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Relationship of Diversity to Outcomes

Relationship of Diversity to Outcomes. UCLA INTERNATIONAL MEDICAL GRADUATE PROGRAM: At the Crossroads of Education & Health. Michelle Anne Bholat, MD, MPH Professor & Vice Chair UCLA Dept. of Family Medicine Executive Director UCLA International Medical Graduate Program.

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Relationship of Diversity to Outcomes

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  1. Relationship of Diversity to Outcomes UCLA INTERNATIONAL MEDICAL GRADUATE PROGRAM: At the Crossroads of Education & Health Michelle Anne Bholat, MD, MPHProfessor & Vice Chair UCLA Dept. of Family Medicine Executive Director UCLA International Medical Graduate Program Patrick T. Dowling MD, MPHAssociate Director UCLA International Medical Graduate Program Diversity Research Conference UCLA Law School June 22, 2012

  2. Why UCLA IMG? • Need + Limited Resources • Trade-Offs & Tensions • UCLA IMG Model & Outcomes

  3. Shortage of Doctors Proves Obstacle to Obama GoalsUSA currently short 16,000 Primary Care Physicians - 2009California Short 17,000 physiciansby 2015! Robert Pear; NY Times pg A1 April 27 09 UC Vice President for Health Affairs 2006

  4. Distribution of U.S. Population by Race/Ethnicity, 2010 and 2050 2010 Pop. 310 million 2050 Pop. 439 million SOURCE: Kaiser Family Foundation, based on U.S. Census Bureau, 2008

  5. Diversity – LA CountyCountry of Origin, Foreign Born

  6. A Case for Diversity in the Physician Workforce Increases access to underserved Advances cultural competence among all Increases patient satisfaction/trust Broadens research agenda with respect to racial/ethnic disparities. -IOM“In the Nation’s Compelling Interest”, 2004

  7. Linguistic Barriers (LEP)= Risk Among LEP Hispanics + an interpreter, only 70% fully understood what the doctor was saying 61% LEP Hispanics uninsured compared to 36% EP Hispanics, 30% African Americans and 20 % NH Whites LEP + Uninsured = ‘double burden’ as 2/3rds lack a usual source of health care Doty, MM Commonwealth Fund

  8. Leaks in the Educational Pipeline:Percent Obtaining College Degree by Race/Ethnicity, 2009 * Excludes NA and PI -U.S Census, Educational Attainment, 2009

  9. U.S. Medical School GraduatesRace/Ethnicity, 1980-2004 Medical School Class Source: American Association of Medical Colleges

  10. Hispanic GraduatesCalifornia Medical Schools , 2011 1DO 2007data AAMC: Data Warehouse: Student file 1/9/2012

  11. Migration of Physicians to the U.S. National Geographic Dec. 2008

  12. The Global Physician Pipeline:International Medical Graduates (IMGs) 1,950 medical schools and 350,000 graduates/year US has relied on IMGs for 40+ years Staff safety net hospitals/waivers to serve in underserved communities

  13. IMGs as a percentage of the U.S. physician workforce

  14. America’s IMG PhysiciansCountry of Origin

  15. Why so Few IMGs from Latin America? Language of instruction is rarely English Unfamiliar with U.S. physician training process Bias against F-1 (Student Visas) despite J-1 waivers U.S. Medical Licensing Exams (3) + Prep. Courses Cost of living

  16. Race/Ethnicity of Practicing Physicians Compared to Population California, 2010, N= 94,631 Sources: AMA Physician Masterfile, 2010; Medical Board of California, 2010

  17. Why UCLA IMG? Need + Limited Resources Trade-Offs & Tensions UCLA IMG Model & Outcomes

  18. Trade-Offs & Tensions • Latinos – not an undifferentiated population • All UCLA IMGS share a common language but differences exist in class, country and experiences.

  19. Trade-Offs & Tensions • External Brain Drain? • Internal Brain Waste? • Internal Tension?

  20. Trade-Offs & Tensions • Borders & Loans • State Medical Boards

  21. Why UCLA IMG? Need + Limited Resources Trade-Offs & Tensions UCLA IMG Model & Outcomes

  22. The UCLA IMG Model Identify & recruitbilingual/bicultural IMGs 1

  23. The UCLA IMG Model Identify & recruitbilingual/bicultural IMGs Provide intensive instruction and clinical observership 2

  24. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Provide intensive instruction and clinical observership

  25. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Provide intensive instruction and clinical observership Scalable & Replicable

  26. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Provide intensive instruction and clinical observership Scalable & Replicable Targeted to Family Medicine

  27. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Integrated with UCLA medical graduate education Provide intensive instruction and clinical observership Scalable & Replicable Targeted to Family Medicine

  28. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Integrated with UCLA medical graduate education Provide intensive instruction and clinical observership Scalable & Replicable Tailored for Family Medicine Residency Programs Targeted to Family Medicine

  29. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Integrated with UCLA medical graduate education Provide intensive instruction and clinical observership Scalable & Replicable Tailored for Family Medicine Residency Programs Targeted to Family Medicine Acculturation to US healthcare system and medical care culture

  30. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Integrated with UCLA medical graduate education Provide intensive instruction and clinical observership Scalable & Replicable Tailored for Family Medicine Residency Programs Targeted to Family Medicine Acculturation to US healthcare system and medical care culture Place IMG grads into Family Medicine Residencies 3

  31. Identify & recruitbilingual/bicultural IMGs Standardized, competency-based curriculum Integrated with UCLA medical graduate education Provide intensive instruction and clinical observership Scalable & Replicable Tailored for Family Medicine Residency Programs Targeted to Family Medicine Acculturation to US healthcare system and medical care culture Match IMG grads into Family Medicine Residencies Secure contractual commitment 4

  32. California’s Future Physician Workforce Needs • Only 16 of California’s 54 Counties meet minimum population to PCP ratio • In 2014, 4.2 million out of a total of 7 million uninsured Californians will receive health insurance

  33. Hispanicsare under-representedin thephysicianworkforcein California

  34. 54 and Counting: UCLA IMG graduates placed in Family Medicine Residencies in underserved California communities, 2007-2012.

  35. IMG Graduate Matches, 2007-2012 Natividad/Salinas 2 Stanislaus/Modesto 2 Kern/Baskersfield 2 Hanford/Loma Linda 4 UCSF/Fresno 6 San Joaquin 1 Kaiser/Fontana 1 Riverside County 7 Glendale Adventist 2 Presbyterian/Whittier 2 UCLA Family Medicine 8 USC/CA Hospital 8 Pomona Valley 4 Northridge Hospital 1 UCSD 2 Naval Hospital 1 JM/Miami 1 TOTAL 54

  36. Health Disparities “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” -Dr. Martin Luther King, Jr.

  37. Google: UCLA IMG PROGRAM

  38. Use this as a template.

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