AAMC President and CEO David J. Skorton, MD, and AAMC Board Chair Kirk A. Calhoun, MD, challenged physicians and scientists from U.S. medical schools and teaching hospitals on Nov. 13 to work collectively to improve the health and mental well-being of colleagues and communities.
Nearly three years after the COVID-19 pandemic caused massive upheavals in the nation’s health care system — in response to which “learners, faculty, staff, and leaders have risen to the occasion magnificently” — challenges remain. “We find ourselves still in a situation of fragmented communities, often bitterly divided public opinion, and severe difficulties hearing and listening to each other,” Skorton told more than 4,200 medical professionals during the leadership plenary of Learn Serve Lead 2022: The AAMC Annual Meeting in Nashville, Tennessee.
Deep-seated inequities, worsening learner well-being, threats to the sanctity of the doctor-patient relationship, and the inability of those with opposing viewpoints to find common ground were among the challenges identified by Skorton as those that “keep him up at night.” Calhoun likewise identified similar “headwinds” to fulfilling the multiple missions of academic medicine.
“Academic medicine lies at the nexus of higher education and health care delivery. Both exist in very treacherous waters of rapidly changing expectations, misinformation, partisan debate, and economic pressure,” said Calhoun, president of the University of Texas at Tyler and chair of the board of directors for UT Health East Texas. “As we engage in informed and heartfelt dialogue based on the facts, I beg you to never forget the immediate unmet needs of our patients and their families, our students, faculty, and community.”
Calhoun urges renewed attention to increasing diversity in medicine
Calhoun began his address with a personal story of growing up “a poor, asthmatic, Black child, bedridden in my mother’s living room.” Indeed, the young Calhoun was too ill to attend school and relied on nuns from the parochial school in his community to come to the house to give him lessons.
That all changed when his mother was able to get him an appointment to see an allergist at an academic medical center in Chicago. The doctor, who was Black, examined him and then said, “I know what this is, and I know how to fix it.” Those words, spoken by someone who looked like him, completely changed the course of Calhoun’s life, sparking in him the ambition and drive to become a physician.
Unfortunately, though, there are still far too few physicians of color, despite yearslong efforts by the AAMC and other organizations, Calhoun noted.
Calhoun recounted the history of efforts to increase the diversity of medical school classes, including a campaign in the early 1990s known as the “3000 by 2000” project. By the time the project ended in the year 2000, it fell 700 students short of its goal. “We have so much more we must do,” Calhoun said. “It is important we do not let today’s ongoing headwinds deter us.”
Calhoun pointed to the AAMC’s strategic plan as identifying some of the other issues for which the opposing headwinds are strong and that require the membership’s attention. These include efforts to improve opportunity, medical education and research, and access to care, but he said that working together, academic medicine can achieve measurable success for patients and learners.
“The accomplishments of academic medicine are immense, and despite the headwinds, our future will be even more remarkable,” he said. “The future journey of academic medicine is in the best of hands. It remains in your hands.”
Skorton highlights four concerns that “keep me up at night”
While lauding academic medicine’s extraordinary response to the COVID-19 pandemic, Skorton also identified four problems that still plague the nation’s health care system but are within the power of academic medicine to solve or at least improve.
The first is the need to improve diversity, equity, inclusion, and anti-racism. “The health inequities that have long plagued our health system are rooted — in part — in bias, discrimination, and systemic racism,” he told the audience. “And it is our responsibility in medicine to address these issues whenever we have the opportunity. Not only because we have to in a professional capacity, but because we have to as human beings.”
In academic medicine, a successful journey toward justice means diversifying medical school classes, faculty, and staff and optimizing the culture and climate of academic medical institutions so that every individual has the opportunity to excel, Skorton said.
The second concern is a deterioration in the well-being of students, due to financial as well as social and academic pressures. “Depression, and therefore the risk of suicide, is more common among medical students than their age-matched peers, and this trend has worsened in the last few years,” Skorton said.
He called on academic medicine leaders to identify and address the problems contributing to student stress, as well as to improve access to behavioral health care for all who need it.
The third concern that worries Skorton is increasing threats to the doctor-patient relationship. This has manifested itself most recently in the Supreme Court’s overturning of Roe v. Wade, which has jeopardized access to reproductive health care for millions of people.
“I am not here at this moment to argue the merits of access to abortion,” Skorton said. “I am here to argue that legislation or judicial opinions that interfere with the relationship between physician and patient, especially if they go as far as intimidating the clinician in the exercise of good clinical judgment, are unacceptable. We must stand firm. We must protect this relationship.”
Finally, Skorton called out the value of free speech and the need to listen to divergent viewpoints. “Let’s challenge ourselves across ideologies to be humble, to be kind, to be empathetic, and to be respectful, and to actively listen and truly be open to other opinions, even if they are different from our own.”
At the same time, he urged the audience to speak out against “intentional and inflammatory disinformation” and to condemn “hate speech, racist speech, or speech that incites violence, including violence against health professionals.”
“As in all of the other issues that keep me up at night, the issue of free speech requires our collective action now,” he added. “The health and mental well-being of our communities and our colleagues are at stake. Through meaningful, open, and honest dialogue, partnership, and collective action, we can and will tackle these problems in service of the greater public good.”
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