
leadership
resources
commitment
17
RECRUITMENT STRATEGIESInstitution Specific

• Identify barriers in the external environment of
  the program
• Access non-medical URM professional/non-profession
  al networking organizations
• Faith based liaisons/collaborations
• Everyday resources
• Create a recruitment package to reflect the
  above/invite participation in the recruitment
  process by networking organizations
• Identify and address barriers in the internal
  environment of the program
• Examine URM trainee experiences on cardiovascular
  rotations
• Timely feedback
• Minimize isolation
• Resident self assessment
• Chairperson commitment to diversify program
  more than lip service

18
RECRUITMENT STRATEGIESInstitution Specific

• Proactive mentoring
• Cardiovascular faculty actively engage URM
  medical students, new residents and fellows
• Mentorship (recognition for role, )
• Funded positions (AHA/ACC/?Min. Org.)

19
RECRUITMENT STRATEGIESSystemic

• Target potential applicants at URM oriented
  conferences (e.g. NMA, ABC, ISHIB etc.)
• Conferences
• Joint sponsorship of URM trainees to AHA/ACC by
  AHA/ACC/Minority organizations
• Biennial Conference for URM sponsored by AHA/ACC
• Target group URM medical students, residents and
  fellows
• Others senior faculty
• Topics to address
• Why choose a cardiovascular subspecialty
• Emphasize diversity of career opportunities
• Establish mentor-mentee (national/local) for
  those interested
• Address how to prepare successful applications
  for cardiovascular fellowships (? additional
  clinical / research experiences required)
• Conference self assessment

20
Recruitment Conferences contd

• ACC/AHA should engage URM trainees in society
  activities early on (e.g. travel awards,
  mentorship, race/ethnic population committees)

21
RECRUITMENT STRATEGIESSystemic

• Target historically URM institutions create an
  alliance between selected URM institutions and
  traditional majority institutions
• Choose a consortium of non-URM institutions in
  different categories (private/state)
• Each majority institution commits to a
  pre-defined URM representation goal at 5yrs 10
  yrs.
• Faculty advisors that includes cardiovascular
  dept. chairs and deans of medical schools
• Co-mentored opportunities
• Research opportunities

22
Retention

• Mentorship
• Inclusive environment
• Faculty
• Examine how to develop URM leaders in academic
  medicine

23
(No Transcript)
24
A look at Academic Faculty Promotion
Assistant professors RR0.68
(0.59-0.77) Associate professors RR0.81
(0.65-0.99)
URM Underrepresented minority, including black,
Mexican American, Puerto Rican, Native Americans
and Native Alaskans. Fang et al, JAMA
20002841085-1092
25
Predictors of Promotion
URM Underrepresented minority, including black,
Mexican American, Puerto Rican, Native Americans
and Native Alaskans. Statistically significant
- 99 confidence interval does not cross 1.0
Fang et al, JAMA 20002841085-1092
26
Minority Faculty Holding Senior Rank
Underrepresented minority black, Mexican
American, Puerto Rican Palepu et al, JAMA
1998280767-771
27
Academic Activities and Productivity
Includes Grants from the NIH, Agency for Health
Care Policy and Research, Health Care Financing
Administration, Veterans Affairs, Military and
other federal, state and local government
sources Palepu et al, JAMA 1998280767-771
28
Demographics, Specialty Choices and Compensation
1,807 Full Time Faculty
? URM Faculty differed significantly from
majority and other-minority faculty on pairwise
testing Palepu et al, Academic Med 2000
29
Brigham and Womens Hospital Senior Faculty
Experience Strategies to improve URM faculty
leaders

• Training of search committees to recognize and
  address bias in the search process Policy
  statement on this issue
• Providing assistance in obtaining skills
  necessary to attract NIH/Industry support
• Ability to take ownership of academic component
  of clinical trial (sub-study/ancillary analysis)
  and take it to completion (high quality
  manuscript)
• Identification of individuals for steering
  committee and other leadership roles
• Ongoing and equitable financial support in both
  early and mid-years
• Address the larger problem commitment to higher
  quality public education at the earliest levels,
  and providing true equal opportunity

• Serving as co-investigators in clinical trials
  with established investigators Providing an
  opportunity to author manuscripts
• Improve minority representation in clinical
  trials and cohorts
• Formal training in clinical investigation /
  clinical trial design
• Building relationships with clinical/industry
  leaders through formal and informal symposia
• Established investigators should take the lead in
  introducing and reinforcing the recognition of
  minority faculty within their senior peer group
  of investigators Regional/national exposure for
  highly qualified individuals
• Affiliation with a large research group

Albert, MA 2007
30
Templates for successful retention of urm faculty

• UCSD Hispanic Center of Excellence (HCOE)1993
• National Center for Leadership in Academic
  Medicine (NCLAM)1998
• Data
• Number enrolled 140 junior faculty
• Number completed 112 junior faculty
• URM 13.4
• Others 86.6
• Following the institution of NCLAM, URM junior
  faculty retention in academic medicine went from
  75 (1991-1996) to 93 (1999-2005)
• Not statistically significant Daley et al,
  J Natl Med Assoc 2006

31
NCLAM Activities Required

• 12 half-day faculty development workshops on goal
  setting and preparing the academic portfolio,
  principles of teaching and learning, leadership
  styles, negotiation skills, stress, grant
  resources, conflict resolution, presentation
  skills etc
• Structured 7-month , one on one instrumental
  mentoring program (averaging 12 hours/month)
• Two hour academic performance counseling session
• A professional development project

32
The Seven P rinciplesStrategies for
Increasing Multicultural Investigators

• P atient Care P opulations
• P ipeline nurture, develop and promote mature
  investigators
• P rocesses understanding how selection occurs
• P ositioning / P osturing networking
• P redicting P riorities understand
  NIH/Industry research priorities
• P ressure Application
• P ersonal Economics

Albert, MA 2007
33
Need for Program Assessment

• Create databases to track the success of programs
  designed to promote URM faculty retention
• Public reporting of institution performance (all
  / top NIH)

34

• THE OFT FORGOTTEN GROUP
• UNDER-REPRESENTED MINORITY WOMEN

35
Distribution of us medical school faculty

Wong et al, J Womens Health Gender-Based
Medicine 2001
36
Landscape for URM Women Faculty

• Slower growth in faculty positions than other
  women
• Most of growth in historically black medical
  schools
• Connections to larger womens initiatives weak
• Significant financial obstacles

37
Thank you