[Senate Hearing 118-331]
[From the U.S. Government Publishing Office]
S. Hrg. 118-331
WHAT CAN CONGRESS DO TO ADDRESS
THE SEVERE SHORTAGE OF MINORITY
HEALTH CARE PROFESSIONALS AND
THE MATERNAL HEALTH CRISIS?
=======================================================================
HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
ON
EXAMINING WHAT CONGRESS CAN DO TO ADDRESS THE SEVERE SHORTAGE OF
MINORITY HEALTH CARE PROFESSIONALS AND THE MATERNAL HEALTH CRISIS
__________
MAY 2, 2024
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
_______
U.S. GOVERNMENT PUBLISHING OFFICE
55-875 PDF WASHINGTON : 2024
BERNIE SANDERS (I), Vermont, Chairman
PATTY MURRAY, Washington BILL CASSIDY, M.D., Louisiana,
ROBERT P. CASEY, JR., Pennsylvania Ranking Member
TAMMY BALDWIN, Wisconsin RAND PAUL, Kentucky
CHRISTOPHER S. MURPHY, Connecticut SUSAN M. COLLINS, Maine
TIM KAINE, Virginia LISA MURKOWSKI, Alaska
MAGGIE HASSAN, New Hampshire MIKE BRAUN, Indiana
TINA SMITH, Minnesota ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico MITT ROMNEY, Utah
JOHN HICKENLOOPER, Colorado TOMMY TUBERVILLE, Alabama
ED MARKEY, Massachusetts MARKWAYNE MULLIN, Oklahoma
TED BUDD, North Carolina
Warren Gunnels, Majority Staff Director
Bill Dauster, Majority Deputy Staff Director
Amanda Lincoln, Minority Staff Director
Danielle Janowski, Minority Deputy Staff Director
C O N T E N T S
----------
STATEMENTS
THURSDAY, MAY 2, 2024
Page
Committee Members
Sanders, Hon. Bernie, Chairman, Committee on Health, Education,
Labor, and Pensions, Opening statement......................... 1
Cassidy, Hon. Bill, Ranking Member, U.S. Senator from the State
of Louisiana, Opening statement................................ 3
Witnesses--Panel I
Butler, Hon. Laphonza, United States Senator, CA................. 6
Prepared statement........................................... 8
Burgess, Hon., M.D., Michael C., United States Congressman,
Twenty Sixth Congressional District, TX........................ 11
Prepared statement........................................... 13
Witnesses--Panel II
Lawson, Yolanda, M.D., President, National Medical Association,
Dallas, TX..................................................... 15
Prepared statement........................................... 17
Summary statement............................................ 20
Cook, Samuel, M.D., Resident, Morehouse School of Medicine,
Atlanta, GA.................................................... 21
Prepared statement........................................... 23
Summary statement............................................ 25
Galvez, Michael, M.D., Valley Children's Hospital; Co-Creator of
National Latino Physician Day, Madera, CA...................... 25
Prepared statement........................................... 27
Summary statement............................................ 29
Andrades, Jaines, DNP, AGACNP-BC, Nurse Practitioner, Baystate
Health, Springfield, MA........................................ 30
Prepared statement........................................... 32
Summary statement............................................ 33
Stone, Brian, M.D., FACS, President, Jasper Urology Associates,
Jasper, AL..................................................... 35
Prepared statement........................................... 36
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.
Sanders, Hon. Bernie:
American Physical Therapy Association........................ 55
American Hospital Association................................ 57
American Medical Association................................. 62
American Academy of Family Physicians........................ 73
The Association of American Medical Colleges................. 80
The American College of Obstetricians and Gynecologists...... 96
The Blue Cross Blue Shield Association....................... 103
The American Academy of Audiology............................ 107
Congresswoman Lauren Underwood............................... 109
March of Dimes............................................... 112
Advocates for Community Health............................... 116
The PA Education Association................................. 120
WHAT CAN CONGRESS DO TO ADDRESS
THE SEVERE SHORTAGE OF MINORITY
HEALTH CARE PROFESSIONALS AND
THE MATERNAL HEALTH CRISIS?
----------
Thursday, May 2, 2024
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The Committee met, pursuant to notice, at 10:01 a.m., in
room 430, Dirksen Senate Office Building, Hon. Bernard Sanders,
Chairman of the Committee, presiding.
Present: Senators Sanders [presiding], Casey, Baldwin,
Kaine, Hassan, Smith, Hickenlooper, Cassidy, Braun, Marshall,
and Tuberville.
OPENING STATEMENT OF SENATOR SANDERS
The Chair. All right. The Senate Committee on Health,
Education, Labor, and Pensions will come to order.
Today, our Committee is going to focus on two extremely
important health care issues that must be addressed. First are
the major need for more Black, Latino, and Native American
doctors and medical professionals.
Second, the alarming rate of maternal deaths in America
that is disproportionately impacting Black, Latino, and Native
American women.
In the midst of a health care system that, in my view, is
largely broken and dysfunctional, where we spend almost twice
as much per capita on health care as the people of any other
country, or 85 million Americans today are uninsured or
underinsured, and where we don't have enough doctors, nurses,
dentists, mental health specialists, or pharmacists, we have
another crisis on top of all of that, and that is that problem
of lack of medical personnel is extremely, especially acute in
Black, Latino, and Native American communities, which is the
subject of our hearing today.
Despite making up almost 14 percent of our population, just
5 percent of all doctors in our Country are Black, less than 4
percent of all dentists, and just 6 percent of all nurses in
America are African American.
Further, despite making up over 19 percent of our
population, just 6 percent of doctors and dentists and just 7
percent of nurses in America are Latino. And, we cannot forget
the Native American community, which makes up 1.3 percent of
our population, but just three-tenths of 1 percent of all
doctors in our Country are Native American. So why is this an
important issue that we have got to address?
Well, the answer is that study after study has shown that
when Black, Latino, and Native American patients have access to
Black, Latino, and Native American doctors, their health
outcomes substantially improve. They are more likely to receive
preventative services. They are more satisfied with their care.
They are more likely to live longer and happier lives. In
my view, it is unacceptable that life expectancy on average,
which is low in America in general, is about 5 years lower for
Black Americans and 11 years lower for Native Americans than it
is for White Americans.
It is unacceptable that Black Americans are more likely to
die of heart disease and have the highest rates of cancer of
any other group in America. It is not acceptable that Black
Americans are more than twice as likely to have diabetes, an
issue that we are dealing with right now.
A major epidemic in America, twice as high in the Black
communities than in the white community. And one of the most
alarming and troubling health disparities in America is the
maternal mortality rate, which is the other major focus that we
will be talking about today.
In America today, we have the highest maternal mortality
rate and the highest infant mortality rate of any other wealthy
country on Earth. In fact, the maternal mortality rate in
America is 19 times higher than Norway, 4 times higher than
France.
Incredibly, according to the CDC, women in America today
are twice as likely to die from childbirth as their--than their
mothers. And as bad as this crisis is overall, it is much, much
worse for Black women and infants.
In America today, Black women are nearly three times more
likely to die from pregnancy related complications than their
white counterparts. The crisis is also getting significantly
worse for Latina women. Between 2019 and 2020, the Latina
maternal mortality rate skyrocketed by 44 percent in just 1
year.
Meanwhile, Black infants in America are almost four times
more likely to die from complications due to low birth weight
than white infants. So, the question then becomes, given that
reality, what are we going to do about it? How are we going to
address what is obviously a major health care crisis in
America?
That is what we will be discussing this morning. Just a few
things that I think we have got to do. We need to substantially
increase the class sizes of historically Black colleges and
universities, and we will be hearing from representatives of
one of them today. We need to pass the Black Maternal Health
Momnibus Act, introduced by Senator Booker and Senator Butler.
Senator Butler will be talking about that today. We need to
substantially increase funding for the women, infants, and
children program. We need to substantially increase funding for
the National Health Service Corps.
In my view, we need to cancel student debt and make all
public colleges and universities tuition free so that all
people, regardless of background and income, will be able to
get the education they need, including going to medical school.
In fact, the good news is that making tuition, medical
school tuition free, is a growing idea. In fact, four medical
schools in America, including the New York University School of
Medicine, are currently tuition free, while five others have
made tuition temporarily free or offering free tuition to
working class students.
We have got a lot to talk about today and I look forward to
a serious discussion about a serious issue, and I thank our
panelists who are here with us.
Senator Cassidy.
OPENING STATEMENT OF SENATOR CASSIDY
Senator Cassidy. Thank you, Chair Sanders. This Committee
has covered the shortages of physicians and other health
workers extensively. Shortages hurt the delivery of health care
in all communities.
My home State of Louisiana, projected to have the third
worst shortage of physicians of any state by 2030. We need more
doctors, particularly in the underserved areas lacking
sufficient health care resources. My practice as a physician
was for 25 years in a hospital serving the uninsured and the
poorly insured, which is to say Medicaid.
This is something which I have spent my professional life
attempting to address. Today, we are going to look specifically
at minority doctors and health professionals underrepresented
in our health care system.
For example, African American physicians account for only 8
percent of all physicians, despite comprising 13.6 percent of
the population. Now, if you are listening carefully, you will
note that my statistics are different than the Chairs'.
His is 5 percent and mine is 8 percent. My data is more--he
uses the Association of American Medical Colleges 2019 data,
and I am using the Bureau of Labor Statistics, which is 2022
data. That is important. 2019, 2022 Government data. A little
bit more up to date, a little bit more valid.
Maybe there is progress being made. And as we look at
something which needs to be addressed, we can also say that if
we have gone from 5 to 8 percent, there may be progress being
made, and that is a good thing.
But it is interesting to note that this disparity is not
felt across all minorities. Asian doctors account for 22
percent of all physicians but are only 6.8 percent of the
population. And this is an important nuance as we address this
situation. It is also important to note, as the Chair notes,
that we have a limited number of GME residency slots to train
new doctors.
These residency positions are not allocated or dispersed to
reflect where underserved communities are. Unfortunately, this
topic is under Finance jurisdiction, but it is an important
context and needs to be considered in any conversation about
addressing health care workforce shortage.
It is kind of a truism that a physician will practice
within 100 miles of whether--where she or he does their
residency. If the residency spot is not in an underserved area,
it is not going to be within that 100 miles.
But access to opportunity is crucial. I want to highlight
and brag on Xavier University, a Historically Black College and
University in my State of Louisiana. This week, they announced
an agreement with Ochsner Health to open a medical school in
New Orleans at Xavier.
Many of the doctors trained at Xavier, which has had a
traditional mission to serve the underserved and to provide
opportunity for minorities, they will stay in Louisiana and go
elsewhere to serve those populations.
I am proud of Xavier, and I look forward to continuing to
support their effort. Now, as a doctor, I am so aware and
desire to support those nurses who have climbed the career
ladder by building credentials over time through upskilling.
Despite from benefiting the individual, it benefits the
capabilities of our workforce. It also benefits their family as
their child sees the impact of their mother or father seeking
through education and delayed gratification, greater
opportunity that results in more prosperity.
There is a woman I worked with named Olive, who went from a
nurse's assistant to an LPN to an RN to a nurse manager, and
the clinic in which she formerly was the NA, she ultimately
ended up being the manager of. Incredible story. We will have
someone here today with a similar story.
Dr. Jaines Andrades will tell us how she has done that in
her career, and that is something that we need to think how to
enable. We should also look at other challenges to ensure our
health care system meets the need of all, especially the
underserved.
Making sure that patients from all walks of life can
participate in clinical trials, which oftentimes gives the most
advanced--most advanced treatment to those who have the most
advanced disease.
As I mentioned from my career, making sure that all have
high quality medical treatment is something I am passionate
about. One of our witnesses today, Dr. Brian Stone, will tell
us how he is trying to address these issues in his community.
The Committee will also discuss maternal mortality, a topic
incredibly important that has been a priority of mine in
Congress, and it is important to acknowledge that this issue
disproportionately affects African Americans.
As a doctor, again, who worked in Louisiana's charity
hospital system, I know this community from my practice, and I
know that this community is at high risk. That is why I am
pleased to have U.S. Representative and Dr. Michael Burgess
testifying.
He is an OB-GYN who stayed up many nights delivering
medical care to pregnant moms and their babies in an
underserved population of Dallas. Now, as a legislator, Dr.
Burgess is a leader in addressing racial disparities in health
care, and it has been an honor to work with him on legislation
specifically tackling maternal mortality.
We were unaware that we were having a Members of Congress
panel until Sunday, so we greatly appreciate him joining us on
short notice when actually they were adjourned last night. His
participation helps make clear that Congress understands the
severity of the issue and is working to address.
I am also proud to have led several bipartisan legislative
efforts to improve maternal mortality and reduce health care
disparities. In 2022, Congress passed the Maternal Health
Quality Improvement Act, which helps address maternal
mortality, particularly that disparity within African
Americans.
It also supports research examining the best practices to
reduce and prevent racial discrimination in the American health
care system. The same year, Congress passed my legislation, the
John Lewis National Institute in Minority Health and Health
Disparities Research Endowment Revitalization Act.
It is a mouthful, but it is a good piece of legislation
that provided funding to institutions, including Xavier, to
conduct research and address minority health disparities. And
last year in this Committee, we passed the Preventing Maternal
Deaths Reauthorization Act, the legislation led in the House by
Dr. Burgess, and the bill directs the CDC to provide hospitals
and other providers information on best practices to prevent
maternal mortality.
This reauthorization has not yet become law, but we are
pushing for passage this Congress. All this work shows a
bipartisan commitment in Congress to addressing health
disparities, but there is more to do.
The connected maternal online monitoring systems or the
Connected MOM Act, doctor--Senator Butler, I was about to
demote you or promote you by calling you doctor, which I
introduced with Senator Hassan of New Hampshire of this
Committee, promotes Medicaid coverage of remote monitoring
technologies for those who are pregnant at higher risk of
complications.
The need for moms in underserved urban or rural areas who
travel sometimes hours on public transportation to a doctor's
office can be a major impediment to care. This legislation
allows a physician to remotely monitor her health, watching for
indicators of potential complications.
It is bipartisan and improves access to crucial health care
for moms, and it prevents maternal deaths. While this bill is
in Finance jurisdiction, I look forward to the discussion today
on how we can continue to make progress on maternal mortality
in the HELP Committee.
Thanks to our witnesses for being here and providing your
expertise on how we better address these important issues. With
that, I yield.
The Chair. Thank you, Senator Cassidy. Our first witness
will be Senator Laphonza Butler, a Senator from California.
Senator Butler is a long standing advocate for health care
workforce and increasing opportunities for students from
underrepresented and disadvantaged backgrounds in the health
professions.
She is also a strong advocate for reducing maternal health
disparities and combating the Black maternal health crisis.
Senator Butler, thanks for being here.
STATEMENT OF HON. LAPHONZA BUTLER, UNITED STATES SENATOR, CA
Senator Butler. Thank you, Chairman Sanders and Ranking
Member Cassidy for the hearing today. Thank you to other
Members of the Committee for joining. Your leadership on this
issue is demonstrable.
Thanks for having me. It is an honor, truly, to sit before
today's Committee to bring added amplification to the lack of
diversity within our Nation's health care system, as you both
have outlined so clearly, and in addition, the worsening
maternal health crisis.
Before I begin my testimony, I would like to acknowledge
those leaders who have been championing this issue prior to my
arrival in the U.S. Senate.
It is leaders like Representative Lauren Underwood, our
colleague Senator Booker, who introduced the Black Maternal
Health Momnibus in the Senate, and Representative Alma Adams,
for their leadership in developing the Black Maternal Health
Caucus, and the leadership. I also cannot sit here without
recognizing Vice President Kamala Harris, who introduced the
first version of the Momnibus while serving in the Senate.
She continues to lead the Biden-Harris administration's
efforts to improve maternal health outcomes. These are
champions that I am proud to stand alongside. I want to also
take a brief moment to highlight Dr. Michael Galvez, who is a
witness in today's hearing and is also a resident of California
and one of my constituents.
Dr. Galvez is a board certified plastic and reconstructive
surgeon specializing in pediatric hand surgery in Valley
Children's Hospital in Madera, California. He co-created
National Latino Physician Day to bring attention to the fact
that while Latinos make up 19 percent of the population, they
account for only 6 to 7 percent of the physician workforce.
Thank you for being here today, Dr. Galvez. Our health care
system and the state of maternal health in this country is at
an inflection point that requires the urgent attention of this
Committee. The numbers should alarm all of us.
The United States has the highest rate of maternal
mortality among high income nations. Within recent years,
thousands of women have lost their lives due to pregnancy
related causes. And over the past decade, while the birth rate
in this country has declined by roughly 20 percent, maternal
mortality rates have steadily risen.
The crisis is exacerbated in communities grappling with a
lack of access to essential maternal health care. According to
a report produced by the March of Dimes, one-third of counties
in the United States are considered maternity care deserts,
meaning there are no hospitals providing obstetric care, no
birth centers, and no obstetric providers.
Think about that. Imagine your loved one preparing to give
birth and bring new life into your family and having no choice
but to drive hours away from home to seek the care they need.
We know from the research and the numbers that this crisis has
not been felt equally.
Among Black and native indigenous communities, maternal
mortality rates are two to four times higher compared to those
of white communities. Two to four times higher are in--Black
and Native American women are more likely to die in a pregnancy
related death.
While Black and Brown communities experience the highest
rates of maternal mortality and morbidity, these populations
also remain starkly underrepresented within the health care
field. While an estimated 13 percent of our Country's
population identifies as Black, only about 5 percent of
physicians in the United States are Black.
Research suggests that under the care of Black physicians,
the mortality rate for newborns decreases by over 50 percent,
which is why I applaud and urge this Committee's continued
efforts to not only bolster the health care workforce, but to
use every tool to ensure that workforce is diverse and equipped
to provide unbiased and culturally competent care.
Only then can we begin to change the course of our Nation's
current health care system. And we know that this must not mean
focusing exclusively on physicians. For families, mothers, and
babies, this means doulas and nurse midwives, nutritionists,
and the full spectrum of reproductive health care professionals
that contribute to their health, well-being, and birthing
experience.
Having access to a comprehensive care team can make the
world of difference for families. For example, in my home State
of California, the Martin Luther King Community Hospital in Los
Angeles has reimagined the birth experience for women serving--
within its service community.
When I visited the hospital, I first--I saw firsthand how
doulas and nurse midwives were integrated into their overall
maternal health care model to ensure that birthing mothers
receive the highest quality and most comprehensive care.
The leadership of Dr. Elaine Batchlor has made an
indispensable difference. And even as we have existing models
and we consider other proposed solutions to this crisis, I
implore this Committee to advance the Black Maternal Health
Momnibus Act led by Senator Booker.
The Momnibus is comprised of 13 individual bills that would
combat the Black maternal health crisis and make historic
investments to address comprehensively and deliver--every
driver of maternal mortality, morbidity, and disparities in the
United States. This legislation is not just about the life and
death of Black women.
Its enactment will improve birthing outcomes for all women.
The Momnibus includes bills such as the Kiera Johnson Act,
which would make necessary investments in community based
organizations that are leading the charge to protect mothers
and support culturally competent training within maternity care
settings.
This bill is named after Kiera Johnson, a Black mother who
in 2016 checked into a hospital with her husband, Charles, to
give birth to their second child, Langston. Despite being in
excellent health, Kiera died from a hemorrhage in the hours
after delivering young Langston. Kiera should be here today.
The lives of her husband and her sons have forever been
changed. The Johnson family's tragic experience, and that of so
many other families, should be a wakeup call for us to act with
urgency to address the need of unbiased, patient centered care.
Today's hearing is an important step in the right direction.
I urge this Committee to hold additional sessions focused
on the Black maternal health crisis and important legislation
that my colleagues and other advocates have introduced and
researched.
This Committee, which holds the primary jurisdiction for
the Black maternal health Momnibus, and so many other maternal
health policy solutions is having a--hasn't had a recent
hearing on the topic.
Last month, during Black Maternal Health Week, I convened a
roundtable of prominent maternal health leaders and experts for
discussion on how we can work together to combat the maternal
health crisis.
We discussed the hurdles that lie ahead in advancing the
Momnibus and similar legislation. Those advocates shared with
me that they believed that they would have to remove the word
Black from the title of the Momnibus. They believe that only
then the legislation would be likely to gain the necessary
support for passage.
After spending some time with my colleagues in the Senate,
spending time with many of you, I don't believe that to be
true. I know this Committee is filled with Senators, public
servants, who represent Black women living in each of their
states.
I am here to stand with you and to show every American
watching that I stand with leaders on this Committee who
together demonstrate our commitment to the Black and Brown
women and their families who suffer the most in our health care
system.
We have solutions at the ready, and I know that anti-Black
sentiment will not serve as a barrier toward progress. While I
serve in this chamber, I will continue to stand with all of you
loudly and proudly, ensuring that we deliver the investments
required to meet this moment for caregivers, health care
personnel, the mothers and families in California, and
throughout the Nation.
I look forward to working with this Committee and my
colleagues in both chambers as we advance comprehensive
solutions and utilize every level to prevent maternal deaths in
this country. Thank you.
[The prepared statement of Senator Butler follows.]
prepared statement of senator laphonza butler
Thank you, Chairman Sanders and Ranking Member Cassidy, for
inviting me to today's important hearing. It is an honor to sit before
the Committee today, to bring critical attention to the lack of
diversity within our Nation's health care system, and the worsening
maternal health crisis.
Before I begin my testimony--I'd like to submit a statement for the
record on behalf of Representative Lauren Underwood who has long worked
to champion these issues. I would also like to thank Senator Booker and
Representative Alma Adams for their leadership in elevating the
devastating Black maternal health crisis.
As leaders of the Black Maternal Health Caucus and the Black
Maternal Health Momnibus Act--they have made it their mission to
thoughtfully address maternal health disparities. I also want to
recognize Vice President Kamala Harris, who introduced the first
version of the Momnibus, while serving in the Senate. She continues to
lead the Biden-Harris Administration's efforts to improve maternal
health outcomes.
Thank you to all of these champions for your unwavering commitment.
I am proud to stand alongside each of you in this effort.
I also want to take a moment to highlight Dr. Michael Galvez, who
is a witness in today's hearing and is also one of my constituents. Dr.
Galvez is a Board-certified plastic and reconstructive surgeon
specializing in Pediatric Hand Surgery in Valley Children's Hospital in
Madera, California. He co-created National Latino Physician Day to
bring attention to the fact that while Latinos make up 19 percent of
the population, they account for only 6-7 percent of the physician
workforce. Thank you for being here today, Dr. Galvez.
Our health care system and the state of maternal health in this
country is at an inflection point that requires the urgent attention of
this Committee. The numbers should alarm us all: The United States has
the highest rate of maternal mortality among high-income nations.
Within recent years, thousands of women have lost their lives due to
pregnancy-related causes. And over the past decade, while the birth
rate in this country has declined by roughly 20 percent, maternal
mortality rates have steadily risen.
This crisis is exacerbated in communities grappling with a lack of
access to essential maternal health care. According to a report
produced by the March of Dimes, one-third of counties in the United
States are considered maternity care deserts, meaning there are no
hospitals providing obstetric care, no birth centers, and no obstetric
providers. Think about that--imagine your loved one preparing to give
birth and bring new life into your family, and having no choice but to
drive hours away from home to seek care.
We know from the numbers that this crisis that has not been felt
equally. Among Black and Native Indigenous communities, maternal
mortality rates are two to four times higher compared to those of White
communities. Let me repeat that--Black and Native American women are
two to four times more likely to die a pregnancy-related death.
While Black and Brown communities experience the highest rates of
maternal mortality and morbidity, these populations also remain starkly
underrepresented within the health care field. While an estimated 13
percent of our Country's population identifies as Black, only about 6
percent of physicians in the United States are Black.
Research suggests that under the care of Black physicians, the
mortality rate for newborns decreases by over 50 percent, which is why
I applaud and urge the Committee's continued efforts to not only
bolster the health care workforce, but to use every tool to ensure this
workforce is diverse and equipped to provide unbiased, culturally
competent care. Only then can we begin to change the course of our
Nation's current health care system.
This must not mean focusing exclusively on physicians. For
families, mothers, and babies, this means doulas, nurse midwives,
nutritionists, and the full spectrum of reproductive health care
professionals that contribute to their health, well-being, and birthing
experience. Having access to a comprehensive care team can make a world
of a difference for families. For example, in my home state of
California, the Martin Luther King Community Hospital in Los Angeles
has reimagined the birthing experience for women within its service
community. When I visited the hospital, I saw firsthand how doulas and
nurse midwives are integrated into their overall maternal health care
model to ensure that birthing mothers receive the highest quality, most
comprehensive care. The leadership of Dr. Elaine Batchlor has made an
indispensable difference.
Even as we have existing models and as we consider other proposed
solutions to these crises, I implore this Committee to advance the
Black Maternal Health Momnibus Act led by Sen. Booker. The Momnibus is
comprised of 13 individual bills that would combat the Black Maternal
Health crisis and make historic investments to comprehensively address
every driver of maternal mortality, morbidity, and disparities in the
United States. This legislation is not just about the life and death of
Black women--it's enactment will improve birthing outcomes for all
women.
The Momnibus includes bills such as the Kira Johnson Act, which
would make necessary investments in community-based organizations that
are leading the charge to protect mothers--and support culturally
competent training within maternity care settings. The bill is named
after Kira Johnson--a Black mother who, in 2016, checked into a
hospital with her husband Charles to give birth to their second child,
Langston. Despite being in excellent health, Kira died from a
hemorrhage in the hours after delivering Langston. Kira should still be
here today. The lives of her husband and sons have been forever
changed. The Johnson family's tragic experience, and that of so many
other families, should be a wake up call for us to act with urgency to
address the need for unbiased patient-centered care.
Today's hearing is an important step in the right direction. I urge
this Committee to hold additional sessions--focused on the Black
maternal health crisis and the important legislation that my colleagues
and other advocates have introduced and researched. This Committee,
which holds primary jurisdiction of the Black Maternal Health Momnibus
and so many maternal health policy solutions, has not held a recent
hearing on the topic.
Last month, during Black Maternal Health Week, I convened a
roundtable of prominent maternal health leaders and experts for a
discussion on how we can work together to combat the Black Maternal
Health crisis. We discussed the hurdles that lie ahead in advancing the
Momnibus and similar legislation.
Those advocates shared with me that they believed that they would
have to remove the word ``Black'' from the title of the Momnibus. They
believe that only then would the legislation be more likely to gain the
necessary support and passage. After spending time with my colleagues
in the Senate, spending time with many of you, I don't believe that to
be true. I know this Committee is filled with Senators, public
servants, who represent Black women living in each of their states. I
know that this body is resolved to ensure that the Black women they
serve can count on you to hear their experiences and take action to
save their lives. I am here to show every American watching that I
stand with the leaders on this Committee as we, together, demonstrate
our commitment to the Black and Brown women and their families who
suffer the most in our health care system.
We have solutions at the ready--and I know that anti-Black
sentiment will not continue to serve as a barrier toward progress.
While I serve in this chamber, I will continue to stand with all of
you--loudly and proudly--ensuring we deliver the investments required
to meet this moment for caregivers, health care personnel, and the
mothers and families in California and throughout the Nation. I look
forward to working with the Committee, and my colleagues in both
chambers to advance comprehensive solutions and utilize every lever to
prevent maternal deaths in this country.
Thank You.
______
The Chair. Well, thank you very much, Senator Butler. Our
next witness will be Congressman Michael Burgess,
representative from Texas. I think Senator Cassidy, you wanted
to introduce the Congressman.
Senator Cassidy. Yes. It is a pleasure to introduce a
witness and a friend, the honorable Michael Burgess, an OB-GYN,
representative for 20 years, the 26th District of Texas in the
House of Representatives.
He is the Chair of the Budget Committee, the health care
task force. Chair of the Rules Committee. He serves on Energy
and Commerce. He has used his wealth of knowledge in maternal
health and in building the health care workforce to advance key
pieces of legislation addressing these issues.
He has, as you might guess, a unique perspective as both a
policymaker and as a practitioner. So, Dr. Burgess, thanks for
being here.
STATEMENT OF HON. MICHAEL C. BURGESS, M.D., UNITED STATES
CONGRESSMAN, TWENTY SIXTH CONGRESSIONAL DISTRICT, TX
Dr. Burgess. Thank you, Dr. Cassidy. Chairman Sanders,
Members of the Committee, thank you for allowing me the
opportunity of testifying here this morning. I do represent the
26th District in the State of Texas.
In the House, we have congressional districts. So that is
the area near the Dallas-Fort Worth airport--just to locate it
for you. Before coming to Congress, I spent nearly three
decades practicing medicine in that area.
Look, I know practicing medicine can be very complex. I
chose obstetrics because if there is attention to detail, the
results can almost always be satisfactory. I spent time in
residency as an OB-GYN at Parkland Hospital.
Statistically, Parkland has some of the best outcomes in
the country due to its emphasis on proper care and attention to
detail. When I started my residency, I remember Dr. Jack
Pritchard, who was the leader of the Department of Obstetrics
and Gynecology at the time, pointing out that in practicing OB,
you are unique in medicine.
Those privileged enough to continue were going to be
charged with taking care of the simultaneous care of two
patients with a combined life expectancy of 100 years. Nowhere
else in medicine does that occur.
The patient population for Parkland, the Dallas County
Hospital District, serves both rural and urban communities in
and around Dallas. In my time, the clientele was multi-ethnic,
almost completely uninsured or underinsured, but again, they
have some of the best statistics in the country.
The lesson for me there always was, it doesn't have to be
this way. You can do better. And I would like for us to focus
on that with whatever our public policies are going forward.
For myself, I have delivered in private practice over 3,000
babies, treated patients who have suffered from miscarriages,
ectopic pregnancy, stillbirths, sickle cell, and other life
threatening conditions.
Whether my responsibility was to step in and deliver a baby
or save a life, I did it without hesitation. For this reason, I
have spent my career trying to increase access to quality
health care for patients through both my experience as a
physician and a legislator.
In 2005, through what I described as the miracle of
redistricting, I picked up an area the East side of the city of
Fort Worth. It had one of the highest infant mortality rates in
the country.
Despite the challenges, it took years of concerted effort,
but eventually I was successful in getting a federally
qualified health center with a pediatric unit in that part of
Fort Worth. A collaboration with a Democratic County
Commissioner, Roy Brooks, the Mayor of Fort Worth, Mike
Moncrief, who was a prior Democratic State Senator.
It was through that joint effort and the experience and the
expertise and the passion that led us to championing those
issues. Now in Congress, I have continued that, as well as
other health care issues that are improving the health of the
Nation.
The alarming trend of our Country's rate of maternal
mortality first came to my attention in September 2018, and my
copy of the Green Journal, the Journal of Obstetrics and
Gynecology.
The original research cited in the journal stated that the
maternal mortality rates increased in Texas between 2011 and
2012. But then a new study found that the number of maternal
deaths in Texas in 2012 was actually half than the number
previously reported. In other words, there was a mistake in the
arithmetic.
Because of that, the focus became on how things were
counted rather than how do we prevent these bad things from
happening. The study was retracted, but again the discussion
became about the numbers, not about the patients, and that was
unfortunate.
I personally believe one maternal death is too many, and it
is important that we capture these deaths accurately to
understand the scope of maternal mortality in the United States
and my State of Texas, and that we have a better understanding
of how to address them.
In combination, we cannot legislate good practice, but we
can provide the tools to be able to come up with the best
practices and increase access to maternity care. These critical
points have influenced my policy work.
Here are some actual tangible results from that. Because of
the Preventing Maternal Deaths Act, which was signed into law
in 2018, and increasing the dollars spent on maternal mortality
review committees, it actually came to my attention that 53
percent of maternal deaths were occurring 1 week to 1 year
after delivery.
I had been focusing on that time actually in hospital, but
by broadening the lens out a little bit, more lives can be
saved. And as a consequence, now there was an amendment to a
state plan amendment available to Medicare--I am sorry, the
Medicaid and CHIP programs that has allowed inclusion of
postpartum care up to a full year after delivery.
Texas, I am happy to say, enacted that on March 1st of this
year, and now new moms in Texas are going to have the benefit
of an additional year of postpartum coverage. 3338, which was
referenced in Senator Cassidy's opening remarks, has passed the
House, and I encourage you to look at that in the Senate.
I think we can do more with what we--our approach that the
disciplinary maternal mortality review committees and the
causes of maternal deaths. I cannot stress enough the
importance of continuing bipartisan work to reduce disparities,
improve outcomes.
We can bolster our public health workforce. We can actually
start by paying our doctors, so they don't retire early, or
never enter the practice of medicine in the first place. That
has been a particular concern of mine since coming to Congress.
Repeal of the Sustainable Growth Rate formula and the
approach to value based care that followed in its place.
Although it is imperfect and we still got a ways to go, these
are important parameters that will benefit all Americans.
I have had the good fortune of working with your future
colleague, Lisa Blunt Rochester, soon to be Senator from
Delaware, in my understanding. I also work with Robin Kelly and
Danny Davis, working with Danny Davis to improve the care of
the sickle cell patient, which importantly really had not
received any new FDA approved therapies in over 40 years until
we began to work on that in--right after the Cures Act passed.
I know my time is done, but I just want to stress that
there are important things we can work on together, House and
Senate, Republican and Democrat, and it is our obligation to
those future Americans that we do so.
This generation of doctors is coming up, is going to have
tools to alleviate human suffering that no generation of
doctors has ever known. It is our job to deliver that to them
in a timely fashion. Thank you for your attention this morning.
I yield back.
[The prepared statement of Dr. Burgess follows.]
prepared statement of hon. michael burgess
Chair Sanders, Ranking Member Cassidy, and Members of the Senate
Health, Education, Labor, and Pensions Committee, thank you for the
opportunity to speak at today's hearing.
I am Representative Michael C. Burgess from Texas' 26th District.
Before coming to Congress, I dedicated nearly three decades to
practicing medicine in Texas. Between myself, my grandfather, and my
father combined we have practiced medicine for nearly the whole of the
twentieth century. Practicing medicine can be very complex. However, I
chose obstetrics since there is almost always a satisfactory result. I
spent time in residency as an OB-GYN at Parkland Memorial Hospital in
Dallas, Texas. Statistically, Parkland had some of the best outcomes in
the country due to its emphasis on proper care and attention of
patients. At the time, I remember the Chairman of the Department of
Obstetrics and Gynecology pointed out that the practice of obstetrics
is unique in medicine, and those privileged enough to continue were
going to be charged with taking care of two patients with a combined
life expectancy of 100 years. Nowhere else in medicine does one have
the ability to do that.
The patient population near Parkland often came from both rural and
urban communities in Dallas. In my time, the clientele was multi-
ethnic, largely uninsured, or underinsured. Throughout my career, I
have delivered over 3,000 babies and treated patients who had suffered
from miscarriages, ectopic pregnancies, stillbirths, sickle cell, and
other life-threatening conditions. Whether my responsibility was to
step in and deliver a baby, or save a life, it was done without
hesitation. For this reason, I've spent my career trying to increase
access to quality health care for patients, both through my experience
as a physician and as a legislator.
In 2005, I became aware of the rising infant mortality rates in
Southeast Fort Worth. Despite the challenges, it took several years of
concerted effort, but eventually, I successfully established a
federally Qualified Health Center (FQHC) with a maternal unit.
Remarkably, the center was opened through a longstanding collaboration
with the Democratic County Commissioner and Mayor of Fort Worth. It was
my experience, expertise, and passion in maternal health care that led
me to championing this issue in Congress as well as other health issues
aimed at improving health disparities.
The alarming trend in our Country's rate of maternal mortality
first came to my attention in September 2018, when I was reading my
copy of the Green Journal. The original research cited in the journal
stated that maternal mortality rates increased in Texas between 2011
and 2012. \1\ The new study found that the number of maternal deaths in
Texas in 2012 was less than half the number previously reported.
---------------------------------------------------------------------------
\1\ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001799/.
The peer-reviewed research, published in the journal Obstetrics and
Gynecology, determined there were 56 maternal deaths among Texas
residents compared with 147 reported in national statistics. \2\ Later
on, it was released that the state overcounted the deaths due to a new
method of how Texas was reporting data that was different than other
states. This retraction of the study made disputes over the statistics
the subject of national news coverage as opposed to the lives that need
saving.
---------------------------------------------------------------------------
\2\ https://journals.lww.com/greenjournal/abstract/2018/05000/
identifying-maternal-deaths-in-texas-using-an.3.aspx.
I believe that any maternal death is one too many. It is important
that we capture these deaths accurately to understand the scope of
maternal mortality in the United States and have a better understanding
of how to address them. In combination, we cannot legislate good
practice, but we can provide the tools to be able to come up with best
practices and increase access to maternity care. These critical points
---------------------------------------------------------------------------
have influenced my policy work during my time as a legislator.
Throughout the years, I have worked across the aisle on several
pieces of legislation that became law, including H.R. 315 The Improving
Access to Maternity Care Act and H.R. 4387 The Maternal Health Quality
Improvement Act. Additionally, I am currently a lead sponsor of H.R.
3838 The Preventing Maternal Deaths Reauthorization Act, H.R. 7432 The
Sickle Disease Comprehensive Care Act, and H.R. 3226 The PREEMIE
Reauthorization Act of 2023. In the past, I have led critical
reauthorizations of Title VII Health Professional Education and
Training Programs to increase access to health care in underserved
areas and diversify the health care workforce. I also worked on H.R.
5395 The Expanding Connectivity for Health Outcomes Act (ECHO) Act,
which promoted connection between primary care providers and
specialists, increasing access to specialty care for underserved
communities.
Part of the goal of H.R. 3838 was to establish Maternal Mortality
Review Committees (MMRCs). These multidisciplinary committees review
the causes of maternal deaths in their state or other localities and
make recommendations based on their findings to prevent future deaths
and improve maternal health outcomes during pregnancy, childbirth, and
the postpartum period. Through my work on this legislation, Maternal
Mortality Review Committees were able to discover that 53 percent of
pregnancy-related deaths happen between 7 days and 1-year post-partum,
leading to the critical extension of the state plan amendment for
Medicaid and Children's Health Insurance Program (CHIP) 12-month post-
partum coverage. \3\ This year, effective March 1st, 2024, Texas
extended postpartum coverage to the full 12 months for eligible
Medicaid and Children's Health Insurance Program (CHIP) recipients
through the Texas Health and Human Services Commission.
---------------------------------------------------------------------------
\3\ https://www.cdc.gov/media/releases/2022/p0919-pregnancy-
related-deaths.html.
I cannot stress enough the importance of continuing bipartisan work
to reduce disparities and improve outcomes, as well as bolster our
public health workforce. Throughout the years, I've developed great
working relationships with Members such as Reps. Lisa Blunt Rochester,
Robin Kelly, and Danny Davis. It is through these great partnerships
that we influence and expand our understanding of health care policy in
the Nation. With that knowledge, it is my belief that Congress should
examine the effectiveness of our existing programs and determine what
---------------------------------------------------------------------------
changes may be necessary to achieve these goals.
Congress has an important role, but so do community/physician-led
efforts. The work of Congress should be informed by what's happening on
the ground. It is our passion and work that define who we are and leave
a lasting imprint on Capitol Hill, shaping policies, building
relationships, and fostering change that impacts the lives of countless
American patients.
Thank you for having me today and for holding this hearing on such
important topics. It has been a privilege to discuss my work and
experience with you.
______
The Chair. Well, thank you very much, Congressman Burgess.
Thank you very much, Senator Butler. We appreciate your
testimony and your excellent work. We will now hear from our
second panel. Thank you. Let me thank all of our knowledgeable
panelists for being with us this morning.
We have five panelists, Dr. Yolanda Lawson, Dr. Samuel
Cook, Dr. Michael Galvez, Dr. Jaines--Jaines Andrades, and Dr.
Brian Stone. And we thank all of them for being here. Our first
witness will be Dr. Yolanda Lawson.
She is President of the National Medical Association, the
largest organization representing Black physicians. Dr. Lawson
is an OB-GYN who is committed to addressing health inequities
and improving diversity among physicians.
She is also committed to eliminating maternal health
disparities. Dr. Lawson, thanks so much for being with us.
STATEMENT OF YOLANDA LAWSON, M.D., PRESIDENT, NATIONAL MEDICAL
ASSOCIATION, DALLAS, TX
Dr. Lawson. Thank you. Good morning----
The Chair. Is your mic on? Press the button.
Dr. Lawson. Okay. Good morning, Chairman Sanders and
Ranking Member, Dr. Cassidy, and Members of the Committee.
Thank you for the opportunity to appear before the
Committee to discuss this critical issue, addressing the
shortage of racial minoritized health care professionals and
maternal health disparities.
I am Dr. Yolanda Lawson, and I am testifying today as an
OB-GYN practicing in Dallas, Texas, and founder of MadeWell
OBGYN and MadeWell Woman, which is a birthing center. I am
currently the Executive Medical Director for Maternal Infant
Health at Healthcare Services Corporation.
Today, I speak to you primarily in my capacity as the
President of the National Medical Association. We are the
largest and oldest national organization representing more than
50,000 African American physicians and the patients they serve
of all racial and ethnic backgrounds. As a physician, my first
duty is to the health of my patients.
As NMA President, my first duty is to fulfill our mission
to eliminate health disparities in this country. The sad fact
is, African Americans, as well as other people of color, are
not as healthy as their white counterparts. African Americans
experience the lowest life expectancies across a myriad of
health care outcomes compared to White Americans, irrespective
of their socioeconomic status.
Research demonstrates that such inequities in health
outcomes have existed since Federal recordkeeping began, and
they cannot be explained solely by socioeconomic differences,
and they are largely preventable through structural
interventions and through the implementation of equitable
health policy and measures before a prospective patient even
enters a traditional medical setting.
In 2020, our Nation watched in horror as Black people died
disproportionately in high numbers from COVID-19. That
extraordinary moment spotlighted a chronic problem of the
ongoing health disparities that exist for Blacks in this
country.
Black people are disproportionately affected by virtually
every major chronic disease, including diabetes, high blood
pressure, and obesity. Even more disturbing are disparities in
maternal health. You all know the numbers.
Black women are more than--are 3 to 4 times more likely to
die from pregnancy related complications than white women, and
maternal health disparities persist as a pressing public health
challenge in the United States despite advances in medical
technology and health care delivery.
These disparities are not solely attributable to
socioeconomic factors but are deeply rooted in systemic racism
and unequal treatment, bias, and inadequate access to quality
health care. This is just--this is not just a matter of equity
or fairness.
When there are more sick people in our Nation, such an
imbalance dynamic creates a bigger burden on our health care
system, reduces workforce productivity, increases disability,
and raises medical costs that ultimately we all pay for,
whether through Medicare, Medicaid, or other high health
insurance premiums.
Avoidable health disparities are deeply rooted in the
operationalization of structural and systemic racism and
discrimination and in the persistence of unequal access to
quality health care. Each of these elements erodes a patient's
health care experience and diminishes their ability to make the
best choices in support of their health today and across their
lifetime.
Today, I would like to emphasize a critical piece of the
American health care puzzle, the shortage of Black physicians.
Research consistently demonstrates that patients from racial
and ethnic minority backgrounds experience better outcomes when
treated by health care providers who share their racial ethnic
backgrounds.
In short, patients can have better health outcomes when
their doctors look like them. Yet Black doctors remain vastly
underrepresented. Representation is critical, and Black
physicians and health care providers are more likely to
understand the unique challenges that Black patients--that
affect Black patients' health.
Black patients are more likely to trust and comply with the
recommendations of a Black physician. This country has a legacy
of distrust among African American--among American health care
institutions, rather well or perceived, and this is rooted in
historical abuses of power.
70 percent of all Black physicians in the U.S. today
attended HBCUs. In the 20th--in the early 20th century, we know
that number was reduced after the Flexner Report was released.
Instead of addressing those concerns about the quality of
education at HBCU medical schools, the AMA allowed them to
close.
We know that likely the number of Black physicians in this
country today would be more proportionate to the Black
population if those institutions had remained open. The NMA
believes we must create pathway programs to address inequities
in the education system.
We must address financial constraints. For many Black
students, medical school is a financial impossibility. We
support programs such as the National Health Service Corps. And
as for resources, for the HBCU medical schools to address
education and infrastructure, medical schools must adopt more
holistic admission processes.
We must address the higher attrition rates among medical--
Black medical students and residents. We advocate, in regard to
maternal health, a companion bill from the Senate to the Black
Maternal Momnibus Act to focus on preventable maternal
mortality.
Finally, we must take steps to reduce the bias in our
health care system by establishing regional centers of
excellence to address implicit bias and cultural competency in
health professions settings like Senator Durbin and Robin--
Representative Robin Kelly's Care for Moms Act.
I believe we are at a turning point in my lifetime. Two
major events have significantly exposed the disparities between
the health of Black people compared to those of our white
counterparts, the COVID-19 pandemic and Hurricane Katrina.
Both catastrophic events revealed the glaring health
inequities that are present in our Country. There is much work
to do, but we also have a historic opportunity to change the
story. Thank you, Senator.
[The prepared statement of Dr. Lawson follows.]
prepared statement of yolanda lawson
Greetings Chairman Sanders, Ranking Member Bill Cassidy, M.D., and
Members of the Committee.
Thank you for the opportunity to appear before the Committee to
discuss this critical issue: addressing the shortage of minority
healthcare professionals.
My name is Yolanda Lawson, M.D. I am testifying today as an OB-GYN
practicing in Dallas, Texas, and as the President of the National
Medical Association, the largest and oldest national organization
representing the interests of more than 50,000 African American
physicians and the patients they serve.
I am the founder of MadeWell OBGYN in Dallas and MadeWell Woman, a
birthing center. I am currently the Executive Medical Director,
Maternal Infant Health at HealthCare Services Corp.
As a physician, my first duty is to the health of my patients. As
NMA president, my first priority is to represent the needs of Black
physicians and Black communities in this country.
The sad fact is: Patients who are African American, as well as
other people of color, are not as healthy as their white (non-minority
counterparts.) And these disparities have existed since Federal
recordkeeping began.
The COVID-19 pandemic brought this issue to the forefront. In 2020,
the entire nation watched in horror as members of the Black community
accounted for a disproportionate number of COVID-19 deaths.
That was an extraordinary situation but reflected a chronic issue.
Black people are disproportionately affected by every major chronic
disease (excluding those with a genetic basis). They are 2.2 more
likely to have diabetes. According to the CDC Black infants 2.4 times
the mortality of White infants. African-Americans have the highest
mortality rates of any racial or ethnic group for all cancers combined
and most major cancers. Black people are more likely to die of heart
disease than any other group. Black women are 60 percent more likely to
have high blood pressure compared to White women.
Other disparities include ``higher uninsured rates, being more
likely to go without care due to cost, and worse reported health
status. The life expectancy of Black people is nearly 5 years shorter
compared to White people (72.8 years vs. 77.5 years).''
Even more disturbing are disparities in maternal health. Black
women continue to experience disproportionately high rates of maternal
morbidity and mortality compared to white counterparts. The Centers for
Disease Control and Prevention (CDC) reports that Black women are three
to four times more likely to die from pregnancy-related complications
than white women.
MATERNAL HEALTH DISPARITIES: A PERSISTENT CHALLENGE
Maternal health disparities persist as a pressing public health
challenge in the United States. Despite advances in medical technology
and healthcare delivery, Black women continue to experience
disproportionately high rates of maternal morbidity and mortality
compared to their white counterparts. The Centers for Disease Control
and Prevention (CDC) reports that Black women are three to four times
more likely to die from pregnancy-related complications than white
women. These disparities are not solely attributable to socioeconomic
factors but are deeply rooted in systemic racism, implicit bias, and
unequal access to quality healthcare.
This is not just a matter of equity. The commitment to safe
birthing processes and positive health outcomes affects everyone, not
just mothers. When there are more sick people, that creates a bigger
burden on our healthcare system, less productivity for the affected
workforce, and higher medical costs that ultimately, we all pay for,
whether through higher health insurance premiums or tax dollars for
Medicare and Medicaid. In 2019, it was noted that the impacts of
maternal morbidity cost the United States $32.3 billion.
To address this problem, we must understand why it's happening.
These disparities are not attributable solely to socioeconomic factors.
Nor is there a genetic or biologic basis. They are deeply rooted in a
myriad of factors that include systemic racism, implicit bias, and
unequal access to quality healthcare. But one key factor, which I'd
like to address in depth, is the shortage of Black physicians.
MORE BLACK PROVIDERS
Research consistently demonstrates that patients from racial and
ethnic minority backgrounds experience better health outcomes when
treated by healthcare providers who share their racial and ethnic
backgrounds. In short, patients can have better outcomes when their
doctors look like them.
Yet Black doctors remain vastly underrepresented relative to their
proportion of the U.S. population. Despite long-standing efforts to
increase minority representation in our physician workforce, gains have
been minimal. African American and Black people represent only 5.7
percent of physicians--which means they are grossly underrepresented
relative to the roughly 13.6 percent of Americans who are Black.
Physicians, of course, are only part of the healthcare workforce.
Recently, the NMA's Annual Colloquium convened the presidents of all
the major organizations of Black healthcare providers, including Black
nurses, Black pharmacists, Black registered dieticians, and Black
physical therapists, Black Dentists and Black Psychologists. We all
agreed: Ensuring the future of a diverse workforce is critical to
ending healthcare disparities.
Why is representation so important? Why do Black patients seem to
do better when they see Black physicians?
One reason is that Black physicians and healthcare providers are
more likely to understand the unique challenges that influence Black
patients' health outcomes. Also, Black patients are more likely to
trust the advice of a Black physician or provider and comply with the
physician's recommendations. Sociocultural understanding and improved
communication can lead to better quality of care. Studies indicate that
Black infants are 3 times more likely to die than non-Hispanic white
infants, however that number decreases by half when they are seen by a
Black doctor. Similarly, cardiovascular deaths in Black men are reduced
by 19 percent when they are seen by a Black physician.
Trust is critical in creating positive health outcomes and there is
a legacy of distrust in our community. This history of distrust is
understandable given the history of healthcare delivery and research in
the United States. The Tuskegee syphilis study is widely recognized as
one key reason for this mistrust. However, studies suggest that the
history of medical and research abuse of African Americans goes well
beyond Tuskegee.
Distrust has so many repercussions and costs. Despite mandates by
the Federal Government to ensure inclusion of women and minorities in
all federally funded research, African Americans continue to
participate less frequently than Whites. Lower participation rates
among African Americans have been reported across various study types
(e.g., controlled clinical treatment trials, intervention trials, as
well as studies on various disease conditions, including AIDS,
Alzheimer's disease, prostate cancer and other malignancies, stroke,
and cardiovascular disease). Black people don't enroll in research
studies because of that legacy of distrust. The presence of more Black
physicians could begin to repair some of that distrust.
Black physicians and healthcare providers can advocate for
equitable healthcare policies and practices within the healthcare
system.
UNDERSTANDING BARRIERS
Several challenges persist for young Black people who aspire to
become physicians:
Structural barriers--including limited access to medical school
education, financial constraints, pervasive discrimination within
academic and healthcare settings--all hinder the recruitment, retention
and advancement of Black medical students, residents and practitioners.
It is important to note the role of historically Black colleges and
universities (HBCUs), which have represented an important piece in the
pipeline. Nearly three-quarters--70 percent--of all Black physicians in
the U.S. attended HBCU medical schools.
At one time, there were seven HBCU medical schools. However, five
of those seven were shuttered after the 1910 release of the Flexner
Report, commissioned by Carnegie Corporation and the American Medical
Association's (AMA)'s Council on Medical Education. In 1910, Flexner
published his report with devastating consequences for the numbers of
Black doctors. He recommended shuttering five of the seven historically
Black medical schools that trained the vast majority of Black
physicians. Within 2 years of the Flexner Report, three Black medical
schools closed, and by 1924, only two such schools remained.
Flexner claimed the Black medical schools were substandard. His
biased thinking suggested that Black medical schools existed primarily
to keep Black citizens from spreading contagious disease to the white
population. The U.S. has yet to fully recover from this loss as there
are now only four HBCU medical schools.
More critically, instead of providing assistance to help raise the
quality of education at these schools, the AMA allowed them to close.
Had they remained open, likely the number of Black physicians in this
country today would be comparable to the size of the Black population,
and more importantly, the tragic health disparities I've described
would be much less.
HERE ARE SOME STEPS THAT NMA BELIEVES MUST BE TAKEN TO BEGIN TO ADDRESS
THE SHORTAGE OF BLACK PHYSICIANS
(1). Address barriers and inequities in the education system
that prevent talented Black students from getting to medical
schools, beginning with early childhood, through elementary and
secondary school and pre-medical education at the undergraduate
level.
(a). Black, Hispanic and Native American students are
more likely to have parents without a college degree
and more likely to attend a low-resourced college.
(b). Not only does that affect their ability to compete
in the admissions process . . . these factors trickle
down to social networks, limiting opportunities that
affect their ability to succeed as medical students.
(c). For example, one study found that students of
color were less likely to have shadowed a physician--an
experience that can burnish a med school application.
(d). Pathway programs should offer early interventions
and exposure to medical disciplines.
(2). Address financial constraints through scholarship
opportunities and additional funding for low-income students. A
student who is the first in their family to attend college, or
who works 20 hours a week to pay expenses while attending
college, faces an uphill battle. It's much more difficult for
those students to earn the same GPA and MCAT scores as a
student who doesn't have those constraints. NMA has established
a Million Dollar Scholarship Challenge to help address that
need--but it's just a start. The burden of student debt
disproportionately affects Black physicians, further
exacerbating existing socioeconomic disparities.
(3). Ensure that guidance counselors at the high school level,
and pre-med advisors at the undergraduate level, encourage and
support Black students who aspire to medical careers. Black
students are more likely to face discouragement from advisers
when applying to medical school compared to their white
counterparts. Instead of discouragement, they need support and
resources.
(4). Create a more holistic admission process for medical
school. Medical schools must expand their recruitment targets
to include ``added values'' that underrepresented and racially
minoritized individuals can bring to a training program or a
department. Admission tests and grades don't tell the whole
story. To quote the American Medical Association (AMA)--
``Scoring highly on the Medical College Admissions Test
(MCAT)--one of the primary measurements used in consideration
of medical student admission by medical schools--doesn't mean
you'll become a great, or even a good, doctor.'' The AMA report
adds: ``Overreliance on just one measure of performance, such
as the MCAT, risks missing a pool of candidates with other
valuable attributes to contribute to the health care system.''
Aspiring Black medical school candidates have valuable
attributes to contribute. They relate to Black patients and
they contribute to better health outcomes. An admission process
that overlooks that potential could exclude some of our best
future doctors.
(5). Increase the number of residency positions.
(6). Address the issue of higher attrition rates among Black
medical students and residents. These are students who managed
to overcome barriers to get into medical school and on to
residency. We need to understand what's keeping them from
meeting these final hurdles and how we can better support them.
(7). Address the especially severe shortage of Black men in
medicine through continued support of funding for graduate
medical education. Black men make up less than 3 percent of the
overall physician population. This disturbing numbers stems
from a history economic disadvantages and systemic racism.
(8). Continue and enhance programs in medical schools aimed at
improving diversity. We've seen a backlash of late against DEI
programs in medical schools. We cannot repeat the mistakes of
the Flexner report. As HBCUs produce 70 percent of Black
doctors, it is paramount that we continue to support these
institutions and support increases in graduate medical
education funding.
CLOSING COMMENTS
I believe we are at a turning point. In our lifetime, we have
experienced two major life events that have significantly exposed the
disparities between the health of Black people compared to those of our
white counterparts: the COVID-19 pandemic and Hurricane Katrina. Both
catastrophic events revealed the glaring health inequities that are
present in our Country. I believe we have the awareness and the
political will to begin to create change.
As I said before, this is more than a matter of equity. It's not
just about representation and fairness. It's about life and death. It's
about the health of millions of Black Americans.
There is much work to do, but there is also an opportunity to
change the story.
______
[summary statement of yolanda lawson]
The healthcare workforce and reproductive justice are not only key
policy foci of the NMA but of myself personally. Representing the needs
of Black communities is paramount in a time where we face some of the
worst health outcomes in the country. Black people are
disproportionately affected by every major chronic disease and have a
much higher likelihood of maternal mortality. Additionally, distrust in
the healthcare system has a longstanding history amongst Black
Americans, which creates additional barriers in receiving quality care.
Sociocultural understanding and improved communication have been proven
to lead to increased patient adherence to healthcare guidelines and
higher patient satisfaction, which results in better health outcomes.
Research continues to show that racial concordant care is key to
improved health outcomes for minority communities, however, due to a
history of racial and systemic barriers, the number of Black doctors in
the United States is staggeringly low. The United States has been
facing a physician shortage for several years, but especially with
Black doctors, who represent only 5.7 percent of doctors in the
country. The COVID-19 pandemic further exasperated these shortages and
brought them to the forefront. The shortage has resulted in lack of
access to receiving care, especially in rural and low-income
communities, extraordinarily long wait times to receive care, a lack of
a diverse workforce, and lack of healthcare workforce retention. It is
important to focus on providing resources to increase support for Black
students seeking graduate medical education. 70 percent of the Black
physicians in the United States attended Historically Black Colleges
and Universities (HBCUs) and the existence and support of these
institutions is critical to the pathway of increasing the number of
Black doctors. The Flexner report severely impacted the number of HBCUs
in our Country and we have yet to recover. By addressing barriers that
contribute to the lack of Black physicians in the United States, we can
begin to dismantle the systems that continue to impact the health
outcomes of our community.
______
The Chair. Dr. Lawson, thank you very much. Our next
witness will be Dr. Samuel Cook, a resident physician at
Morehouse School of Medicine. Dr. Cook received his medical
degree from Drexel University and is an advocate for improving
diversity of the physician workforce. Dr. Cook, thanks very
much for being here.
STATEMENT OF SAMUEL COOK, M.D., RESIDENT, MOREHOUSE SCHOOL OF
MEDICINE, ATLANTA, GA
Dr. Cook. Thank you, sir. Senator and Chairman Sanders,
Senators of the HELP Committee, my fellow panelists and guests,
thank you so much for having me here today. I am Dr. Samuel
David Cook and a PGY-3 internal medicine resident at Morehouse
School of Medicine.
I was born and raised in the Bronx, New York, by my two
loving parents, Ronald Cook and Ambassador Susan Johnson Cook,
who instilled in me a deep love of God and the impetus to serve
those among us who are most in need.
Though all of us in this room today are red blooded
Americans, my journey to this platform has been anything but
traditional. The doctors I saw as a child never looked like me,
so I made it my life's mission to be the change I sought in
medicine.
During my undergraduate studies at Johns Hopkins
University, I was told by my medical school admissions
counselor that my above average GPA at one of our Nation's top
ten universities was not strong enough to make medicine a
reality.
Nevertheless, I persisted and entered a post-baccalaureate
pipeline program for underrepresented minorities at Drexel
University's College of Medicine. In this Drexel pathway to
medical school program, I thrived in the specialized and
supportive environment and quickly excelled.
I then graduated to become a medical student at Drexel,
where I earned top academic awards above my peers of all races
and published my medical research, even authoring a paper with
decorated physicians at Harvard's medical school.
As the things go, you can't judge a book by its cover, and
it takes a village to raise a child. It is a fact, not an
opinion, that historically Black colleges and universities have
been instrumental in creating their own pipelines to medical
schools.
Between 2009 and 2019, HBCUs have seen the most Black
graduates to them. Last year, HBCU medical schools produced 10
percent of our Nation's Black doctors, while only accounting
for 2 percent of all medical colleges.
Assuming we beat an educational system that is stacked
against us, many Black students are then faced with hundreds of
thousands of dollars in student loan debt. For me, the current
sum of medical student loan debt plus accrued interest stands
just shy of $400,000.
Though the costs are the same, no matter the student's
race, the financial impact it will have on their families is
not. Racially biased and systemic wealth inequity is an
undeniable truth in our Nation, and one that has barred far too
many students of color from becoming the doctors they were
qualified to be.
Thus, we call on you to increase funding for HBCUs to
reduce the cost of producing high quality physicians of color.
This is with the understanding that these institutions have a
proven track record of incubating some of our Nation's
brightest minds, those nearly snuffed out by the waves of
racial bias and injustice.
How does having a Black doctor better serve Black patients
or save them from undue harm? I wrote in my testimony about a
Black woman who was nearly committed and chemically and
physically restrained, all because her medical team didn't know
that hitting your head to scratch an itchy scalp doesn't make
you crazy. It simply means you don't want to mess up your hair.
How it was the presence of a Black psychiatrist that saved
them and that hospital from what would have been justifiable
malpractice lawsuits. So, this is not just an issue for Black
American, Senators. This is an issue for all Americans.
What is more, a 2016 study found that half of white medical
trainees surveyed, 50 percent believe such myths as Black
people have thicker skin or less sensitive nerve endings than
white people.
They continued, participants who endorsed these beliefs
rated the Black patients pain as lower and made less accurate
treatment recommendations. In this population of white medical
students, we see evidence that negative racial biases are
currently and have long been harming America's Black patients.
Senators, I humbly come before you today as nothing more
than a mouthpiece for our collective struggles. We serve
tirelessly, Senators. We, resident physicians and medical
students of color sacrifice our physical, mental, spiritual,
and financial well-being to be the change in the medical field
we so desperately seek.
Now we ardently advocate for the reintroduction of
legislation which would specifically fund and protect the
growth of HBCU medical schools like that proposed by Chairman
Sanders in 2023.
This is what the sentiment that we make these vital
pipelines more affordable, because the financial manacles of
medical schooling are the greatest impediments in recruiting
Black and Brown doctors to our workforce.
It frightens me to think that after today, nothing will
change to render our physician workforce more representative of
the racial and ethnic makeup of our great nation. Therefore, I
am challenging you, Senators, calling upon you to each assure
the American public and your constituents that you will vote to
support our HBCUs and empower future generations of Black and
Brown physicians.
The time to act is never tomorrow, Senators. It has been
and always will be today. Thank you.
[The prepared statement of Dr. Cook follows.]
prepared statement of samuel cook
Senator and Chairman Sanders, Senators of the HELP Committee, my
fellow esteemed panelists, and guests.
Thank you so much for having me here today to speak on one of the
most critical issues in the U.S. Healthcare system as it currently
stands.
I am Dr. Samuel David Cook, a PGY-3 Internal Medicine Resident
Physician at The Morehouse School of Medicine. I was born and raised in
the Bronx, NY, by my two loving parents, Ronald Cook and Ambassador
Suzan Johnson Cook, who instilled in me a deep love of God, and the
impetus to serve those among us who are most in need.
We come here today for an awesomely important purpose: to recognize
the shortage of Black doctors currently in the American workforce, to
understand why it is an issue, and to identify actionable steps that
you may take as Congress to rectify this gap.
Though all of us in this room today are red-blooded Americans, my
journey to this platform has been anything but traditional. I grew up
in a neighborhood that was inherently sick, underserved from the most
critical healthcare needs. The doctors I saw as a child never looked
like me, so I made it my life's mission to be the change I sought in
medicine. During my undergraduate studies at Johns Hopkins University,
I was told by my medical school admissions counselor that my above-
average GPA at one of our Nation's top ten universities was not strong
enough to make medicine a reality. Nevertheless, I persisted and
entered a post-baccalaureate pipeline program for under-represented
minorities at Drexel University College of Medicine. In this Drexel
Pathway to Medical School Program (DPMS), I thrived in the specialized
and supportive environment, and quickly excelled. I then graduated to
become a medical student at Drexel, where I earned top academic awards
above my peers of all races, and published my medical research, even
authoring a paper with decorated physicians at Harvard Medical School.
As the sayings go, ``You can't judge a book by its cover,'' and ``it
takes a village to raise a child.''
While I do not have as many years of experience as my colleagues
testifying today, I do possess the benefit of recency in pursuing a
medical career.
What is the true measure of a physician? Is it how well they score
on a standardized exam, or is it the care and poise with which they
utilize such knowledge? I submit to you today that high-quality medical
care necessitates qualified, yet compassionate and culturally competent
physicians.
Historically Black Colleges and Universities (HBCUs) have been
instrumental in creating pipelines to medical schools. Between 2009 and
2019, HBCUs sent the most Black graduates to medical schools. According
to the Association of American Medical Colleges (AAMC), ``Howard and
Morehouse graduated more than 400 each over this time period, while no
predominantly white institution graduated as many as 300.'' Of the
three undergraduate institutions supplying medical colleges with the
most Black entrants in 2023, ``two were HBCUs--Howard (first) and
Xavier (third).'' Additionally, HBCU Medical Schools produced 10
percent of our Nation's Black doctors last year while only accounting
for 2 percent of all medical colleges.
Assuming we beat an educational system that is stacked against us,
Black medical students have one of the most difficult and potentially
injurious decisions facing them: Should I assume hundreds of thousands
of dollars in student-loan debt without any guarantee I will actually
become a practicing physician? For me, the current sum of medical
student loan debt and accrued interest stands just shy of $400,000.
Though the costs are the same no matter the student's race, the
financial impact it will have on their family is not. Racially based
and systemic wealth inequity is an undeniable truth in our Nation, and
one that has barred too many students of color from becoming the
doctors they were qualified to be.
Acceptance into medical school and matriculation through residency
are crucial pain points when looking at the employment gap, but
retention and support are, nevertheless, equally as important. We are
often bound by our debts to work in hospitals in which we may not be
equally supported, or worse, face reprimand at unjustly higher rates
than our peers. One 2020 study published in JAMA Surgery found that
over 70 percent of Black surgical residents who were surveyed faced
discrimination during their residency. Another showed that ``Black
trainees accounted for only 5 percent of all residents in 2016 but 20
percent of those who were dismissed from a residency program.'' Thus,
we call on you to increase funding for HBCUs to reduce the cost of
producing high-quality physicians of color. This is with the
understanding that these institutions have a proven track record of
incubating some of our Nation's brightest minds, those nearly snuffed
out by the waves of racial bias and injustice.
How does a black doctor better serve Black patients, or save them
from undo harm? I will give an especially poignant example. I was
informed of the particularly harrowing story of a Black patient at one
of our area's hospitals. She was seen furiously hitting her head, to
the degree that her medical staff were alarmed, insisting that the
patient be placed under a psychiatric hold as they judged she was a
direct harm to herself. When the Black female Psychiatrist went to the
bedside to see this patient, she immediately indicated to the rest of
the medical team that the patient was, in fact, not harming herself,
but simply patting her head because that is how you scratch an itchy
scalp without messing up your hair. Had a Black physician not
intervened in this instance, that patient was on a pathway to being
chemically or physically restrained, and that hospital and staff would
have justifiably faced a malpractice lawsuit. So, this is not just an
issue for Black Americans, it is an issue for all Americans.
Senators, cultural competence directly saves our patients' lives
and well-being. It protects them from the perils of physicians who have
sheltered in their own cultural bubbles without true understanding of
the diverse communities they serve.
What's more, a 2016 study published in the Proceedings of the
National Academy of Sciences (PNAS) found that ``Half of white medical
trainees [surveyed] believe such myths as Black people have thicker
skin or less sensitive nerve endings than white people.'' They
continue, ``participants who endorsed these beliefs rated the Black
(vs. white) patient's pain as lower and made less accurate treatment
recommendations.'' In this population of white medical students, we see
evidence that negative racial biases are currently, and have long been,
harming America's Black patients.
To support our efforts further, I ardently advocate for the re-
introduction of legislation which would specifically fund and protect
the growth of HBCU medical schools, similar to that proposed by
Chairman Sanders in 2023.
Senators, though I have faced my own substantial tribulations on
the path to becoming a physician, I humbly come before you today as
nothing more than a voice for our collective troubles. We serve,
tirelessly, Senators. We resident physicians and medical students of
color sacrifice our physical, mental, spiritual, and financial well-
being to be the change in the medical field we so desperately seek. We
physicians, residents, and medical students of color humbly ask that
you increase spending on medical education at HBCU medical colleges,
because the financial manacles of medical schooling are the greatest
impediments in recruiting Black and Brown doctors to our workforce.
Americans need us in these roles to provide the high-quality,
culturally competent care they require. So let's work together to fund
the new wave of Black and Brown physicians our Country, including you
all, will need in the future. The time to act is never tomorrow,
Senators; it has been, and always will be, today.
Samuel D. Cook, M.D.
PGY-3 Internal Medicine Resident Physician.
Morehouse School of Medicine
REFERENCES
Gasman, M., Smith, T., Ye, C., and Nguyen, T.-H. (2017). HBCUs and
the production of doctors. AIMS Public Health, 4(6), 579-589. https://
doi.org/10.3934/publichealth.2017.6.579.
Table 6. U.S. medical schools with 150 or more Black or African
American graduates (alone or in combination), 2009-2010 through 2018-
2019. AAMC. (2019, August 19). https://www.aamc.org/data-reports/
workforce/data/table-6-us-medical-schools-150-or-more-black-or-african-
american-graduates-alone-or-combination-2009.
2023 facts: Applicants and matriculants data. AAMC. (1023, October
17). https://www.aamc.org/data-reports/students-residents/data/2023-
facts-applicants-andmatriculants-data.
Steele, D. (2022, May 12). New Med schools planned as need for
black doctors continues. Inside Higher Ed. Higher Education News,
Events and Jobs. https://www.insidehighered.com/news/2022/05/13/new-
med-schools-planned-needblack-doctors-continues.
Yuce, T. K., Turner, P. L., Glass, C., Hoyt, D. B., Nasca, T.,
Bilimoria, K. Y., and Hu, Y.-Y. (2020). National Evaluation of Racial/
ethnic discrimination in U.S. surgical residency programs. JAMA
Surgery, 155(6), 526. https://doi.org/10.1001/jamasurg.2020.0260.
Ellis, J., Otugo, O., Landry, A., and Landry, A. (2023).
Dismantling the overpolicing of black residents. New England Journal of
Medicine, 389(14), 1258-1261. https://doi.org/10.1056/nejmp2304559.
Sabin, J. A., By, Sabin, J. A., and 6, Jan. (2020, January 6). How
we fail black patients in pain. AAMC. https://www.aamc.org/news/how-we-
fail-black-patients-pain.
Hoffman, K. M., Trawalter, S., Axt, J. R., and Oliver, M. N.
(2016). Racial bias in pain assessment and treatment recommendations,
and false beliefs about biological differences between blacks and
whites. Proceedings of the National Academy of Sciences, 113(16), 4296-
4301. https://doi.org/10.1073/pnas.1516047113.
______
[summary statement of samuel cook]
Growing up in the Bronx, NY, my parents instilled in me a deep
sense of duty to help those in need, casting my journey into medicine.
Nevertheless, I have encountered and overcome numerous challenges on my
path to serving others. Despite facing recurrent discouragement,
particularly during my undergraduate education, I remained steadfast in
my commitment to advocating for underserved communities and healing
other families as if they were my own.
Through programs like the Drexel Pathway to Medical School (DPMS)
Program, I have been blessed to educationally excel, and recognize the
crucial role of Historically Black Colleges and Universities (HBCUs) in
nurturing diverse talent within the medical field. However, I have
directly witnessed the disproportionate impact of student loan debt on
medical students of color, hindering their access to and progression
within medicine. Nevertheless, my journey is just one among many. I
believe that, by working together, we can overcome these obstacles and
create a brighter future for healthcare in America.
As an Internal Medicine Resident Physician at Morehouse School of
Medicine, my experiences have led me to recognize the urgent need for
change in the medical field. Despite the progress we have made thus
far, there is much work to be done. Moreover, there are still far too
many barriers preventing individuals of underrepresented backgrounds
from pursuing and thriving in healthcare careers.
In light of these challenges, I humbly urge Congress to expand
support for HBCU medical schools, and establish a fund to directly
increase their available resources. By amplifying support for HBCUs and
implementing targeted initiatives, we can empower the next generation
of diverse medical professionals and ensure equitable access to quality
care for all. These steps are essential to addressing systemic barriers
in medicine, ensuring a more inclusive healthcare landscape where all
patients receive culturally competent care.
In advocating for change, I am not just speaking for myself, but
for countless others who have faced similar struggles. Together, we can
work toward a healthcare system that reflects the rich diversity of our
Nation and meets the needs of every patient, regardless of their
background or circumstance. It is time, Senators, to acknowledge the
shortcomings of our current healthcare system, and turn our collective
focus to the action needed to revive it.
______
The Chair. Thank you very much, Dr. Cook. Our next witness
will be Dr. Michael Galvez, who specializes in pediatric
reconstructive hand surgery in Madero, California. Dr. Galvez
co-created the National Latino Physician Day, and the phrase 6
percent is not enough, to bring attention to the need to
diversify the physician workforce. Dr. Galvez, thanks so much
for being with us.
STATEMENT OF MICHAEL GALVEZ, M.D., VALLEY CHILDREN'S HOSPITAL;
CO-CREATOR OF NATIONAL LATINO PHYSICIAN DAY, MADERA, CA
Dr. Galvez. Buenos Dias, Chairman Sanders and Ranking
Member Cassidy. Thank you for having me here today. My name is
Dr. Michael Galvez, and I stand before you as a husband,
father, son of Peruvian immigrants, a surgeon, and an advocate
for Mi Comunidad, My Latino Community.
I am honored to serve as a pediatric hand surgeon to help
children with complex hand conditions at Valley Children's
Hospital in the Central Valley of California, a region with
significant disparity and need for high quality care. Hablo
Espanol todo los dias. I speak Spanish every day with my
patients.
In my practice of medicine, I have come to recognize that
my language and culture are as valuable as my training at
prestigious universities. There is nothing like seeing a face
of a Latino child's mother when I come through a clinic door
and begin speaking Spanish, alleviating fear as their first
encounter with a physician that speaks el idioma, the language.
I see complex problems, and having the superpower of
language proficiency and understanding the culture adds clarity
and connection. After working at medical institutions across
the United States, I have asked myself constantly, why don't I
see more students and faculty like myself?
For that reason, I helped co-found National Latino
Physician Day, celebrated on October 1st, along with Stanford
Obstetric Anesthesiologist Dr. Cesar Padilla, to spotlight the
underrepresentation of Latinos and Latinas in medicine.
This effort has rapidly evolved into a movement supported
by the National Hispanic Medical Association, the Latino
Medical Student Association, and nearly every medical
organization in this country and multiple hospital systems
across the country.
We rally behind the motto, 6 percent is not enough, in
recognition of the public health crisis affecting our
community. Despite being the largest minority group in the
United States, Latinos represent only 6.9 percent of the
physician workforce, which is a big contrast to almost 20
percent representation in the Nation's population and nearly 40
percent in the States of California and Texas.
There are not enough physicians to provide high quality
care to communities that are the backbone to our economy--and
overrepresented in difficult professions such as agriculture
and construction. Latinos in the U.S. have the fifth largest
gross domestic product in the world, GDP.
However, limited access to health care, face language, and
cultural barriers experience poorer cancer and maternal health
outcomes and had increased COVID-19 mortality during the
pandemic. This deeply burdens the Nation's social safety nets,
more missed school days for children, and lower productivity,
which really stunts the potential of our Country.
Our hospitals, our institutions, medical schools, and
indeed, Congress have the ethical responsibility to address the
underrepresentation of Latino physicians to meet the needs of a
growing Latino population, which is estimated to comprise one-
third of the population by 2050. But the journey to medicine is
full of socioeconomic barriers, especially for Latino and
minority students.
In my journey, community college education was key to my
success, but it can really just be the--it is really the only
educational option for some students. To expand the percentage
of Latino physicians and minority physicians in general, it is
critical to meet them where they are, and that is in our
Nation's community colleges.
The commercialization of medical school admissions and the
reliance on standardized tests, such as the MCAT, overlooks the
potential of a compassionate and capable physician candidate.
Having helped excellent students navigate these waters, I am in
disbelief when they are not recruited, despite our physician
shortage.
The National Latino Physician Day highlights the persistent
shortage of Latino physicians, which underscores the need for
change and opportunities for action that Congress can take.
First, expand funding for pathway programs and new medical
school programs.
We can increase the minority physician workforce by
recognizing the value of lived experience of Latino identified
individuals through pathway programs that begin at community
colleges, earlier exposures to medicine, and advocate for
holistic medical school admissions.
We need a bilingual and bicultural medical school anchored
in a Hispanic serving institution, partnered with local
hospitals. We can start with regional satellites of medical
schools in predominantly Latino areas of California.
We also should not be ignoring language. Language
proficiency by physicians is a proven strategy for improving
patient outcomes demonstrated by the UCLA Latino Policy and
Politics Institute, which has shown that concordant language
enhances compliance with treatment plans and medication
adherence.
Mandating medical schools to value bilingual skills and
community college background by tying medical school funding
and NIH grants to admission practices that prioritize these
elements.
This will drive medical schools to align more closely to
their local, underserved areas. For example, the University of
California could be mandated to recruit, accept, and retain
these qualified students to take care of those underserved
populations.
Finally, funding loan repayment programs. In California, I
am grateful to be the recipient of a Cal Healthcare's loan
repayment to serve patients on Medi-Cal. But federally, the
National Health Service Corps is essential to attract and
retain physicians in underserved areas, ensuring equitable
health care access.
We can no longer allow the status quo from our medical
schools. As the Latino population increases, we must confront
this public health crisis head on. Necesitamos mas, we need
more. Thank you so much.
[The prepared statement of Dr. Galvez follows.]
prepared statement of michael galvez
``Buenos dias!'' Chairman Sanders and Ranking Member Cassidy.
My name is Dr. Michael Galvez. I stand before you as a husband,
father, son of Peruvian immigrants, surgeon, and advocate for ``mi
comunidad'' (my Latino community).
I am honored to serve as a Pediatric Hand surgeon to help children
with complex hand conditions at Valley Children's Hospital in the
Central Valley of California--a region with significant disparity and
need for high-quality care.
``Hablo espaol todos los dias'' (I speak Spanish every day) with my
patients. In my practice of medicine, I've come to recognize that my
language and culture are as valuable as my training at prestigious
universities. There is nothing like seeing the face of a Latino child's
mother when I come through a clinic door and begin speaking Spanish--
immediately alleviating fear as their first encounter with a physician
that speaks ``el idioma'' (the language). As a specialist, I see
complex problems and having the ``superpower'' of language proficiency
and understanding the culture adds clarity and connection.
After working at medical institutions across the United States,
I've asked myself constantly, ``why don't I see more students and
faculty like myself?''
For that reason I helped co-found National Latino Physician Day
celebrated on October 1st, along with Stanford Obstetric
Anesthesiologist Dr. Cesar Padilla, to spotlight the
underrepresentation of Latinos and Latinas in medicine. This effort has
rapidly evolved into a movement, supported by the National Hispanic
Medical Association, the Latino Medical Student Association and nearly
every medical organization across the country.
We rally behind the motto ``6 percent is not enough!'' in
recognition of the public health crisis affecting our community.
Despite being the largest minority group in the U.S., Latinos represent
only 6.9 percent of the physician workforce, a contrast to our almost
20 percent representation of the Nation's population and nearly 40
percent in the States of California and Texas. There are not enough
physicians to provide high-quality care to communities that are the
backbone of our economy and overrepresented in difficult professions
including agricultural and construction work. Latinos in the U.S. have
the fifth-largest Gross Domestic Product *(GDP) in the world, however
we have limited access to healthcare, face language and cultural
barriers, experience poorer cancer and maternal health outcomes, and
had increased COVID-19 mortality during the pandemic. This deeply
burdens the Nation's social safety nets, more missed school days for
children, and lower productivity. In a real way, it stunts the
development and potential of our Country.
Our institutions, hospitals, medical schools, and indeed, Congress,
have an ethical responsibility to address the underrepresentation of
Latino physicians to meet the needs of a growing Latino population
which will comprise one-third of the population by 2050. But the
journey to medicine is full of socioeconomic barriers, especially for
Latino students and other underrepresented backgrounds.
In my journey, community college education was key to my success,
but sometimes can be the only educational option available. To expand
the percentage of Latino physicians, and minority physicians in
general, it is critical to meet them where they are at--in our Nation's
community colleges. The commercialization of medical school admissions
and reliance on standardized tests often overlooks the potential of
compassionate and capable physician candidates. Having helped excellent
students navigate these waters, I am dumbfounded when they are not
recruited despite our physician shortage.
Programs to improve physician access, such as CalHealthCares a
California loan repayment program, alleviates loan burden to help
physicians root down in underserved areas.
The persistent shortage of Latino physicians underscores the need
for change and opportunities for actions Congress can take:
(1). Expand Funding for Pathway Programs and New Medical School
Programs. We can increase the minority physician workforce by
recognizing and valuing the lived experiences of Latino
identified individuals through pathway programs that start at
community colleges, early exposures to medicine, and advocate
for holistic medical school admissions. We need a Bilingual and
Bicultural Medical School anchored in a Hispanic Serving
Institution partnered with local hospitals. We can start with
regional satellites of medical schools in predominantly Latino
areas of California.
(2). Not Ignore Language. Language proficiency by physicians is
a proven strategy for improving patient outcomes demonstrated
by the UCLA Latino Policy and Politics Institute, as research
has shown that concordant language enhances compliance with
treatment plans and medication adherence.
(3). Mandating Medical Schools to Value Bilingual Skills and
Community College Background. By tying medical school funding
and NIH grants to admission practices that prioritize these
elements. This will drive medical schools to align more closely
with underserved areas. For example, the University of
California could be mandated to recruit, accept, and retain
these qualified students for the betterment of severely
underserved areas.
(4). Funding Loan Repayment Programs. Including the National
Health Service Corp, is essential to attract and retain
physicians in underserved areas, ensuring equitable healthcare
access.
We can no longer allow the status quo from our medical schools, as
the Latino population increases. We must confront this public health
crisis head-on.
``Necesitamos mas!'' We need more.
Thank you.
______
[summary statement of michael galvez]
Good morning, Chairman Sanders and Ranking Member Cassidy.
My name is Dr. Michael Galvez, a proud husband, father, and
Pediatric Hand surgeon. As a son of Peruvian immigrants and an advocate
for my Latino community, I am privileged to work at Valley Children's
Hospital in California's Central Valley, a region that faces
significant health disparities.
I communicate daily in Spanish, the native language of many of my
patients, allowing me to connect with them. This linguistic ability,
paired with an understanding of my culture, proves as invaluable as my
academic qualifications from prestigious institutions. The relief
visible on the faces of Latino families when they interact with a
Spanish-speaking doctor highlights the profound impact of language and
culture.
Despite my experiences across various U.S. medical institutions, I
frequently reflect on the scarcity of Latino faculty and students in
medicine. This observation led me to co-found National Latino Physician
Day on October 1st, along with Dr. Cesar Padilla from Stanford. This
initiative, now supported by key medical associations nationwide,
focuses on the underrepresentation of Latinos in the medical field. We
rally around the slogan ``6 percent is not enough!'' acknowledging a
public health crisis within our community. Latinos constitute the
largest minority group in the U.S., yet make up just 6.9 percent of the
physician workforce. This discrepancy is stark, considering Latinos
represent nearly 20 percent of the U.S. population and significantly
more in States like California and Texas. The shortage of Latino
physicians exacerbates the lack of access to quality healthcare in our
communities, which form an essential part of the national economy. Our
community's economic contribution is immense, being the fifth-largest
GDP globally if considered independently. Yet, we face limited
healthcare access, language barriers, and poorer outcomes in conditions
like cancer and maternal health. It is not just a matter of healthcare
but of national productivity and potential. Medical institutions, along
with Congress, hold an ethical obligation to address this imbalance to
support the growing Latino population, projected to reach one-third of
the U.S. by 2050.
The path to increasing Latino representation in medicine is
hindered by socioeconomic barriers. Community colleges, often the only
higher education avenue available to many, were instrumental in my own
medical journey.
Several actions are crucial for Congress to consider:
(1). Expand Funding for Pathway Programs and New Medical School
Programs. We can increase the minority physician workforce by
recognizing and valuing the lived experiences of Latino identified
individuals through pathway programs that start at community colleges,
early exposures to medicine, and advocate for holistic medical school
admissions. We need a Bilingual and Bicultural Medical School anchored
in a Hispanic Serving Institution partnered with local hospitals. We
can start with regional satellites of medical schools in predominantly
Latino areas of California.
(2). Not Ignore Language. Language proficiency by physicians is a
proven strategy for improving patient outcomes demonstrated by the UCLA
Latino Policy and Politics Institute, as research has shown that
concordant language enhances compliance with treatment plans and
medication adherence.
(3). Mandating Medical Schools to Value Bilingual Skills and
Community College Background. By tying medical school funding and NIH
grants to admission practices that prioritize these elements. This will
drive medical schools to align more closely with underserved areas. For
example, the University of California could be mandated to recruit,
accept, and retain these qualified students for the betterment of
severely underserved areas.
(4). Funding Loan Repayment Programs. Including the National Health
Service Corp, is essential to attract and retain physicians in
underserved areas, ensuring equitable healthcare access.
We need more dedicated professionals who reflect the communities
they serve. Thank you for your attention to this public health crisis.
______
The Chair. Thank you very much, Dr. Galvez. Senator
Cassidy, do you want to introduce your panelists?
Senator Cassidy. Yes. My pleasure to introduce doctor--I am
sorry. Dr. Jaines Andrades, who is a certified Nurse
Practitioner who completed her doctor--nurse practitioner at
Elms College 2020 and her Bachelor of Science in Nursing from
Elms College in 2014.
She is a native of Springfield, Massachusetts, dedicated
her professional career to caring for vulnerable populations
with addiction, mental illness, and chronic disease. She
credits her pre-nursing experiences in the hospital setting as
a catalyst to pursuing a career in health care.
Her clinical experience as a registered nurse began as a
correctional nurse for the Hampton County Sheriff's Department,
where she conducted mental health evaluations and incorporated
a multidisciplinary approach to care.
Later joined the Baystate Mason Square Neighborhood Clinic,
providing drug and alcohol abuse nursing care. She enhanced her
clinical skills as an inpatient staff nurse and joined Baystate
Medical Center team as a trauma surgery nurse practitioner in
September 2020.
Her commitment to be a voice for the disenfranchised has
allowed her to be a change agent and a role model for others.
Dr. Andrades, thank you for being here.
STATEMENT OF JAINES ANDRADES, DNP, AGACNP-BC, NURSE
PRACTITIONER, BAYSTATE HEALTH, SPRINGFIELD, MA
Ms. Andrades. Chairman Sanders and Ranking Member, Dr.
Cassidy, I am Jaines Andrades, a nurse practitioner in trauma
surgery at Baystate Medical Center in Springfield,
Massachusetts.
It is an honor to present my testimony before you today,
and I thank you for the opportunity and your attention to
addressing the shortage of minority health care professionals.
I want to tell you a bit of my experience and offer you
some insight into ways I believe Congress can help increase the
number of minority health care workers in the future. I went to
high school in Springfield, Massachusetts, at Putnam High
School, an urban vocational school.
I was enrolled in the cosmetology program but had dreams of
becoming a lawyer. At that time, I struggled to figure out how
to make this dream come true, coming from a single parent home
where my mother didn't have the means to save for college or
law school.
I was fortunate, though she did have the drive to instill a
strong work ethic and the foresight to encourage me to
contemplate my talents and choose a career which would offer
economic stability.
One day at a medical appointment with my mom, a nurse
started talking to me about the opportunities her nursing could
offer. I was intrigued. To get a better sense of how I would
fare on the path to becoming a nurse, I started taking courses
at Holyoke Community College.
I took prerequisites for the nursing program and eventually
enrolled to Elms College to earn my Bachelor's of Nursing.
While I was going to school, I wanted to support myself and
thought taking a job at a hospital to get my foot in the door
and learn more about health care would benefit me in the long
run.
I began working in environmental services as a custodian at
Baystate Medical Center. I worked to keep surgery and procedure
rooms clean. This allowed me to see firsthand what nurses did,
what I would need to know moving ahead in the health care
environment, and to get advice on how to proceed in my career.
My colleagues offered incredible insight into ways I could
fund my education. They pointed me toward resources like the
Western Mass Community Foundation, where I had access to
scholarships and interest free loans. Without my colleagues, I
would not have been able to find these resources, which I
believe were instrumental to my education. These resources need
to be made more visible and accessible to students.
I proceeded through my nursing school and stayed at BC
Medical Center in Environmental Services. Eventually, I was
hired as a nurse, once I graduated, in a community health
center, Mason Square.
There again, with the support of my colleagues, I was
encouraged to earn my Doctorate of Nursing Practice. I did this
at the height of the COVID-19 pandemic, which was not easy, and
eventually I was able to come full circle and take a job as a
nurse practitioner in trauma surgery again at Baystate Medical
Center.
Looking back on my experience, if I could make suggestions
to lawmakers on how to improve the shortage of minority health
care providers, I would offer a few thoughts. First, I would
say robust college and career planning is very critical.
Many students at all schools, most especially those in
lower income areas aware of health care as an attainable career
opportunity would go so far. Letting these students know it is
within their reach, and that there are resources available to
them to embark on their journey to higher education is key.
At Baystate Medical Center, we have a program called the
Baystate Springfield Educational Partnership, or BSEP. This is
a program for the youth in Springfield, which helps connect
them with hospital based learning and opportunities to learn
about different professions within the health care system.
It allows students to engage with professionals and learn
from them, like I did while being a custodian. But in this
program, they are still in high school, and this option helps
them evaluate what health care career they could select.
I did not go through this program myself, but I would
recommend supporting similar opportunities for minority youth
for early professional mentorship. There are a number of
physicians, physician assistants, and nurse practitioners like
myself who entered BSEP as high school students and now work
for Baystate.
Many of the BSEP students also fill other roles in Baystate
while advancing their education. I believe Federal support for
programs like this could lead to many more minority students
embarking on prosperous careers in health care.
Another way to make this journey more accessible is tuition
free community college. This would allow students to begin
their education without taking on a financial burden. This
opportunity to begin to pursue the education needed to become a
professional health care provider at a community college should
not be underestimated.
Additionally, state and Federal grants to reduce loan costs
would make their career paths a more appealing option. Helping
fund the education of minority students interested in becoming
professional health care providers is a wise investment.
It fills in demand jobs in the health care field and
connects people with practical careers, which will allow them
economic stability to support themselves and their families.
Thank you again for the opportunity to testify and share my
experience with you. I appreciate your consideration of my
recommendations.
[The prepared statement of Ms. Andrades follows.]
prepared statement of jaines andrades
Chairman Sanders and Ranking Member, Dr. Cassidy, I am Jaines
Andrades, a nurse practitioner at Baystate Medical Center in
Springfield, Massachusetts. It is an honor to present my testimony
before this Committee today. I thank you for the opportunity and your
attention to addressing the shortage of minority health care
professionals.
I want to tell you a little bit about my experience and offer you
some insight into ways I believe Congress could help increase the
number of minority health care professionals in the future.
Currently, I work as a nurse practitioner in the trauma and surgery
unit at Baystate Medical Center. That is not exactly where my journey
in health care began--but in some ways, it is close.
I went to high school in Springfield, Massachusetts, at Putnam High
School, an urban vocational high school that frequently failed to meet
state standards. I was enrolled in the cosmetology program but had
dreams of becoming a lawyer. As time passed, I struggled to figure out
how to make that dream come true, coming from a single-parent home,
where my mother didn't have the means to save for college or law
school. I was fortunate, though, that she did have the drive to instill
a strong work ethic and the foresight to encourage me to contemplate my
talents and career which would offer economic stability. Not every kid
has that behind them.
One day, I was at a medical appointment with my mom, and a nurse
started talking to me about the opportunities nursing offered. I was
intrigued.
To get a better sense of how I would fare on the path to becoming a
nurse, I started taking courses at Holyoke Community College. I took
prerequisites for programs to become a registered nurse, eventually
enrolling at Elms College to earn my BSN.
While I was going to school, I wanted to work to support myself,
and thought taking a job at a hospital, to get my foot in the door and
learn more about health care, would only benefit me in the long run.
I began working in ``environmental services,'' as a custodian, at
Baystate Medical Center. I worked to keep surgery and procedure rooms
clean. This allowed me to see, first-hand, what nurses did, what I
would need to know to move ahead in a health care environment, and to
get advice on how to proceed in my career. My colleagues also offered
incredible insight into ways I hadn't thought of to fund my education.
They pointed me toward resources like the Western Mass Community
Foundation, where I had access to scholarships and interest-free loans.
Without my colleagues, I would not have been able to find such
resources, which I believe were instrumental to my education. These
resources need to be made more visible and accessible to students.
I proceeded through nursing school and stayed at Baystate in
environmental services for quite some time, waiting for a nursing
opportunity. Eventually, I was hired as a nurse at one of our community
health centers. There, again with the support of my colleagues, I was
encouraged to earn my doctor of nursing practice degree.
I did that at the height of the COVID-19 pandemic, which was not
easy. I eventually came ``full circle'' and took a job as a nurse
practitioner in trauma and surgery back at Baystate Medical Center.
Looking back on my own experience, if I could make suggestions to
lawmakers on how to improve the shortage of minority health care
providers, I would offer a few thoughts.
First, I would say robust college and career planning is very
critical. Making students at all schools, most especially those in
lower-income areas, aware of health care as an attainable career
opportunity would go far. Letting these students know it is within
their reach and that there are resources available to them as they
embark on the journey to higher education is key.
At Baystate, we have a program called the Baystate Springfield
Educational Partnership, or BSEP. This is a program for youth in
Springfield, which helps connect them with hospital-based learning and
opportunities to learn about different professions within the health
care system. It allows students to engage with professionals, and learn
from them, like I did working alongside them as a custodian, but while
they are still in high school and evaluating their options. I did not
go through this program myself, but I would recommend supporting
similar opportunities for minority youth for early professional
mentorship. There are a number of physicians, physician's assistants,
and nurse practitioners who entered the program as high school students
and now work for Baystate Health. Many of them also fill other roles in
the Baystate system while advancing their education. I believe Federal
support for programs like this could lead to many more minority
students embarking on prosperous careers in health care.
Another way to make this journey more accessible is tuition-free
community college. This would allow students to begin their education
without taking on a financial burden. The opportunity to begin to
pursue the education needed to become a professional health care
provider at a community college should not be underestimated.
Additionally, state and Federal grants to reduce loan costs would
make these career paths a more appealing option. Helping fund the
education of minority students interested in becoming professional
health care providers is a wise investment; it fills in-demand jobs in
the health care field and connects people with practical careers which
will allow them economic stability to support themselves and their
families.
Thank you again for this opportunity to testify and share my
experience and insight with you. I appreciate your consideration of my
recommendations and thank you in advance for your questions.
______
[summary statement of jaines andrades]
Chairman Sanders and Ranking Member, Dr. Cassidy, I am Jaines
Andrades, a nurse practitioner at Baystate Medical Center in
Springfield, Massachusetts. I thank you for the opportunity and your
attention to addressing the shortage of minority health care
professionals.
Currently, I work as a nurse practitioner in the trauma and surgery
unit at Baystate Medical Center.
I went to high school in Springfield, Massachusetts, at Putnam High
School, an urban vocational high school that frequently failed to meet
state standards. I had dreams of becoming a lawyer but eventually it
became clear this was not realistic financially.
I was inspired by a nurse I met at a medical appointment and
started taking the prerequisites to becoming an RN at Holyoke Community
College, eventually enrolling at Elms College to earn my BSN.
While I was going to school, I took a job as a custodian at
Baystate Medical Center to support myself and work alongside nurses. My
colleagues pointed me toward resources to help fund my education like
the Western Mass Community Foundation, where I had access to
scholarships and interest-free loans. These resources need to be made
more visible and accessible to students.
I proceeded through nursing school and was hired as a nurse at one
of our community health centers. There, again with the support of my
colleagues, I was encouraged to earn my doctor of nursing practice
degree.
I eventually took a job as a nurse practitioner in trauma and
surgery back at Baystate Medical Center.
If I could make suggestions to lawmakers on how to improve the
shortage of minority health care providers, I would offer a few
thoughts.
First, I would say robust college and career planning is very
critical.
At Baystate, we have a program called the Baystate Springfield
Educational Partnership. This is a program for youth in Springfield,
which helps connect them with hospital-based learning. I did not go
through this program myself, but I would recommend supporting similar
opportunities for minority youth for early professional mentorship.
Another way to make this journey more accessible is tuition-free
community college.
Additionally, state and Federal grants to reduce loan costs would
make these career paths a more appealing option. Helping fund the
education of minority students interested in becoming professional
health care providers is a wise investment; it fills in-demand jobs in
the health care field and connects people with practical careers which
will allow them economic stability to support themselves and their
families.
______
The Chair. Senator Cassidy, you want to introduce your last
witness?
Senator Cassidy. I will let my Senator from Alabama
introduce the doctor from Alabama.
Senator Tuberville. Thank you, Senator Cassidy. Welcome to
all of you. It is my honor to introduce today Dr. Brian Stone
of Jasper, Alabama.
Dr. Stone grew up in Birmingham and received his undergrad
degree from Rutgers. He went on to earn his medical degree from
the University of Alabama, Birmingham. He was identified as a
top urologist in New York and New Jersey, in his years of
tenure at Columbia University's College of Physicians and
Surgeons.
He has received so many awards for his success, it is hard
to count them all, but he has been honored by the NAACP, the
Morehouse School of Medicine, the American Cancer Society, and
the American Urology--Urological Association.
Because of his leadership on issues like health disparities
and prostate cancer, he has served in many capacities as a
consultant and scientific advisor. He has served in advisory
positions on the local, national, and international level over
the years.
He also worked in partnership with pastors and different
denominations in Jefferson County, and the Jefferson County
Department of Health to educate and recruit Black patients to
participate in the clinical trials process.
He serves on the Committee for Underrepresented Minorities
at the University of Alabama, Birmingham School of Medicine, in
conjunction with School of Medicine's National Alumni
Association. He created a medical scholarship program for
deserving male students of color from Alabama who have been
accepted into the UAB School of Medicine.
The goal is to increase the number of minority physicians
who are from Alabama and are willing to practice medicine in
the state. He has also worked to increase STEM exposure to K-12
students in the city of Birmingham, in partnership with the
Boys and Girls Club.
Dr. Stone is currently the President and Chief Medical
Staff of Walker Baptist Regional Medical Center, and the
President of Jasper Urology Associates. I couldn't be more
proud to have him here today, and we all look forward to his
testimony. Thank you, Dr. Stone.
STATEMENT OF BRIAN STONE, M.D., FACS, PRESIDENT, JASPER UROLOGY
ASSOCIATES, JASPER, AL
Dr. Stone. There we go. Good morning. I would like to thank
Chairman Sanders, Ranking Member Cassidy, Senator Tuberville,
and Members of the HELP Committee for having me present to
speak today.
My background is a urologist. I think I am the old guy on
this Committee. I graduated in 1985. I have had a breadth of
experience working in the inner city, having trained in the
Bronx, having worked at Harlem Hospital, which was connected to
Columbia University. And I am now in a rural setting, and I see
the similarities between the health problems that we see in the
inner city as well as in rural America.
When I think of America, I think of the saying that you
can't choose your family, but you got to love them anyway. Our
diverse people make our Country the greatest country in the
world. But our greatness cannot be maintained if we can't keep
our people healthy.
Currently, we have about 71,000 physicians retiring per
year over the past few years, and we are only graduating 21,000
medical students per year. And if you follow the mathematics,
you see where we are going to end up.
We are going to need some very creative ideas to get us out
of this situation. The impact of under--the low numbers of
physicians has downstream impact on the number of specialists.
And we feel that at our hospital now with our inability to
recruit physicians in various specialties. An unhealthy nation
is a less productive nation.
Certain segments of American population are less healthy
than others, as other speakers have spoken about. Black
Americans have the highest death rate from all causes in our
Country. These higher rates of disease and death have economic
consequences, and that is why this is important for us to
address.
I grew up in a segregated Birmingham, where every Black,
regardless of his socioeconomic status, lived in the same
neighborhood. This had benefits because I had the opportunity
to grow up with role models like Dr. James Montgomery, Dr.
Clarence Hickson, Dr. Herschel Hamilton.
My uncle, Dr. Warner Meadows was one of the first Black
surgeons in Atlanta. These role models made me know that I
could be whatever I wanted to be, but that is not the case for
a lot of kids in America today.
Unfortunately, technology has almost become an impediment
to educating our children, and America appears to be at a major
inflection point in how we educate our children, because this
is the pool from which physicians are recruited.
America and the Black community have a serious challenge in
addressing the STEM gap that exists between white and Black
students. Richard Coley and Barton noted that progress was
being made in recruitment of African Americans to medical
school, but this peaked in 1994.
A 2018 Pew Research study showed that the poor foundation
of STEM education in K-12 was the root cause of the recruitment
problem for medical schools of medical students. There is a
wealth of data showing better health outcomes when Black
patients have Black physicians, and this applies across
different cultures.
This is because when you have cultural connectivity, you
have better communication, you have shared experiences, and you
can overcome the mistrust that has developed over the decades.
Alabama has a population of 4.8 million people, 25.8 percent of
whom are Black.
Yet we only have 7 percent of the physician workforce that
is Black. We are dealing with some serious health care issues
in our state, particularly with limited access to health care
in many of our rural areas. We have had closure of many of our
rural hospitals and clinics, particularly in the Black belt of
the state, and we got to come up with some real solutions.
Most of our physicians tend to be concentrated in the major
metropolitan areas of the state, leaving our rural areas at
risk. It is no wonder that Alabama always ranks at the lowest
as far as health amongst states in the area and it is--not only
is the overall health of Alabamians comport--poor compared to
residents of other states, but the health disparities between
African Americans and Whites are very considerable.
What are some of the potential solutions? Enhancing K-12
STEM education. Incorporating mentors early. Creating a health
focused fast track--to fast track students into medicine.
Reducing the financial burden of medical education.
Increasing the size of medical school classes. Increasing the
size of residency training programs. The problem cannot be
corrected overnight, but the crisis is real, and I think we
need to start thinking out of the box. Thank you very much.
[The prepared statement of Dr. Stone follows.]
prepared statement of brian stone
Increasing Diversity in the Healthcare Workforce
The U.S. will see a shortage of almost 139,000 physicians by 2032
as the demand for physicians grow faster than the supply according to
data published by the Association of American Medical Colleges. This
physician deficit has many downstream affects and translates into
shortages in both primary care and specialty care. Among specialists,
the data project a shortage of up to 12,100 medical specialists, 23,400
surgical specialists, 39,100 other specialists such as pathologists,
neurologists, radiologists, and psychiatrists. 2032 is only 8 years
away!
America's strength is in its diverse population. Our grand
experiment in democracy, which is a byproduct of the sacrifice and toil
of religious refugees, slavery, immigrants, and native Americans has
resulted in the most powerful country in the world. However, we are
only as good as our health. An unhealthy nation is a less productive
nation. Certain segments of the American population are much less
healthy than others. Black American's have the highest mortality rate
of all causes in the U.S. These high rates of disease and death have
economic consequences. Increasing diversity in the healthcare workforce
is one of the solutions in reducing the historic differences in health
outcomes. The problems are complex, and the potential solutions
complicated.
Background
America and the black community have a serious challenge in
addressing the STEMM (Science Technology Engineering Mathematics
Medicine) education gap between white and Black students. Furthermore,
African Americans represent 4 percent of U.S. physicians but
approximately 14 percent of the population. This chasm widens further
when you include the under representation of Hispanics who represent
18.3 percent of the U.S. population and only 5 percent of the Nation's
physicians. Richard Coley and Paul Barton note that progress was being
made in recruitment of African Americans into medical school and peaked
in 1994. However, there has been a precipitous decline in recruitment
since that time creating a critical shortage in diversity in the
physician workforce which adversely affects the care provided to
underserved communities.
According to 2023 data from the Association of American Medical
Colleges, it is estimated that there are over 989,000 physicians in the
U.S., but only approximately 46,000, were Black or African American.
Forty-four percent of African American physicians are between the ages
of 55 and 64 while another 35 percent are 65 or older. Among younger (<
34 years old) African American physicians, the overwhelming majority
(67 percent) are women, reflecting the dearth of young African American
men entering the practice of medicine. The inequities in access to
healthcare, participation in medical research, and current treatments
can be mitigated by the presence of physicians that have been recruited
from the communities that they treat. The COVID-19 pandemic has made
evident the chasm between access to care in communities of color
compared to white communities.
Coley and Barton and multiple studies have consistently confirmed
that Black and Hispanic physicians are ``significantly more likely to
practice in underserved areas comprised largely of minority and poor
populations''. The devastating, asymmetric impact of COVID-19 on
communities of color and the racial inequities of the vaccine rollout
highlighted the need for Black and Hispanic physicians. There is a
wealth of data confirming better health outcomes in Black patients who
have Black physicians. Dr. Karey Sutton, Ph.D. (Director of Health
Equity Research; Medstar Health Research Institute) oversaw a
systematic review of over 3000 studies on the impact of physician and
patient race. The conclusion was that Black patients had better
outcomes in the care of Black physicians because the care was better.
Cultural connectivity is important, particularly in the context of
historical mistrust. The negative impacts of outright racism (both
individual and structural) on patient care like healthcare workers
minimizing the pain of Black patients' complaints of pain and
encounters of racism in emergency departments have been well
documented. The bottom line is that racial concordance studies have
illuminated the ways in which race affects how patients and doctors
communicate and make decisions, regardless of either person's intent.
Physicians and patients bring subconscious racial perceptions to their
conversations. These problems can be mitigated by having a healthcare
workforce that reflects the community that it serves.
A 2018 Pew Research Center review described the poor foundation of
STEMM education in K-12th grade as the root of the recruitment problem
of Black students into medical school. The declining quality of public
education, shrinking education budgets, loss of programs in the arts
and music, greater emphasis on athletics and the increasing societal
distractions (electronic gaming, social media, cell phones, etc.) have
made educating our youth much more challenging. The shift to virtual
learning due to the pandemic has had an additionally devastating impact
on learning, particularly among African American males. A U.S.
Department of Education's study of students beginning college as early
as 1989 -1990 found that African American men were less likely to major
in science than white males and females or African American women. Only
2.6 percent of African American males were science majors in their
first year of college, representing only 1/3 of the proportion of 1st-
year white males majoring in science during the same year. Coley and
Barton concluded that this alarming trend supports the observation that
African American men are steering away from majoring in science,
leaving only a small pool of African American male science majors for
medical schools (and STEMM entities) to recruit from. African American
women, while performing better than the males, are being negatively
impacted as well. I would dare say that at the current rate of decline
in the recruitment of Blacks into medicine that there may come a day
that Black physicians are rarely seen, especially Black men!
The impact of structural and systemic racism continues to hinder
entry of Black students into STEMM career fields in 2021. In 2019, we
saw the lowest representation of African Americans in the incoming
medical school classes of the country's medical schools since 1978!
Even more alarming is the fact that most Blacks entering graduate
medical education programs are female. This trend of declining Black
male representation in medical school began in 1988-89 when the
percentage of Black female medical school graduates became the majority
at 51-52 percent. In 2018, Q. M. Capers and L. Clinchot concluded that
Black gender disparity rapidly accelerated to 35 percent male versus 65
percent female medical school graduates in 2015.
Health Disparities in Alabama
My home state of Alabama has a population of 4,833,722 and is faced
with some serious healthcare challenges, particularly with limited
access to healthcare in many of its rural areas. Many of our small
rural hospitals have closed. The ``Black Belt'' of the state, with some
of its poorest areas, has suffered the most. We are experiencing
significant healthcare workforce shortages.
------------------------------------------------------------------------
Per 2023 AAMC Data: Alabama's Physician Race/Ethnicity
-------------------------------------------------------------------------
White 69%
Black 7%
Hispanic 3%
Asian 10.5%
American Indian/ Alaska Native 0.3%
Unknown 8.4%
------------------------------------------------------------------------
------------------------------------------------------------------------
Per the 2020 U.S. Census Data: Alabama's Race & Ethnicity Composition
-------------------------------------------------------------------------
White alone 64.1%
Black alone 25.8%
Hispanic 5.3%
Asian alone 1.5%
American Indian/ Alaska Native alone 0.7%
Native Hawaiian/ Other Pacific Islander alone 0.1%
Some Other Race alone 2.7%
Two or More Races 5.1%
------------------------------------------------------------------------
The ``Alabama Health Disparities Status Report 2010'' confirmed the
startling tragedy of minority healthcare in Alabama, which consistently
ranks as one of the least healthy states (46th out of 50) in the
Nation. Similarly, Alabama ranks 37th in health care access, 39th in
health care quality and 47th in public health. Not only is the overall
health of Alabamians poor compared to that of residents of other
states, but health disparities between African Americans and Whites are
considerable. African Americans comprise approximately 82.75 percent of
the non-white population in Alabama. These health disparities in both
access to care and the delivery of care to minorities in the state.
African Americans in Alabama had higher rates of all chronic diseases,
injury, premature death and disability. The consequences of these
disparities include shorter life expectancy, diminished quality of
life, loss of economic opportunities and socioeconomic inequality.
There are significant racial disparities in cardiovascular disease,
diabetes, obesity, kidney disease, cancer, infant mortality, chronic
lung diseases, stroke, and complications (and severity) of the COVID-19
infection. It is a moral imperative that we actively seek to increase
the numbers of physician healthcare providers in the State of Alabama
and ensure that there is appropriate representation of African American
physicians. Studies have shown that Black patients are more likely to
feel comfortable with physicians with a similar cultural framework and
more likely to adhere to preventative medical recommendations offered
by Black physicians. Cultural competency is the key to improving
patient compliance and trust. The COVID-19 vaccine rollout has
confirmed that the Black community continues to distrust majority
health institutions, reflected in the ``PTSD'' of the ``Tuskegee
Experiment'' and the legacy of physicians like James Marion Sims (the
``father of modern gynecology'') who performed unethical surgical
procedures on enslaved Black women. In addition to these landmark
research abuses, there is both a long legacy and, in some settings, an
ongoing pattern of racial bias experienced by African Americans seeking
care. It is for these reasons that we must provide early introduction
to STEMM education, mentor, prepare and recruit more African American
students into medicine. The presence of diversity in medicine enhances
African American (Hispanic, Asian, and Native American) cultural
competency by increasing empathy and cultural sensitivity in the entire
medical community.
The Lack of a Pipeline
Coley and Barton write that a college graduate's educational
choices directly affect the size of the pool of candidates available to
apply to medical school. This talent pool is deeply deficient in the
U.S. and even more so in Alabama. Multiple factors, early in the lives
of young Alabamians, hinder growth of the pool of qualified students
applying to STEMM graduate programs. The ``molding'' of talent starts
at the birth of the child and extends to care provided in early
formative years. This process continues through the K-12 education
system as the students potentially lack rigorous academic curricula and
subsequently don't graduate from high school or attend college. Even
among those Alabamians who do attend college, many, lacking early
stimulation of their interests in science and math, do not choose a
STEMM major or even succeed in graduating.
Multiple sources including Parker and Funk as well as Shamard
Charles recognize that the overwhelming challenge is to enhance the
educational process, introduce the students at an early educational age
to STEMM, ``steer'' their education choices toward STEMM and reduce the
attrition rate. Enlarging the pool of qualified African American
students who realistically have a choice of a higher education pathway
to medicine requires increasing their academic proficiency during the
period from middle school to high school. The success of increasing the
pool of academically qualified Black students from Alabama for
acceptance into the medical school requires a dual approach of
developing and exposing students early in their academic journey to a
STEMM curriculum and exposing them to Black STEMM role models.
Controlling the attrition rate will require reinforcing this exposure
through continuous contact with Black STEMM mentors. The more ``African
American success'' they see, the more confidence they will have that
they too can ``succeed'' in STEMM. The goal should not be to lower
academic standards but to enhance student education and preparation.
Economic Impediments to Medical Education
It is no secret that there is a significant economic gap between
white communities and communities of color in the U.S. Many aspiring
students and their families struggle just to provide financial support
for a college education. The cost of collegiate and graduate education
has increased significantly over the years which represents a greater
barrier to entry for students of color. Graduate school can be a
financial ``Mount Everest'' for most qualified students of color. On
average medical school tuition, fees, and health insurance during the
2019-2020 academic year ranged from $37,556 (in-state, public) to
$62,194 (out of state, public). Additionally, among persons entering
medical school in 2018, African Americans were more likely than other
racial and ethnic subgroups to owe > $50K dollars even before
accumulating any additional medical school debt. It is imperative that
financial support be readily available to those students who
successfully navigate the academic rigors of a collegiate pre-medical
program and are accepted into a medical school program.
What Are the Solutions?
The ideal goal should be to create a healthcare workforce that is
representative of the population that it serves (preferably staffed by
members from that community). This means setting recruitment goals
based on the ethnic make-up of the state or community.
K-12 STEMM Education--Building the talent pool of kids interested
in undergraduate education in the sciences and ultimately pre-medical
education.
Completely Changing the K-12 Education Paradigm--Moving away from
the educational structure of the past and shortening the pathway into
medicine. Developing health academies in high schools in partnership
with a state's undergraduate universities and medical schools creating
curriculums that ``fast track'' qualified students into medical
careers.
Reducing the Financial Burden--The cost of an average 4-year
undergraduate education at a public institution is approximately
$120,000 (out-of-state $180,000). Combine that with the average medical
school cost of $300--400,000 and a student pursuing a career in
medicine is looking at shouldering over $500,000 in debt! This is
outlandish and has a negative impact on diversity in the healthcare
workforce.
Increasing Medical School Class Sizes--U.S. medical schools
graduated 28,700 students in 2022. The training of new doctors must
keep tract with the physician retirement rate. The challenge facing our
Nation is the substantial number of ``baby boomer'' physicians, like
me, who will be leaving the workforce in the coming 5-10 years that
will create the projected shortfall of 139,000 physicians by 2033!
Increasing the Number of Residency Training Positions--As medical
school enrollment is increased the concern is the lack of residency
programs and clinical training sites for the graduates. According to an
AAMC annual survey, the number of residency training positions has not
kept pace with the increasing number of medical students. This dilemma
threatens to exacerbate the Nation's physician shortage.
Conclusions
(1). Our country has faced daunting challenges before. This is not
a Democrat or Republican problem; it is an American problem.
(2). Heart disease, diabetes and cancer don't care about political
party affiliation or race. The health of ``all'' of our population must
be our No. 1 priority. Our people are our greatest strength and our
treasure and should be treated as such.
(3). Assembly of talented people who have different experiences and
perspectives empowers the necessary cultural translation when people
need assistance facing challenges that have the complexity and intimacy
of healthcare.
(4). Diversity improves cultural competence for the collective body
of the healthcare workforce. Better cultural competence facilitates
better engagement with patients which leads to better understanding,
better shared decision-making, better compliance with treatment plans,
and, ultimately, to improved patient outcomes.
(5). Furthermore, as we consider the wholistic approach of
improving the health of the population, cultural differences not only
affect engagement with people who have clinical needs but also
influences how different peoples ingest information to consider
participation in clinical research.
(6). A healthcare workforce that reflects the heterogeneous
population of the U.S. increases patient ``trust'' which is necessary
to achieve greater participation in clinical research and achieve
better clinical outcomes to improve the health of the entire U.S.
population. To optimize effectiveness for healthcare outcomes we must
confront the reality that communication and trust are essential to be
most effective, as we focus on the opportunity to help those who need
the most help.
______
The Chair. Well, let me thank all of the panelists. Every
one of you made extremely important issues, and I hope very
much that this Committee will act on some of your thoughts. Let
me start with, and I must confess that until fairly recently, I
did not appreciate this issue.
Until a couple of years ago, we had some, young people from
Howard University coming into the office, and they were chiming
in. And one young one was saying, talking about the experience
her mom had of going to a physician's office and not being
taken seriously and so forth. And I know all of you in various
ways have raised the issue.
Let me ask, I think many Americans would say, hey, this as
a physician, what difference does it make white, Black, Latino,
who cares, as long as they are a good doctor. What difference
does it make for having--going to a physician who kind of
understands your life maybe comes from your community. What
difference does it make? Dr. Lawson, you want to start? We will
go right down the line.
Dr. Lawson. Absolutely. It makes a huge difference. Me,
myself, in practice, many times the trust, when I build trust,
my patients really do respect and comply with therapy.
It is not uncommon for me to experience many of my patients
may go to, a physician of a different race or ethnicity and
question, right, the treatments that they are prescribed or
have given me or provided personal experiences where they
weren't respected within the system, or they were provided
treatments that were inadequate or substandard, or not even
given options--especially being an OB-GYN.
I don't have to tell you that historically, so many women,
Black women and Latino women, underwent hysterectomies
unnecessarily. The options of childbirth were taken away from
them. And so, these are everyday experiences.
The Chair. Thank you very much. Please be brief. I want to
hear from everybody. Dr. Cook.
Dr. Cook. Yes, sir. Thank you so much, Chairman Sanders. It
is really an issue of cultural competence. You don't understand
the perspectives and the concerns of people from other races as
well as they do for themselves.
We grow up in similar situations. We know very similar
circumstances that happen to all of our families. And, as Dr.
Lawson alluded to, there is an inherent mistrust. We saw that
even with COVID vaccinations and the inability to get Black
Americans to even take those vaccinations. So it is a
widespread problem, and it will only improve with more
representation.
The Chair. Thank you very much. Dr. Galvez--the microphone,
yes.
Dr. Galvez. Thank you. For the Latino population the
patient physician concordance is so important to have that
cultural competency, to decrease miscommunication. And the
language component for Latinos in particular is very important
because things can get lost in translation.
A story I can think of is a patient comes in, their child
needs a surgery, has a congenital hand difference, and
everything gets discussed in the visit, but the family is more
worried about general anesthesia.
That question doesn't get asked or doesn't get fully
addressed. And so, they leave the visit. They maybe booked the
surgery because someone said just, we are ready to do the
surgery. You got to fix this problem.
They book the surgery but then the patient just cancels
because they are so concerned, and they didn't get their
questions answered. And so that miscommunication results in
delays in care.
The Chair. Dr. Andrades.
Ms. Andrades. I think for patients, especially in my field
of trauma surgery, I meet patients on their worst day. I am of
Puerto Rican descent, so in being able to speak to someone who
just went through a terrible car accident or some trauma, I
think gives them a breath of fresh air.
Again, as the other panelists have alluded to, it is the
trust that you have someone that speaks your language and looks
like you at the forefront of your medical care. And I think
that really makes a difference in patient satisfaction and
patients trusting the health care system.
The Chair. Thank you. Dr. Stone.
Dr. Stone. I deal with it daily when it comes to, say,
prostate cancer, the difference between a Black male and how he
communicates than a white male. The concerns they may have, the
trust factor. All of that plays into the relationship and
patient compliance.
The Chair. My last question, briefly. I am running out of
time now. Dr. Cook mentioned that he graduated medical school
for $400,000, and that I have talked to doctors who graduated
with more debt. Nurses, graduating with a lot of debt.
Generally speaking, Black, Latino, Native American
communities are poorer than White communities. What does the
financial constrictions mean to young people in minority
communities who want to pursue a career in medicine? Dr.
Lawson, briefly.
Dr. Lawson. Absolutely. The financial implications can
almost make it impossible to pursue the degree or be very
discouraging to individuals.
I myself am working on scholarships for students, but I
encourage anything that we can do. I myself participated in
many disadvantaged programs to fund my medical education. But,
I was told that I couldn't do it literally because my family
did not have the resources.
The Chair. If people could go to medical school without
having to worry about tuition or student debt, would that make
a difference in your communities, Dr. Cook?
Dr. Cook. Of course. The price tag in itself is a barrier.
Think for 1 second if you took out $400,000 in debt and you got
sick in your first year of residency, you will have no way to
repay that. You will be forever in debt.
The Chair. Dr. Galvez.
Dr. Galvez. Those socioeconomic differences make a big
difference. And the difference for Latinos in particular is the
need to work. And so, when you have to take on all this debt,
it really is something you are deciding for your family.
The other difference that happens frequently is you have a
student who has to work and do classes at the same time, and
pay for tuition, versus a student who is in a more affluent
community and has an office space to study and dedicated time.
That is where these disparities begin.
The Chair. Dr. Andrades.
Ms. Andrades. It gives students a chance to be able to even
start to feel that a health care career is in their realm of
possibilities because, finances and the financial burden, as
again the other panelists have alluded to, really is a huge
deterrent for minority students.
The Chair. Dr. Stone.
Dr. Stone. I mentor a lot of kids that are bright and could
be physicians, but they are deterred by the cost. So, if there
was a way to offset the costs, we could increase the numbers.
The Chair. Good. All right. Thank you, panelists.
Senator Cassidy.
Senator Cassidy. I thank you all. Dr. Stone, my wife is a
1983 graduate of UAB.
Dr. Stone. Okay.
Senator Cassidy. I kind of hide that fact in Louisiana, but
that is okay. And I will note, Dr. Galvez, you don't respect
our Spanish. If you are interpreting, this is--I am telling you
why you should do it.
[Laughter.]
Senator Cassidy. Thank you all. Dr. Stone, African
Americans have a, as we both know, as you particularly know,
much higher incidence of prostate cancer. And there is a
certain kind of, I don't know, cultural kind of reticence to
have it address sometimes. I am a gastroenterologist.
Dr. Stone. Yes.
Senator Cassidy. Same sort of thing. And I see that you
have partnered with communities of faith by which to, I assume,
allay concern and spread the word. So, will you comment on
that?
Dr. Stone. Yes. One of my particular concerns has been the
lack of inclusion in clinical trials and the fact that most
therapeutics, as matter of fact, all therapeutics that are
developed in the U.S. are developed based on data from white
patients.
The Human Genome Project has shown that the way drugs are
metabolized is different between cultural groups. So, I am
concerned that the dosing, when doses are established and the
FDA approves it, that it may not be appropriate for different
cultural groups.
I am trying to increase participation in clinical trials by
engaging the faith-based community, through which we can
recruit and try to get more patients to participate, because
the trust bridge is already established in the church.
Senator Cassidy. I am totally with you on that. I used to
do clinical research and treated a lot of hepatitis, and my
population was 60 percent African American. I ended up being
the lead recruiter for African Americans because I had worked
for two decades in the hospital and there was a trust there.
Dr. Stone. Yes.
Senator Cassidy. The first time they were invited in was
not to participate in a trial. The first time they were invited
in was to see me. And then I saw them for 10 years before
speaking about a trial.
Dr. Stone. Absolutely.
Senator Cassidy. I congratulate you on that because as we
both know it can bring great benefit.
Dr. Stone. Thank you.
Senator Cassidy. To the individual and to the patient. So,
Dr. Andrades--for some reason my Rs are not rolling today. I am
so impressed with how you were kind of what is the word,
inspired to pursue health care, and move from cosmetology into
doing that environmental services work, etcetera. How do we
light that same flame in others?
Ms. Andrades. I think as I said in my testimony, I think,
again, it is making the financial burden on students of
minority less.
Senator Cassidy. Yes, but I am not speaking about--it has
to first have that spark of interest. And the next is, how do
you reduce the barrier. But the first is a spark of interest.
So how do you spark that interest?
Ms. Andrades. I think sitting here today is one way to
spark that interest so that other minority students can see
that this is a reasonable idea for them, and they can see
someone that looks like them in a space where typically you
don't see minorities.
Senator Cassidy. I accept that because people see a role
model. My daughter is an air traffic controller, whatever,
because she saw a YouTube of a female air traffic controller.
So that makes sense to me that you would do that. And then what
inspired you to continue to upskill, if you will, to become
that nurse practitioner?
Because it is obviously what--I went to med-tech, and she
had already taken all the pre-med courses. She was med tech,
and then she advanced her skills and became an MD. So just to
point that out, that works, right? So, your thoughts on that.
Ms. Andrades. I was inspired to continue my education to
become a nurse practitioner by actually an African American
nurse, Gloria Wilson, who worked with me at Mason Square. She
was in her 60's at the time, and she was going to school for
her master's degree.
She kept kind of saying, but you can do it. Like, you can
do it. And I just said, Okay, well, I will apply. If I get in,
then I will continue my education. So, my inspiration to
continue was this African American nurse who is in her 60's and
still searching and looking for opportunities for her own
education.
Senator Cassidy. A role model and a mentor.
Ms. Andrades. Again, a role model, yes.
Senator Cassidy. Dr. Galvez, you had mentioned increasing
the Latino workforce by having some sort of Federal funding tie
that would require someone to have a second language in order
to advance.
But frankly, that would discriminate against like African
Americans or against others who might--a Native American who
may not have a second language. And so, square that circle for
me. It seems like we are creating another barrier to require a
second language.
Dr. Galvez. It is a great question and thank you so much
for it. It really is, as I mentioned as well in my testimony,
language has frequently been ignored.
Yes, it is challenging. I didn't want to--like my parents
forced me to speak Spanish at home. That is how I learned it.
And yes, I am privileged that I was able to learn it at home
and very grateful because it is my superpower, like I
mentioned.
But it is something that I believe should be encouraged,
especially if you have a medical school that, for example, in
California, by 2050 it is going to be almost 50 percent Latino.
Those considerations of language will improve efficiency in
your clinic, right. If you have a 15 minute visit----
Senator Cassidy. I accept that. We are almost out of time--
we are.
Dr. Galvez. Oh, sorry. Yes.
Senator Cassidy. But maybe as a question for the record, we
have to see we don't create other barriers for a future Dr.
Cook.
Dr. Galvez. Yes.
Senator Cassidy. Let me just finish by saying this. As a
physician, I thank you all for still seeing patients. So, thank
you. I yield.
The Chair. Senator Casey.
Senator Casey. Let me start by thanking you, Mr. Chairman,
and the Ranking Member, for having a hearing on this range of
critically important issues, whether it is the diversity of the
workforce or whether it is health disparities or maternal
health or maternal mortality.
I believe that in order to nurture a future generation of
Black and Brown health care workers, or in order to close gaps
between outcomes for white and Black mothers, we have to start
in childhood.
That means that the Congress of the United States has to
get into the game in a way that we haven't ever really. I
believe it comes down to at least five basic freedoms that
every child should have a right to enjoy, and we should invest
in those freedoms, not just talk about them like their
platitudes.
The freedom to be healthy, the freedom to learn, the
freedom to have economic security, which means giving children
the opportunity--their families, the opportunity to save at a
very young age for their future.
The fourth freedom would be the freedom from hunger. And
the fifth freedom would be the freedom to be safe from harm.
Every child has those five, health, the opportunity to learn,
economic security, freedom from hunger, and to be safe. We will
have a much different outcome on all these issues we are here
to talk about. But the Federal Government hasn't done that.
I think it requires a maximum commitment to our children. I
will start with Dr. Lawson, you had talked about the improved
outcomes patients have when they are able to see health care
providers that look like them, a very important point to make
in this hearing and beyond.
In the context of maternity care, what has your experience
been with both midwives and doulas, and what role can they play
in reducing health disparities?
Dr. Lawson. Absolutely. Thank you, Senator. I have had a 22
year history with experience in OB-GYN. My entire career I have
worked with midwives and doulas. I even owned a birth center
myself and employed midwives. Very impactful.
No. 1, I believe women should have a choice with what type
of provider they want, and that is what midwives can do. I
think that doulas are an excellent support for women. They were
an extension of me.
I could send the doula to the house, help a woman in early
labor, postpartum checks, mood disorders. Sometimes they would
share things with the doula they may not want to share with me.
So very important aspect and add on support for women during
pregnancy and childbirth.
Senator Casey. Well, thank you. We are all trying to do
more to invest in programs that would support doulas and
midwives. Dr. Galvez, you mentioned the role of community
colleges in helping to develop the pipeline of health care
workers and for diversifying the workforce. Community colleges
are the most diverse sector of higher education.
I know that just from representing Pennsylvania. We have
got 15 community colleges, and I am amazed at the
sophistication of the curriculum and how well-prepared young
people are coming out of those community colleges. How can we
better use the opportunities that community colleges offer to
help grow and diversify the health care workforce?
Dr. Galvez. It really was, at least for me--I didn't know
how to study. I did poorly in high school. It wasn't until
community college that I learned how to study, and I learned
those skills--I used those skills at Stanford for medical
school, the same study skills.
I do think, as I mentioned, I think it is an untapped
resource. I think recruiting early and encouraging students to
consider a career in medicine and other health care fields is a
good source, just like you said. It is a very diverse pool.
Better use them and include them. It is to create pathway
programs where we have--in California, we have the California
Medical Scholars Program, which is in development, where they
are linking community college.
But it really is--it is providing mentorship and guiding
them, but it is not guaranteed acceptance. And that is where I
think taking it a step further and guaranteeing these students,
and creating even a quota for medical schools so that they can
better reflect their community is a strategy for this--for
diversifying the workforce.
Senator Casey. Doctor, thanks very much. And before I
conclude, I want to commend Dr. Cook for your telling your
story here today. The fact that you attended Drexel helps in my
estimation. But it is a great American story and I know you
worked hard to achieve it. So, thanks for being here today and
providing that testimony. Thanks, Mr. Chairman.
The Chair. Thank you. Senator Marshall.
Senator Marshall. All right. Thank you, Chairman. This is
obviously an issue very near and dear to my heart. It is an
issue that I have dedicated my life to solving. And before I go
on with my remarks, I want to make sure everybody knows that
one maternal death is too many.
Yes, we need more minority doctors, nurses, the whole
gamut, Okay. I totally acknowledge that. Mr. Chairman, I would
suggest that the work we have done with community health
centers will do more to impact this than all the other ideas we
are hearing about.
That our vision of these community health centers would
have prenatal clinics in them and then help take care of the
woman after the baby is delivered, something as an obstetrician
that maybe I didn't do the best job after we got to about 6
weeks.
The other thing that would impact this more is stopping the
illegal crossings on our border and the fentanyl poisoning that
is just--it is accumulating problems for my moms as well. My
story--I think you have to hear my story. And I am sorry, but I
am a first generation college student too.
I went to a community college. My wife went to a community
college, a community college nurse. 90 percent of nurses in our
hospital are community college nurses. Went to a residency
program in Saint Pete, Tampa. Very busy.
Eight residents, 5,000 deliveries a year. So, in 20,000
moms that we delivered, do you know how many maternal deaths we
had? Zero. And how so? The answer is how come? Two things. One,
we had incredible committed doctors and nurses and ultrasound
techs. But No. 2 is I set up a prenatal clinic.
When I got there, a fourth, maybe half of our moms were not
getting any prenatal care. I went to a church on the wrong side
of town, and said, we will use your basement to set up a
prenatal clinic and made sure that every mom had prenatal care
before they ever got to the hospital.
That probably, how many lives that saved. But that was one
simple solution. And then in my private practice, half of my
moms, we delivered--I delivered over 5,000 babies personally,
and half of my moms drove more than 60 miles to see me. By the
way, the only thing worse than no prenatal care is bad prenatal
care.
It scares me to death when people think that they should be
delivering babies in facilities that have one delivery a week
or one a month. That is a scary situation as well. But again,
zero deaths. Why? Because--and I am going to--half the babies
we delivered in residency were minority.
Half the babies we delivered in my private practice were
minorities, half of which were on Medicaid or had no money. So,
it wasn't like it was this perfect group of people that had
everything in life. Half of my patients spoke Spanish that I
delivered.
Those were challenges, but no deaths is because we gave
prenatal care and I was obsessed with prenatal care, and my
nurses were obsessed with giving good prenatal care.
Ask the panel, how many women died in 2023, maternal deaths
were there in 2023? Does anybody know the answer to that? Okay,
it was 684. In 2021, it was 1,205. So, we dropped from 1,200 to
684.
First of all, I want to thank all the hard working nurses
and doctors and the people out there, community health centers
that are making a difference. Next, what is the most common
cause of maternal death now? Does anyone in the panel know
that? Go ahead.
Dr. Lawson. In Black women, cardiovascular disease. In
Native American men and women, and in Caucasian women, we
sometimes see mental health and substance use disorders.
Senator Marshall. Yes. I wish that was the case, but the
most common cause of maternal death now is suicide and drug
overdosing and fentanyl poisoning, Okay. That is the No. 1
cause. What percentage of these deaths occur more than a week
after delivery?
Dr. Lawson. Over half--around 52 percent.
Senator Marshall. Yes, 52, 53 percent. So, half of these
deaths are occurring after--a week after delivery. It is why
these community health centers are so important, is to follow-
up on the mental health aspect, let alone the addiction issues
as well, Okay.
That is the solution to the postpartum issues. Inter-
partum, No. 1 cause is now hemorrhage, heart disease, stroke
PE, cardiomyopathy infection, and hypertension. Those are the
ones that we can impact with prenatal care and intra-partum
care as well.
I think we have to also acknowledge why is heart disease
spiking right now from a maternal M and M situation as well?
Well, it is several reasons. One is our moms are older.
No. 2 is they are heavier. And No. 3 is diabetes. I mean,
the amount of diabetics, type 2 diabetics that I saw in my
clinic doubled or tripled over my 25 year career. So again, we
go back to our community health centers with nutrition as a
component, with mental health as a component, that we hopefully
have healthier moms before they get pregnant. That is what is
going to impact all these.
We don't need to form committees and pray about it. We know
the solutions. I think our community health center is the best
thing I see out there that is going to touch all people, and
just look forward to continue the great work the Chairman and
Ranking Member have done in these issues.
Thank you so much. I yield back.
The Chair. Let me just inject. What Senator Marshall was
talking about is fairly comprehensive legislation that left
this Committee. And Senator Marshall and Senator Braun, among
others, Senator Murkowski played an important role in that. And
I hope we can get that legislation moving again.
Senator Kaine.
Senator Kaine. Thank you, Chair Sanders. And thanks to the
panel. What a great panel. So, you all in your professional
lives have some pinnacle days that really make it worth doing.
And I just wanted to reflect as I think about the work we do
here, we may not have as many as you, but we have some.
Three times in the 11 years I have been here, we passed
meaningful legislation or taken meaningful action on the floor
of the Senate by one vote. And on those days, it makes me
think, wow, what if I hadn't run.
In August 2017, we saved the Affordable Care Act in the
U.S. Senate by one vote, and 30 million people did not lose
health insurance, and tens of millions of people did not lose
the ability to be protected against discrimination because they
had a preexisting condition.
In 2022, we passed the Inflation Reduction Act by one vote,
capping prescription drug prices, out-of-pocket costs,
negotiating for prescription drugs under Medicare passed it by
one vote. The third one voter is not generally thought of as a
health bill. It is the American Rescue Plan in March 2021.
But it had within it something really important. Prior to
the American Rescue Plan, Medicaid would cover a mom after
birth for 60 days. In the American Rescue Plan and then
subsequently in appropriations bills, we extended that option.
States could choose that a mom would be covered post-
delivery for a year by Medicaid. It is interesting it was a
state option, but it was enormously popular. 46 states have
embraced this option, 3 are in the process of embracing it, and
only 1 has not pursued it.
What is this likely to mean playing out over time that
Medicaid will now cover moms, not just the kids, but will cover
moms for a year after delivery? Please, Dr. Lawson.
Dr. Lawson. Sir, thank you. Thank you for that comment and
I appreciate your work. The one state that has not adopted
legislation is Arkansas and that is originally where I am from,
where over 50 percent of moms here are on Medicaid that
deliver.
This has huge impacts. And I extend to you that it is
beyond even maternal care. When you look at the five top causes
of infant mortality in this country, two of those five are due
to either maternal complications or low birth weight babies,
really due to preterm birth. So, you are talking about lifelong
impact, because we know that infant health also is an important
marker of the overall health of society.
When you talk about how impactful this is, major impactful.
Again, I am in Texas. We are excited. I remember and certain my
colleagues that have done OB-GYN as a rotation, even as a
student, know that we would try to compact all of a woman's
health care in those 6 weeks where she had Medicaid coverage.
So, we thank you for the work that you all have done for this.
Senator Kaine. Yes, the ability not to have to cram it into
6 weeks, but to have it for a year. I mean, it is--I think we
will start seeing statistics and I would suspect the statistics
because of who Medicaid covers, are not just likely to be a
reduction in maternal mortality, but it should start to eat
away at some of the disparities that we are seeing in maternal
mortality.
I am really interested in following this. It is still
relatively recently implemented. I think Virginia might have
been the first state that embraced it. We happen to have a
doctor as Governor when this got passed, the American Rescue
Plan, so he was fast out of the starting gate.
But the fact that now every state has either done it or in
the process of doing it save one. We seldom do things that are
so popular here where states say we want to be part of this,
and I am excited that we are.
I want to just--my colleague, Senator Casey, asked the
question about community colleges, and I don't need to go into
it as much. But I mean, it is interesting to note that of our
five panel, I think both Dr. Galvez and Dr. Andrades were
community--began in community college, and it is really
important.
Community college students--just who is a community college
student? The average community college student is older than
25, receives a Pell Grant, attends part time, and is a woman.
And is more likely than the population norm to be a person of
color. That is our community college population.
Many fantastic health care professionals start there, and
we just need to do more really to recognize our community
colleges as great beginning places, accelerators, on ramps,
right, on ramps to success in many ways, but including in
health care professions. And so, I think it is just
interesting.
In the randomness of who are our five witnesses. We have
two who began in community college, and I appreciate that. The
last thing I will say, it is not really a question, but we have
to get a hold of it.
We have been using a set of maternal mortality statistics
to compare to other nations and also to look at disparities.
And there has been some recent churn about whether the
statistics that we have been using are accurate.
I am kind of a data geek, and I really hope that we can
work together with the CDC to arrest any confusion about the
statistics. I think measured accurately, we are still going to
find we are an outlier with other nations, and we are still
going to find these significant disparities.
But to the extent there has been a little bit of
controversy about them, I think--I hope we can work together to
improve the data and how we report it. Thank you, Mr. Chair.
The Chair. Senator Braun.
Senator Braun. Thank you, Mr. Chairman. In my home State of
Indiana, we have the third highest maternal mortality rate at
44 deaths per 100,000 births in 2022. That is sad. Regarding
this sad state of affairs, local news article said that nothing
has changed in 10 years. That needs to change.
That lack of improvement is disappointing state by state.
That is why I have been vocal on health care in general here.
And we did pass out of this Committee the Preemie Act
reauthorization, which renews resources for HHS to promote
healthy pregnancies.
The Improving Access to Maternal Health for Military and
Dependent Moms Act, that is being reviewed. Hopefully we get
that through this Committee. And the Standing with Moms Act,
which would increase the availability of pregnancy related
resources to expectant mothers. Another bill.
We are drawing attention to it. My question is for Dr.
Lawson, in your home State of Texas, what have you seen there?
Have they been improving? There is a lot more agility at the
state level to address things. Tell me what has been happening
there.
Dr. Lawson. Thank you for the question. So, over the--up
until 2021, we have not improved. Some new data--I know that
our MMRC is working on the biennial report. We will hopefully
have that this summer to see where we are for 2022 and thus
far.
But overall, Texas has one of the worst rates of maternal
morbidity and mortality. We are very excited that the
postpartum Medicaid extension was made, but of course, we are a
state that does not have Medicaid expansion.
What we are also concerned about from a workforce
perspective is some--having enough physicians, right, for the
population and enough physicians that actually take Medicaid
coverage for those populations.
We have some strong county hospital networks there. But of
course, we have not seen the reduction in numbers that we would
like to see ideally.
Senator Braun. Have any states, from your observation,
found best practices that are doing a good job? Do you keep
track of that? Because you think among the 50, that someone
would actually be doing a decent job with it. Have you noticed
anything to that effect?
Dr. Lawson. There are some states that I think--I can point
to California, the California Perinatal Quality Collaborative.
They are doing some really great work. And especially when you
think about that population.
Also, New York is doing some really great work. I think,
again, in collaboration with the MMRCs, the data piece is very
important. That drives a lot of policy from a public health
perspective and for hospital quality improvement projects.
Senator Braun. This is such an important area, along with
getting more doctors and professionals paying attention to it,
especially among minorities as well. We should be throwing
everything in the kitchen sink at this, both federally and by
state.
I want to segue to one other issue that I bring up always,
is the broken nature of our health care system that is
increasingly being run by large corporate entities that I don't
know that have any interest in prevention and wellness--mostly
in expensive remediation.
Until we get that fixed, we are going to keep, I think,
avoiding what we all know makes more sense, prevention and
wellness. And that is going to take a cultural change within
health care itself.
Probably the biggest thing would be how do you lower costs
among insurance companies and hospitals? I can tell you what
has been happening has been the opposite. It has alienated even
a lot of physicians and nurses from getting into the business,
because their dream wasn't to be working for huge corporations
that don't have practitioners in mind and the patient.
That has got to change in terms of what we can do state by
state, and here as well. Senator Sanders and I introduced a
bill, and it is already got a lot of bipartisan support.
Senator Smith, Hickenlooper, Grassley, Coons, Hassan, Ernst,
and Baldwin.
This would be transformational. It is a bill that is going
to force corporate health care to accept transparency and
competition, not to have barriers to entry for people to get
into the health care business or try to corner the market with
high costs along the way.
I would urge all of you to make sure in a grassroots way
you get behind it. And until we break that grip to where that
is in control, we are never going to address this, or many
other issues related to health care. Thank you for being here
today.
The Chair. Well, let me just thank Senator Braun for his
work and mention to him, this whole issue of corporate and
private equity control over our health care system is
exploding. You are right, young doctors don't want to be
corporate employees. It is an issue we will deal with.
Senator Hickenlooper.
Senator Hickenlooper. Thank you, Mr. Chair. And thank all
of you for being here, but also for your service. You could all
be making more money doing other things and appreciate your
commitment.
I am from Colorado, and we have been working a lot on
apprenticeships. And I think on a broader scale, they can help
address the shortage of minority health care professionals.
Colorado Public Health Works is one of the first of its
kind that connects AmeriCorps volunteers with a registered
apprenticeship program run by a Trailhead Institute. Their goal
is to recruit a more diverse workforce.
Allows the apprentices to get valuable on the job
apprenticeship experience while we make progress in our public
health needs. So, I will start with Dr. Galvez and Dr.
Andrades.
How are apprenticeship models and other on the job training
models particularly helpful in terms of the recruitment and
retention of diverse healthcare forces? And then follow that up
with additional Federal support for apprenticeship programs,
which we have worked on this Committee. Would that be helpful
also in terms of recruiting students of color?
Dr. Galvez. Thank you for that question, Senator. The
apprenticeship model is fantastic. And I think of it from the
medical side, we frequently shadow.
Shadowing a physician is where you learn what you
potentially could be, what you are getting into, right. And so,
there are some shadowing experiences that aren't great, like at
an ER where you are passing out juice and blankets. That is not
really learning about how the ER functions.
But when you are in an ER where you are taking care of
patients or helping to translate, and seeing what a physician
is doing, that buy-in, that spark that was mentioned, that is
what really gets people hooked, right, that they want to
proceed and go into that model.
I think that is a good format, and it likely would reduce
attrition. Because there are--like an example is you have
someone who goes to an Ivy League school, right. They want to
be a doctor.
Yes, they will get some research experience, but they don't
they--and yes, they will be shadowing in a clinical setting.
But it is--you see a high attrition rate in people interested
in entering medicine who didn't really get a great initial
experience. And so, apprenticeships I think are a fantastic
model.
Senator Hickenlooper. Dr. Andrades.
Ms. Andrades. I also believe that apprenticeship model is
probably the best way to help minority students.
As I mentioned in my testimony, BSEP, the Baystate
Springfield--educational partnership is really a mentorship
program between the city of Springfield Public Schools and
Baystate Medical Center to provide underserved students with
the opportunity to work alongside different health care
professionals.
I think one of the major benefits there is that maybe a
student may go into it saying, well I want to be a radiology
tech, but--or I may want to be a nurse, but students have
followed me, and I work very closely with surgical residents
and surgeons.
Maybe that exposure to another level in the health care
field is integral in them making the decision, Okay, I don't
just have to be, let's say--I don't have to be in this
position. I can be the surgeon.
I can be the nurse practitioner. And again, that program
really offers them an opportunity that they wouldn't have
otherwise.
Senator Hickenlooper. Thank you. I appreciate that. And Dr.
Braun--or Dr. Braun--Senator Braun and I have worked on this
and had a lot of support on the Committee. We are making
progress.
Dr. Lawson, as you noted in your testimony, CDC reports of
Black women are tragically two, three, four times more likely
to die. And we also just heard, a lot of that is due to mental
health issues. Colorado has a 2023 maternal mortality report
based on 4 years, 2016 to 2020.
They found that basically a third of all deaths were
attributed to suicide or accidental overdose, which is
staggering. What do you think we can best--how do we best
address this mental health, substance use disorder epidemic
that we have?
Dr. Lawson. That brings up one of our focus areas as an
organization. There are certain specialties we are worried
about the workforce and availability.
I have not been to one state during my presidency during
this past term where they do not have a shortage of behavioral
health care providers. I myself practice in Dallas. I am not in
Podunk, but we still don't have an availability of behavioral
health care providers.
There needs to be investments on how we can give
scholarships for those students, medical students to get them
interested in that career. Second, thinking about psychologists
and other specialties, right, that support those services.
Also, when you think about women, about 55 percent of
women, even if they had Medicaid, there is a coverage gap. So,
we got to also think about coverage. Many of my psychiatry
colleagues do not accept commercial insurance because of low
reimbursement.
Really the root cause of this is reimbursement for
behavioral health care services and showing value on that.
Senator Hickenlooper. Great. Thank you all. I am out of
time. I yield back to the Chair. Thank you.
The Chair. Senator Marshall, did you want to stay----
Senator Marshall. Well, I just want to again, thank all of
our witnesses for coming. Thank you for your dedication to the
health of women and pregnancies and deliveries, and all the
other aspects of health care. Thank you so much.
The Chair. I just want to echo Senator Marshall. Thank you
all. This is without exception, excellent testimony, and we
look forward to continue to work with you to implement many of
the very important suggestions that you made. So, thank you
all. And with that, let me just say that the hearing is over.
For any Senators who wish to ask additional questions,
questions for the record will be due in 10 business days, May
16th at 5.00 p.m.. Finally, I ask unanimous consent to enter
into the record 12 statements from stakeholder groups.
[The following information can be found on page 55 in
Additional Material:]
The Chair. The Committee stands adjourned. Thank you,
again.
ADDITIONAL MATERIAL
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[Whereupon, at 11:50 a.m., the hearing was adjourned.]
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