the health disparities podcast

195: Fostering tomorrow’s healthcare workforce: Opening doors & opening minds

The case for diversity in healthcare professions is strong. Research shows that a diverse healthcare workforce improves health outcomes, particularly for patients of color, and also increases people’s access to care and their perception of the care they receive.

Physicians of color are more likely to build careers in underserved communities, which can contribute even more toward the goal of reducing healthcare disparities.

So, what does it take to cultivate a strong and diverse health care workforce? On this week’s episode, we gain insights from two knowledgeable guests, who spoke with Dr. Hadiya Green at  Movement Is Life’s annual summit:

• Dr. Cheryl Brewster, Senior Executive Dean for Access, Opportunity, and Collaboration and a Professor in the Department of Bioethics, Humanism, and Policy Roseman University College of Medicine
• Dr. Jarrod Lockhart, formerly an instructor at Morehouse School of Medicine, now Assistant Vice Provost, Education Outreach & Collaboration at Oregon Health & Science University

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The transcript from today’s episode has been lightly edited for clarity.

Dr. Jarrod Lockhart: I know I use my story when I’m talking to my students. I messed up in undergrad but part of that was, it was my first time out of the house, you know, under strict guidelines from parents, right? But I was finding myself, I was finding that identity. So beyond going to school, you’re going through life changes that happen, right? But I messed up. But I went and did a master’s program and all of that, and what I’m able to say, and even before I got into my doctorate program, I was able to say, hey, that doesn’t represent who I am. Let me show you who I am. And I walked them through the journey, right? I walked them through that journey to say what I learned at each step. I messed up in undergrad, but this is how I improved over time. And so I think mentorship is important to be able to share those stories so that students can build that muscle of not giving up, but also how to navigate those conversations.

Dr. Hadiya Green: You’re listening to the Health Disparities podcast – from Movement Is Life — being recorded live and in person at Movement is Life’s annual health equity summit. Our theme this year is “Health Equity: Solutions from Healthcare Leaders.”

I’m Dr. Hadiya Green, a steering committee member of Movement Is Life and doctor of physical therapy and founder of Healthy Healing Community. Today, we’re taking a deep dive into what it takes to cultivate a strong and diverse health care workforce. I’m joined by two illustrious guests who are going to help us unpack all this. Dr. Cheryl Brewster is the founding executive dean for equity, inclusion and belonging at the Roseman University College of Medicine in Nevada. And Dr. Jarrod Lockhart is the director of the Health Careers Exposure Program Academy at Morehouse School of Medicine in Atlanta. Both of you – welcome to the Health Disparities podcast. Thanks for being here!

Dr. Cheryl Brewster: Thank you for having us.

Green: Before we get into our discussion about the future of the healthcare workforce, let’s talk about where things are today. So I’ll start with you, Cheryl, how’s the healthcare workforce doing today, especially as we consider the lens of diversity, inclusion and belonging?

Brewster: Yeah, that’s a really important question, because these are the folks that are actually serving us today, and so as we look at what we’re seeing is a lot of health disparities in a lot of communities of color and amongst our aging population. We’re also seeing a couple of things. One, we have an aging physician population, so a lot of them are aging out of practicing medicine. We also are seeing our levels of diversity amongst our healthcare workforce are diminishing, actually, and so what has happened over the past 20 to 30 years, we’ve seen very stagnant numbers of what are considered underrepresented in medicine. So that would be African American, Latino or Hispanic American and Native American. And so when we look at those populations compared to their populace in the country as a whole, those numbers have gone down, and we’re not seeing the growth that we need to see in order to address health disparities in our communities. And so how is it? It’s tough going. I’m just going to be honest, it’s very tough going. You have communities that have long wait times to get an appointment with a family physician, or there might not be any specialists when it is within certain communities. So you know, we we really haven’t addressed healthcare needs across the board for this nation as a whole the way we should have, for a country as prominent and as esteemed as we are, I would like to see more diversity in our healthcare workforce overall.

 

Green: Thank you for stage setting us. So here at the Movement is Life Summit, the two of you have led us in a workshop that focused on several things, including the barriers or identifying barriers to entry to healthcare professions for underrepresented groups in particular. So Jarrod, I’d like to start with you, and can you tell us about some of the known barriers that there are to the entry into the healthcare workforce?

Lock: So yeah, great question. I’ll probably start here. So this financial burden, right? And I think not only from the undergraduate student perspective, professional student perspective, but even as we go down into the K-12 space as well, and that financial burden and limited resources when it comes to that so if I start in the K-12 space, many of the schools that we were, I’ve been in schools that don’t have computer labs. I’ve been in schools that just don’t have access to certain resources that are needed, even just to develop students professionally for a career in medicine, right? And so we’ve done some work around trying to write grants to be able to support those schools to make sure that those students have the skills that they need. So as a transition into college, is this conversation about financial burden, right? And so are they going to be able to take on undergraduate debt and medical school debt, right? All of that.

And so partnering with people in the community that allow that are focused on scholarship. You know, we have a partner called a scholarship academy that helps us in being able to help our undergraduate students and our high school students be able to get scholarships for both levels, right? And so I think that financial burden is a huge piece, but also this thing around, even when we talk about pathway program and all of that, I can’t put on a summer program and not think about stipends, right, because many of our students actually are working to bring to pay bills, right, and so if we can offer a stipend for shadowing, for internships and all of that, then it gives them this opportunity to earn while they learn, is what we say. And then it takes that burden of where I don’t have to work, I can actually come and focus on this exposure opportunity, focus on the resources and all of that. So we provide SAT prep. That’s a financial burden. MCAT prep, GRE prep, all of these are resources that these students will have access to because of that financial burden. So that’s a big piece in my mind. And then, of course, we kind of talk about mentorship too, having people that look like them, having people that are doing intentional mentorship that’s longitudinal and last, making sure that they know that they can make it no matter what route or failures may happen along the way, but also giving them access to shadowing and internship and job opportunities. So that mentorship piece is important.

Green: Thank you for talking about the routes and in the umbrella of mentorships, because that really leads us into the next question that I’ll address towards you, Cheryl, as far as pipelines are concerned, and I think Jarrod did an excellent job of leading us and giving us some of these pipeline holes as sometimes they’re referred to. So I want to ask you, what are ways that medical schools in particular, can help with these pipeline issues and with cultivating in mind a more diverse and inclusive workforce? And how early do you feel like these interventions should actually start?

Brewster: Right, so I think one of the things that medical schools really need to think about is they are in communities. They are not just a standalone entity, creating medical students right and future physicians. I think they need to recognize where they sit in the community and what they have have historically taken from communities, right without payment and sometimes without consent, and so they need to recognize the historical disadvantages that a lot of these communities in which they sit are facing. So I think it is their obligation to fund and what I call grow your own medical students. I should not have to look at students in I’m in Las Vegas. I shouldn’t have to look to California for my student body. I should be able to look to my community, my direct state, and say, I want to provide Nevada students with an opportunity to go to medical school should they so desire? Medical schools have an obligation to provide opportunities for students that want to pursue those dreams, and they need to invest in pathway programs. Bottom line, like a dedicated budget line item every year that says, you know, we want to fund, you know, 50 students a summer to come in and do something around STEM exploration, health professions exploration, something but they, you know, and it can be measured. There can be longitudinal outcomes. I mean, this is not something where they’re just going to throw money. If there’s a program where we can literally follow students through this pathway and they do not fall out of the holes, or there’s no leaks in the pipe, we can actually guarantee that students will succeed when given the proper resources and the playing field is leveled.

Green: I love what you’re saying, Cheryl, about changing the lens that I think people look at this challenge through. We talked about lens when we first started speaking, and then we touched on pipelines with Jarrod. And I think some of what you just said and what I heard is taking some of that responsibility, or the onus on the student and the family, as far as the burden of how do I even navigate into this space, and placing it on to those who have already taken advantage of those of us who are at the other spectrum of this challenge of getting into the healthcare workforce, funding it, making sure you have the network and connections necessary, and puts the onus on those who are already in the space, those who have already taken advantage of the position that they’re in and actually pull up people as they they’re already risen. So in that vein, Jarrod, I’d like to talk to you a little bit more about that family and community piece and ask like, as far as the healthcare workforce workshop is concerned. We talked about in your workshop the strong family and community engagement piece. How important is that for the success of the students or the upcoming healthcare professionals? Can you unpack that for us a little?

Lockhart: Yeah, I think is, I think it’s super important. And even just to even go back to the last question, is really starting in kindergarten. I know we do at Morehouse School of Medicine go that low because in the early ages, really building that self concept. Right? May not be throwing careers at them, but we’re actually just trying to figure out what they enjoy doing and what they love doing, and then kind of working into that. And so some of the work that we even do in that space is STEAM and STEM programming, but in order for we can throw all of these things at these students, we can provide them with these hands on experiences and all of that, but they may go home into an environment that doesn’t support that, right? And so I think it’s very important for us, and what we do is actually bring parents and families into some of these engagements, right?

We have a family STEAM night where they’re side by side with their kids, doing these activities so that they know, right? And so as we’re moving up and we’re exposing them to careers, I think it’s important for us to make families aware what it takes for them to become a medical doctor, right, so that they can support it, or start raising money early to be able to help that financial burden. So I think it’s very important for us to make them aware of those pieces. I can also just well, we have a partner. I’ll say this first, we have a partner who also gets into the entrepreneurship of healthcare and stem right. And so as we’re teaching our students those skills, we’re also doing parent sessions to be able to teach them those skills, because not only are they learning what their child is learning, but it may impact their profession. It may impact, you know, when we talk about AI and all of that, how, how are you interfacing with AI and all of that as a parent? And so I think it’s important for them to know what’s going on. And then lastly, I’ll say I can remember from my childhood spaces like the church and you know, all of that, whatever I did in school, you know, research I did, it was showcased at church. You know, my first public speaking opportunity was at church. And so these spaces, I think, are very important that really support, provide this accountability for the student, but also really this sense of belongingness all around, right?

Green: Yeah. Cheryl, did you want to add anything?

Brewster: I was just, this idea that a student is just the student that presents to us is insane to me, right? Like you, when we treat a patient, we recognize you have to treat the whole part of the patient, which includes their family, their lived environment. So why do we think students are any different and that they are just on their own willy nilly? Oh, I won’t go to med school. Yes, that’s what I’m going to do. But we have to work with families, and a lot of times those families are struggling. Yeah, right. And so we do something very similar, and that we we have a program where the parents can enroll in our program and they can meet with a community health worker to help them navigate whatever issues that they have going on, to sort of alleviate, you know, some of that burden for them, but also teach them. What does it take for you to support this young person in this journey? How long is this journey and why you can’t sort of detract from that journey, right? Because the thing we want to do is talk about generational wealth like nobody talks about that. It’s like, oh, you’re just gonna be a doctor.

 

You get a kid from a community where there are no doctors, and you make them a doctor, not only are you building generational wealth for that family, but people in the community are looking like, oh, somebody made it. Somebody did this. It’s not impossible. So they can actually see that. They can actually support their young person in this journey, and it’s not something that I mean, like we’ve already always heard, it takes a village, and that’s how we need to treat students from underrepresented backgrounds in this journey, as if we are the village that is raising this child to be a future healthcare worker, whether it’s PT, doctor, nursing, whatever it is, I think we we fail our young people on many, many ways, but I think this wraparound process is important for our students to succeed.

Lockhart: And challenging our institutions and organizations to believe in that. Right?

Green: Right. Leadership matters, show up for the show up, I like to say, right? You’re asking these kids to show up from themselves. You’re asking their families to show up. But how do we support them and create a system in which these system, these micro systems, can show up in a way that will look like what we’re deeming a success, or successful completion of the attributes that would not only get them into medical school, but to graduate from medical school or nursing school, and to enter a healthcare workforce or a job and be able to sustain whatever they’re going to encounter as an underrepresented person in a healthcare workforce that doesn’t look a lot like them either. There’s so many layers to it. So to your points about the wrap around and having that familial support, like even knowing how to show up for your student is like, it’s invaluable. So thank you both for those contributions. Cheryl, you added to that, and I wanted to expand a little bit more on what do you think it takes to build that supportive environment for the underrepresented students exploring healthcare careers, and how do we ensure that those support, or this support, continues as students from marginalized groups graduate and embark on their careers in healthcare?

Brewster: I think you know, one of the ways that, and we’ve sort of touched on this in both of our responses, is that we show up, right? We have to be there consistently. And so a lot of times there are a lot of different programs that are out there that are one offs, like, come to an event, and we’ll show you all the things you can be and then we leave and we don’t come back and we don’t follow up. And so I think continuity matters. So it’s sort of like continuity of care, right? You can have the one off event, but then what do you do with that student, or those students, right? So I think we have to sort of think about how we’re doing our programming around STEAM and STEM and ensuring that there’s longitudinal follow up with these students, because oftentimes they’re the ones that fall through the cracks in the education system anyway. And so if we can provide longitudinal, which is very time consuming and costly, right, but it’s an investment, right? If I can, if I can invest in one child in this community and bring them all the way through. I’ve done a great service, not only to my school, but I’ve done it to the community as well, for the community as well, or with the community.

And so I think really thinking about where our funding goes, and in order to ensure that we can do these longitudinal programming and they do work, because we’ve seen data that shows that longitudinal program is successful. But the other component that a lot of programs don’t address is the psychosocial right? And so talking about we had a program, we had licensed clinical social workers on our team, and so they were required to meet with the licensed clinical social worker on a monthly basis just to talk about things right. Academic Advisement is key as well. Like you have to have all of these different components. These are all components that they get in medical school. Why aren’t we giving them to the students prior to medical school? Because these students are coming from and I don’t want to preface, I want to preface this. Not all students come from under resourced backgrounds. We have to be like, that’s the reality. There are students that come from that, right? But we don’t address those, what people call social determinants of health, right?

So if a kid can’t get up in the morning and have breakfast and you want them to go to school and learn and do all the things that they need to do in order to thrive, they’re never going to get into some at school. So I think it’s all of these services and resources they need to be allocated at a very early age for those students that need them, and even students that might not need financial or support in that way, they still need that social support, right? They need that psychosocial support because they go through a lot as students of color, right? And so you’re not they have to feel like they have that support from the very beginning of this journey, and when they feel that support, they stick with it. I mean, like, I can talk about students that have done residency and are still reaching out to me, saying, Hey, Dr. Brewster, you know this was great. Can you know I have somebody that’s interested in your program. Can you know what I’m saying? So it impacts not just them, but future potential students.

Lockhart: I’ll also add to that too, you know, as we’re thinking about the student, you know, and I’m thinking a lot of times, I think in the K-12 space, as we prepare them to come to us, right? How can we also impact the systems in that time period, right? And so being intentional about our high school partners or middle school partners, where, you know, hey, we’re longitudinally working with this student, but we also want to work with you to make sure that we can impact all your students, right? And so it can be, she was talking about one offs, but even it can be just showing up. We’ve done things where we go and show up first day of school, and we’re high fiving the students as they’re walking into the school just to say, hey, Morehouse School of Medicine is here. We’re going to be here this year, and we’re going to be supporting you, but also getting into that school and shaping curriculum. You know, how do we prepare them for a career in health, or how to ensure that the school is giving them the resources? And we talked about this ask, being able to ask for help, critical thinking skills, all of that. How can we as institutions and organizations shape what’s going on in their school as well, so that when we do this longitudinal work with the students, it’s twofold.

Green: So I’m glad you brought in, brought up the critical thinking and some of the other things that go into supporting the journey into this workforce. As someone who is in the healthcare field, I can recall the prerequisites of undergraduate and graduate training, and at least anecdotally, several classes seem like weeder classes, so to speak, i.e. organic chemistry. So how much does this play into who we see showing up, who we see applying to medical school and healthcare professions, or even dropping out of pre med and pre health pathways? What suggestions, and I know you’ve touched on this some already, both of you have, so this question is open to either one of you, what suggestions or thoughts do you have to mitigate this for students of underrepresented and or underserved socioeconomic backgrounds?

Lockhart: I mean, we, part of our how we develop our curriculum is really based in this, and we talk about this in the session, taking students from this fixed growth mindset, right? And so a lot of times we, I mean, even on a medical level, student does bad on a test, and they’re coming crying, like, I am not going to be a doctor, and all of that, and we having to say, you’re okay, we’ve got some resources for you. What you’re going to work through this, because they think they have to make straight A’s, and it’s a straight path, and just really being able to help them navigate that by Hey, failures don’t mean that you’re a failure. What can we learn from this failure? And so I think it’s very important that we kind of think from a curriculum perspective, not only just that well, just taking those students from that fixed growth mindset, which helps to mitigate that whole getting to your organic chemistry or whatever, and having difficulty and thinking it’s the end of the road, right? And so I think it’s, those are some of the things that we need to think about. But also just building this, and we talked about this building this sense of it’s okay to ask for help. It’s okay to ask for those tools and resources early, before you even need them. Hey, what do I have access to so that you can be on that path to be successful? So yeah.

Brewster: I think there’s a couple things that play with that. So as undergrads, a lot of times there are schools that have pre health advising, right? I would like to see pre health advisors get and I know they, they were General. Everybody wanted to go into different fields within healthcare, but I’m finding that a lot of them are very metric minded. And so when a student comes in with that C in in orgo, their organic chemistry, and they are the first to tell them, you can’t be a doctor. Oh, you should think about X, Y, Z.

Lockhart: That happened to me.

Brewster: And so, and they need to be very mindful, one, of breaking a student’s spirit.

Lockhart: Yeah, absolutely.

Brewster: But two, that’s not the truth. It’s just not the truth. It’s a bold faced lie, honestly, and students can get into medical school with a C on their transcript, right? Plenty of times I’ve seen it this idea that you have to be the perfect student and get the highest MCAT score is a fallacy, right? There are a number of schools that will take a lower MCAT. I’m not saying don’t strive to be the best. A test is one point in time, if you can show, over the course of your four years, one that you have mastered the sciences, right from the lower level to the upper level, you have a better chance of fairing in medical school, then the kid that’s like a 3.0 student but gets a 512 on that, yeah, right, because you show, over time consistently, that you have a grasp of the information, those are the kind of things that they don’t tell students that one point you can take a C, take that class over and get an A, and it’s done, you’re fine, right? And so I think there’s these fallacies around what it takes to get into med school that have made it very difficult for students to see themselves overcoming barriers to med school because they’ve gotten a poor grade.

And there’s all kinds of programs out there that allow students to improve academically. They can do a post bac, they can do a master’s program, you know? They can get those rigorous classes along the way and bolster their applications. And they think if they don’t get the score they need, that it’s over for them. Now, listen, I tell you, I have a student that is second year now, and at Howard, the struggle I had with her, it to find out that she’s a second year at Howard right now. I was like, holy cow, right? Like she, her journey was not straight. And I think students feel like, boom, I gotta just do it this way, because that’s the best way to know your journey is your journey, and you have to live in that journey, and you have to accept the people around you to help guide you through that journey. And I think we forget that there’s other things in play for students, and that’s not just the student on this journey.

Lockhart: And that ties back to mentorship, right? Because I know I use my story when I’m talking to my students. I messed up in undergrad 100 but part of that was, it was my first time out of the house, you know, under strict guidelines from parents, right? But I was finding myself. I was finding that identity. So beyond going to school, you’re going through life changes that happens, right? But I messed up. But I went and did a master’s program and all of that, and what I’m able to say, and even before I got into my doctorate program, I was able to say, hey, that doesn’t represent who I am. Let me show you who I am. And I walked them through the journey, right? I walked them through that journey to say what I learned at each step. I messed up in undergrad, but this is how I improved over time. And so I think mentorship is important to be able to share those stories so that students can build that muscle of not giving up, but also how to navigate those conversations.

Green: We’re going to spend about a minute on the next questions each and again, you’re both welcome to respond. One that I’m gonna throw out there is admissions, because we’re talking about the workforce, right? And so there are people at medical school, healthcare professionals, that sit at the table. What can you share? As far as thoughts, data or information on what needs to happen at those admission tables or during the admission process, for the people who are choosing these selecting the students that will help diversify this workforce in the healthcare system.

Brewster: So first, they must be trained. They must be trained on mitigating bias and it has to be reinforced throughout the year, throughout that admission cycle, right? So you can’t just do it one point in time. You have, there has to be a checkin a couple points in throughout that 10 month nine month admission cycle. So there’s that part they need to understand, not only bias, but also looking at a student holistically, and not just at the metrics. So in the past, medical school was all about metrics, and we realized that students have different experiences that lend themselves to being good qualities that a physician needs, or any healthcare provider, the ability to effectively and humanely communicate with patients, colleagues, you know, whomever is so vital right now, and a lot of students don’t have that that quality, right? And so we have to help grow that for them. So yeah, I think looking at it, looking at the student holistically, but also making sure we’re mitigating bias along the way, and allowing students to show their full selves, I think is really important.

Green: Jarrod, I’m going to ask you to start with this question, but I’d like to hear both of your input, and we’ll wrap up with this, which is when you think about the direction that we’re headed in as a nation in terms of health equity and diversity in healthcare. What gives you hope?

Lockhart: Well, joining with people like this, knowing that we have people out there that’s dedicated to the mission of making sure that our workforce stays diverse, and being intentional about making sure that our students reach that level. I you know, financially, we’re going to have to navigate some things you know, as far as where our funding sources come from, you know, and really diversify that portfolio, but hopefully from a philanthropic, you know, we’ve got more people coming in giving money to be able to support these type of programs. And so that gives me hope, and the fact that I know what this type of program did for me as a pathway student and staying committed to that cause and educating people from that perspective.

Brewster: I ditto a lot of his sentiments, the outcomes, seeing students walk across the stage at the end of their journey is what gives me hope. But the other thing that gives me hope is this, this idea that we are at one point in time, right? And so this is a moment in time we will get through it. We’ve gotten through it worse, right? And as long as there are people like us standing committed in this, I think we will be fine. I really think we are. I mean, I think one of the things we have to do is really understand that the way we selected students in the past was somewhat lazy, relying on race and ethnicity is a metric to say those are the students that can come in. I think we need to really be holistic in our pursuit of students that are best fit for our schools. Not every student is made for every school, and we need to make sure that if we are serving an underrepresented community, that our students resemble that community, that come from that community, and hopefully return to that community. So that gives me hope, like just knowing that we have to find innovative ways to find the students that need us.

I’d like to thank my guests, Drs. Cheryl Brewster and Jarrod Lockhart for being with us today. You can find links to more information about the work each of our guests do at the links in our show notes. That brings us to the end of another episode of the Health Disparities podcast from Movement Is Life. I’m Dr. Hadiya Green, until next time, be safe and be well.