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To inspire the next generation of underrepresented in medicine (URM) educators, the STFM Foundation is launching a year-long blog series. In the new series, The Path We Took, URM members will share the path they took to become faculty and leaders in family medicine. This post was written by Edgar Figueroa, MD, MPH

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One African American Woman’s Leadership Journey

STFM Blog

Judy Washington, MD Judy Washington, MD

To inspire the next generation of underrepresented in medicine (URM) educators, the STFM Foundation is launching a year-long blog series. In the new series, The Path We Took, URM members will share the path they took to become faculty and leaders in family medicine. I’m delighted to kick off the series by sharing my own leadership journey.

One African American Woman’s Leadership Journey

When you have the privilege to serve in leadership, you have the responsibility to reach back and identify other colleagues who would not otherwise have the opportunity to be recognized. You can do this through mentoring, building systems to support the underrepresented, or financially supporting the individuals or the systems that assist them.

When the opportunity was presented to be a cochair of the Minority and Multicultural Health Collaborative, I said “Yes!”  I was fortunate to work with two wonderful African American women…

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One of Those Kids in That Class Is Me and They Deserve a Chance

STFM Blog

Crichlow_R_2015 Renee Crichlow, MD

In the last couple of years, I have been a co-teacher in an undergrad program part of whose mission is to increase underrepresented in medicine (URM) students in our medical school. There are many reasons I have chosen to do this and to fully understand, I thought it would be important to share a little bit of my student career history.

To begin, nothing in here is about bragging. It’s really about sharing a story that may be similar to what others have seen.

My high school was a very high performing public school: we had 13 National Merit Scholars in the year I graduated, and I was one of them. (Except at that time in 1985 my award was called National Merit Outstanding Negro Scholar. I’m not joking. That’s exactly what it was called in 1985.) I mention this because it’s an indication of the fact…

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Happy Father’s Day

I have been fortunate to have experienced the effect  loving fathers  have on the lives of their families, friends and colleagues. My grandfather was the ideal father.  He was always so loving and caring.  He never raised his voice but when he did it was well deserved. He provided for 10 children and scores of grandchildren, great-grandchildren, nieces, nephews, friends and everyone else who found themselves in our extended family.  We called him “Big Daddy.” To others, he was Mr. John, Uncle John and Mr. Waldrop.  I cannot forget my uncles who were my mother’s brothers and her sister’s husbands. They cared for all of us like we were their own children.  My parents were divorced when I was five years-old so they all filled the void.

The others were patients I have cared for over the years.  So many of them I met because their wives pushed them in to the office.  When they finally got there, they often shared why they were so reluctant to come. Many thought I was just this kid and I had to win their respect with my skill. Once accomplished, they came in and confided in me.

They appeared to be healthy hard-working husbands and fathers. Unfortunately, I diagnosed quite a few with untreated hypertension, cancer and diabetes. It can be the hardest thing a man does when he admits he has an illness.  I found what I thought was just a cyst on a patient’s back.  It turned out to be metastatic kidney cancer.  He was so strong through the ordeal.  Most concerned about his wonderful wife and his children.  His wife was my patient. It was not a prolonged illness and he did not have a  long battle.  We did not have many treatment options.

My favorite couple was one of my most tragic cases. Mr. C ‘s wife had multiple medical problems. Through it all he was there. She developed a blood clot in her leg and then we finally diagnosed cancer of the kidney. We transferred her to the University Hospital but she died during surgery. He was devastated.  Every visit was not about his medical problems but about the loss of his wife, soul mate after more than thirty years of being together.  He was comfortable enough after all this time to reveal how lost he felt. He was overwhelmed by the advances from women who wanted to take his wife’s place.  He was surprised because many of them were her friends.  I tried to be helpful and not offend him. I told him he was such a good husband that they wanted to have the same loving relationship. He was not ready.  I found myself giving him tips on how to handle those lovely church ladies many of whom I knew because they were patients or I knew them through my work in the community. He would just say “She was a beautiful woman and no one can replace her.”

One of my colleagues, Dr. S, entrusted the care of his beloved wife to me. It was a compliment but I felt I had failed the first time I admitted her to the hospital. I soon learned that he had been taking IV bags on vacations just in case she had a problem. She had decided he needed support. She was devoted to him. She would tell me stories of the old days when doctors lived in the hospital housing.  She was a nurse and that is how they met.  She held the family together while he was always in the operating room.  They lived on what she earned because residents had meager salaries at that time. He was the beloved surgeon. She had managed his office and his life. When she died, I remember telling him to take care of himself.  He had retired.  His daughter-in-law hugged him and said that was her responsibility now and she was honored to do it.  He had been there for everyone.  I did respect his philosophy; he was going to use all the money he made to enjoy time with his wife.  He planned to leave no money for his children and they knew that.  However, he left them more, the legacy of his hard work and total devotion to them.

We always think the smoker will get lung cancer. Sometimes, it is the innocent one who spent all those years saying, “Please stop smoking.” Finding out that the lung mass in the non-smoking wife is cancer can be devastating to the family.  When that cancer is one typically associated with second-hand smoke exposure, it is especially hard.  I had cared for the wife and my male colleague, her husband. She died from her cancer. He had to go on and struggle through her loss and unfortunately, emphysema. His daughters took care of him because he was a loving father and husband who made sure they all had the best.

Father’s Day is a time to honor those men who love and support their families. I remember admitting a dad who had developed pertussis (whooping cough). The pediatrician admitted the infant daughter.  He was so upset that he had been the one to make his child sick.  We explained this can happen

Loving husbands and fathers make a difference. My husband has cared so lovingly for his children. He spent many hours taking our son to the Pediatrician alone for shots.  It was difficult for me to get away from my training and later the office.  He did the soccer games, tennis lessons and all the homework.  He was the Book Fair volunteer; he and another Dad would make sure the kids made smart book choices.  He was the chaperone on the school trips. He made all the visits to the orthodontist for the braces, found the Barber for the haircuts and scheduled the music lessons.  He cooked all our meals and even did the laundry.   He also just made sure I was always safe and loved as I navigated my professional career.  He made some sacrifices that made it possible for me to focus on my career goals.

Happy Father’s Day!!!!

Yes, Medicine too

“Many white Americans of good will have never connected bigotry with economic exploitation. They have deplored prejudice but tolerated or ignored economic injustice”. Dr. Martin Luther King Jr, Why we can’t Wait, 1964

My mother worked two jobs to support the three of us. She did refuse to clean houses.  That was not where she saw herself day in and day out.  She landed a job in an upscale boutique in a wealthy section of Birmingham.

I learned early in my life about racism and sexism and how it can hold a family back. When I applied for summer jobs, they were always filled. The jobs in fast food restaurants that paid well went to white students and the openings in our community were filled.  So, I was a camp counselor for free, taught vacation bible school and did a summer science program.

I have never made a comparable salary to white male or female colleagues. As a minority or Underrepresented in Medicine (URM) physician, you are always negotiating a contract; you find out later that even when you asked for the higher salary, it is negotiated down to a lower salary.  You have a suspicion that the salary is low but you really want the position because it is the next logical step in your career. I remembering emailing back and forth with one department chairman furiously trying to get the salary higher only to he was just trying to save money.  I found out later, that he had offered a higher salary to the male and he turned it down because it was too low.  When I asked for a comparable salary to what I was making, he said he couldn’t meet that.  I wanted the position so I took it.  Every time, I got a new committee position or asked to head a committee, my husband would ask “Does that mean you get a raise?” My answer “No, just more work and late nights.”  I spent hours putting together reports, presentations, new curriculum and taking courses to increase my credentials.  I did get finally get merit pay and bonuses after the second year but there were later budget constraints and the end of the grant that paid my salary.  Such is the fate of many URM academic physicians.

I left one position and in asking me to say, my boss said, “I realized when you gave notice that I should have been paying you more for all the work you were doing.” I had tried for over a year to negotiate a bonus structure but she was resistant to the idea.  She even refused to negotiate a contract.  When I left, I was happy that I could leave without any contractual obligations.

My first job out of residency revealed that the hospital administrator knowing lowered the salary and my later partner knowing allowed me to be cheated. I took that knowledge and went on to build a successful practice by taking on contracts as a consultant to increase our practice revenue and my credentials.

Even in medicine, women but especially URM women are paid far less than their white male counterparts. I support the “Time’s up Now Movement.” In every place of employment in the US, we need to have an open review of job descriptions and salary compensation for men and women.

“Injustice anywhere is a threat to justice everywhere”. Letter from Birmingham City Jail, 1963

“Each time a [ woman] stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, [she] sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring those ripples build a current which can sweep down the mightiest walls of oppression and resistance.” ― Robert F. Kennedy

As we commemorate Martin Luther King Day, let’s recommit to fight racism and social injustice.

Happy New Year

I am so glad 2017 is coming to an end.  I hit the big 60 this year and that was a high point.  However, the low points cannot be overlooked.

Socially and politically, we witnessed outrage and disgust. Women marched on Washington.  The blatant assault on our rights was too much and women of all cultures and faiths banded together across the world to demonstrate in record numbers.  Black women in Alabama stood together and drowned out the overt racist, sexist and vulgar representation from one man and sent a powerful message across the world.  I had the pleasure of celebrating that victory with two friends  and my husband with dinner and  a bottle of the best champagne I have ever had.  But once again, I was appalled by the number of people who voted for this person.  It mirrored the horror of the presidential election but with poetic justice.  So, I do admit I am having a hard time talking with and listening to people who say they voted the way did to protect “Christian values”. Because, there was nothing Christian displayed.

On the right to vote, Dr. Martin Luther King said:

“Voting is the foundation stone for political action.”

The unspeakable acts committed against women in the workplace was especially upsetting.  This behavior highlighted the lack of diversity, the abuse of power and the ineffectiveness of the present training.   However, despite what we have heard,  there are still so many other stories out there to be told. So many of these incidents happen daily in workplaces in small towns and in immigrant communities.  Women forced to survive and care for themselves and their children are victims.  In doctors’ exams rooms, women tell horrific stories, we listen and offer support.  We can’t force them to file complaints with Human resources or the police.  Many are scared because of their undocumented status.

Dr. King on silence:

” Our lives begin to end the day we become silent about things that matter.”

In healthcare, the defeat of the whatever that awful bill was to overturn the Affordable Care Act was a step but the erosion to that law is going to have major consequences. Many aspects are not being funded.   I am a medical educator. That means I am paid to mentor the next generation of primary care providers. Very few Americans understand how we pay for medical education in this country. Well, it is paid for by first the student who decided to go to medical school.  The average student completes medical school with over $200,000 worth of educational loans.  They enter residency training and then out to practice or into fellowships.  The need for primary care physicians is great and the number is growing too slowly.  The Graham Center has projected that in order to maintain current rates of utilization, New Jersey will need an additional 1,116 primary care physicians by 2030, a 17% increase compared to the state’s current (as of 2010) 6,236 PCP workforce.  Compared to the Kentucky, which will need an additional 624 primary care physicians by 2030, a 24% increase compared to the state’s current (as of 2010) 2,520 PCP workforce.  To achieve this, we will need an increase in dollars directed toward Graduate Medical Education and medical education debt relief. So, I hope you see why I am not cheering my tax savings because I and all of you are losing a whole lot.  The tax cuts will be “disastrous”.

The blatant attack on the Children’s Health Insurance Plan shows the lack of insight and compassion to understand the implications of not insuring children and protecting their families.  Many parents are forced to leave their jobs to care for children with chronic medical conditions or acute illnesses that require extended hospitalizations.  Parents need their children to be covered because they forfeit the insurance once provided by their employers.  If the other parent picks up the cost of providing that benefit, then the cost is much higher.  In our office, we see daily the benefit of children getting Medicaid.  Newborns are covered from the moment they are born. Both inpatient and outpatient care is provided.  The immunizations are covered.  The other assault is on Federally Qualified Community Health Centers.  They provide the care in communities across the country that are underserved by primary care physicians.  Care is based on income and they provide care to Medicaid and underinsured patients.  The number of these FQHC’s were expanded under George Bush’s administration. Physicians in these FQHC’s are often recipients of loan assistance through the National Health Service Scholarship program.  The funds for this program are included in the Affordable Care Act.

Despite all of this, I do remain hopeful.  If the success of the vote in Alabama teaches us anything, it does show the power of voting and we should never sit home again and feel that our one vote does not count.  It does and it can change the world.

Martin Luther King quotes for the New Year:

 

“The whirlwinds of revolt will continue to shake the foundations of our nation until the bright day of justice emerges.”

 “With patient and firm determination we will press on until every valley of despair is exalted to new peaks of hope, until every mountain of pride and irrationality is made low by the leveling process of humility and compassion; until the rough places of injustice are transformed into a smooth plane of equality of opportunity; and until the crooked places of prejudice are transformed by the straightening process of bright-eyed wisdom.”

Vacations are important

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Definitions of vacation include ” a period spent away from home or business in travel or recreation”  I just had a long vacation.  It started on a Friday a and ended on a Wednesday 12 days later.  I a great deal of my time being asked and answering questions for my patients, residents, staff and administrators. I think vacations are important. I think I waited too long to take this one. I had so many tasks to complete to end one academic year and start a new one.  Research day completed, new rotations updated and arranged and lectures planned.  Also starting our new resiliency curriculum.  Last year at this time, I was starting a yoga instructor training program.  I completed it in December.

It started with delayed flights on Friday.  Finally arriving in Puerto Rico.  I had a brief rest after getting to the hotel at 5 am on Saturday.  We had a beautiful walk on the nearby public beach (all the beaches in PR are public).

Then a  tour of Old San Juan.  I am ashamed to say this was my first visit but it will not be my last one.  We had traditional food at Raices Restaurant in Old San Juan.  It was so good we went back on Sunday.

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We boarded our Carnival Cruise ship, the Fascination.  We were off to celebrate my stepdaughter’s 40th birthday.  I started the cruise with a long massage. It set the tone for what would be a very relaxing vacation.  We embarked to our first destination.

 

 

St. Thomas was sunny and beautiful.

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View of ship docked in St. Thomas

After a rainy day at see, we were rained out in Barbados and St. Lucia.  We did brave the rain but ended up getting a ride back to the ship.

St. Kitts was sunny and we did the Island tour.

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We spent the last day in beautiful St. Maarten

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We ended up back in Old San Juan with a tour of Bacardi.  It was living history through the story of rum.

I will not wait so long for another vacation.  I hope to stay connected to this sweet feeling of relaxation and calm. The best part of the trip was spending it with the ones you love.

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The War on Drugs or Not?

I try to reinforce to my doctors in training the importance of getting a social history from their patients.  Where do they work, what are they job responsibilities, where they live, do they drive and of course family connection?  This also includes a sexual and history.  The last is the substance abuse history.  More and more, patients are admitting to use of marijuana which doesn’t surprise me.  The opioid pain-killer and heroin use is hidden from us when we ask but we have to start pushing to get the answer.   We have to be more comfortable discussing opioid misuse and abuse with our patients.

I have found that our Black and Latino population does not use drugs in the numbers we would think.  The myth of their increased use had been perpetuated in the news media until recently. We have a large Latino population in our practice.  Most of our Black and Latino female patients do not smoke drink much less use drug.  Our Caucasian patients are more likely to be smoking marijuana, drinking socially, using opioid pain killers and heroin.  That is a fact that is now just being openly discussed and represented in the news media.  This graph shows the shift.  You would be wrong to think this represents more Non-Hispanic whites seeking help than Non-Hispanic blacks.  It clearly shows the dramatic increase in the number of addicted white patientsOpioid Stats

I was a medical student and a resident during the devastation of the Black community from drug addiction and AIDS and the cruelty of the “War on Drugs.” We asked for more drug treatment and needle exchange programs.  We got more prisons, harsher jail sentences and cutting of funding for treatment.  Now the face of the addiction epidemic has morphed from the Crack Cocaine addicted black face to the Opioid Addicted white face with an epidemic proportion of overdoses and deaths.  No jail time.  I remember that tragic scene from “Lady Sings the Blues” as Billy Holiday (Diana Ross) is locked up and withdrawing in such pain and agony.  Congress has the opportunity to right a terrible wrong by increasing the funding for the Opioid epidemic.  That will not erase the harm done to our community but it will finally acknowledge that addiction is a medical problem. The psychosocial problems that Americans face and are now leading to lack of hope must also be addressed.

Death rates

The other issues in the Health Bill such as keeping funding for Planned Parenthood, keeping the mandate for coverage of contraception and maternity care are crucial to the health of women. White females are dying at higher rates from opioid overdoses.  Their rate is higher than that of Black and Latino women.  White males now have the highest rate at present.  Drug use among white suburban teenagers is increasing while it is decreasing in Black and Latino teens.  These are just the facts.

Some part of me is angry that the Black community had to suffer such devastation without much help.  Black and Latino teens will always be arrested and serve time for drugs.  They can’t get into medical or law school. They are limited in their career choices. Now whites, are still less likely to serve time because their parents call for treatment and less strict drug enforcement is being heard.

I started reading The New Jim Crow: Mass Incarceration in the Age of Colorblindness by legal scholar Michelle Alexander. I had to put it down because it evoked such emotion.  All the people in the on-line book group I was in had the same feelings. “Black people comprise just 13 percent of the U.S. population and use drugs at a similar rate as other racial and ethnic groups – but they comprise 29 percent of those arrested for drug law violations and roughly 35 percent of those incarcerated in state prison for drug possession only.”  These are the facts.  Until we as a country address this issue, we cannot move forward in the treatment of addiction as a medical not legal problem.

It is compassionate care but if we punish one group and have leniency with the other it is not justice and medical care is not provided equally