One of the most profound lessons I’ve learned over the past year as MMA president is that health equity is our generation’s great challenge in medicine. It was, therefore, disappointing to me to hear earlier this month about physicians in California filing a lawsuit to resist efforts to expand their knowledge and skills about implicit bias (don’t get me wrong – I’m not a fan of state-mandated CME requirements, but their argument is troubling).  

For most of us, this is a clear and present crisis. Although political spin and societal contradictions abound, the evidence is clear, and the pathogens are proven. The quality of care you receive and your access to care is too often based on the color of your skin, who you choose to love, or the circumstances of your geography.

Need some reminders of these inequities? According to research by the Minnesota Department of Health (MDH), African American and Native American babies die in the first year of life at twice the rate of white babies. Gay, lesbian, and bisexual university students are more likely than their heterosexual peers to have struggles with their mental health. African American and Hispanic/Latina women in Minnesota are more likely to be diagnosed with later-stage breast cancer. There is a troubling persistence of racial disparities in maternal health outcomes across education and income levels.  

The challenge of equity has become very personal to me. I have taken time to listen to the voices of my colleagues of color as they've described the racism they continue to experience. I have witnessed the insidious nature of inequity and how it can undermine the connection and trust between patients and their physicians. I have seen how the persistence of inequity, in spite of great efforts trying to ameliorate, can drive burnout and despair among the most passionate and talented of physicians. And the sheer scope of morbidity and mortality associated with something outside of our patient’s control is morally agonizing.  

Physicians need to lead on equity. We see the real toll societal injustice takes on our patient’s health. We frequently smash up against institutional biases as we try to help our patients navigate the healthcare system. And while other states may feel compelled to turn to legislating mandatory training, Minnesota’s physicians are stepping up to improve their competency to partner with and inform policy makers, not vice versa.  

The MMA’s mission is to make Minnesota the healthiest state and the best place to practice. To deliver nation-leading quality care we know we can’t leave anybody behind. Every Minnesotan deserves great care and the opportunity for optimal health.  

Yet, for many of us, tackling the root causes can seem unassailable – where to begin? Fortunately, the MMA is here to help. Start by understanding the experiences of your fellow physicians through the MMA’s recently released Racism in Medicine video series. Avail yourself of free online training in implicit bias – we all have them – and how you can manage your biases as you care for your patients. Talk with your colleagues, through MMA-facilitated conversations on race and equity. Assess your personal and your practice’s intercultural competence, with MMA-provided guidance and debriefings. Participate – or urge your practice staff to participate – in quarterly meetings of our Health Equity Community of Practice to learn strategies for how to make enduring practice-based changes. Share with us your reactions to the MMA’s examination of our own legacy of intolerance. For questions about any of these offerings, please contact Haley Brickner, the MMA's healthy equity coordinator.

The great challenge of our generation isn’t just inventing new cures or making new breakthroughs. Our greatest challenge is to help every single patient benefit from the cures and breakthroughs we’ve already made by confronting the legacies of racism and discrimination in our communities and institutions, and by acknowledging that we each can do our part to contribute to that change. If you haven’t yet, please join me. 

Will Nicholson, MD
MMA President

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Well thought out and defined editorial piece. Superb. Greetings to all!  
Paul S. Sanders MD

Great message! Thanks, Wil!
Kathryn Kramer, MD

There is an excellent workbook - “Do the Work” by W. Kamau Bell and Kate Schwatz that addresses how to understand and react to systemic racism.
Dale Lietzau, MD

Well said, Will! 
Daniel Larken, MD

Great message!  
Keith Stelter, MD

Always good to hear from am old friend, especially when he is like you engaged in a worthwhile cause. 
Claus Pierach, MD

I read Will Nicholson’s comments with interest and hope. I did not find support for universal, comprehensive, affordable health insurance. I am perplexed that health insurance for everyone is not first on the list of needed solutions. I am not saying the issues mentioned do not need attention, they do, but how can one hope to achieve equitable healthcare if people do not get care due to financial barriers?
Mark Brakke, MD

We are writing to thank you for your excellent recent MMA letter on the importance of equity in health care. Equity is central to our group, Doctors for Early Childhood. You described the profound harm done by inequity at every level and the insidious nature of implicit bias in all of us. Thanks to the MMA for championing this cause and for providing materials in many formats to educate physicians in providing bias-free care to all patients. We commend the MMA leadership for this effort and hope that it receives the attention and participation it deserves.

Mary Meland, MD FAAP
Dale Dobrin, MD FAAP
Ada Alden, EdD
Roger Sheldon, MD FAAP

Members, Doctors for Early Childhood

Excellent message! I agree with Dr. Mark Brakke's comment. To reach the goal of healthcare equality and equity may require consideration of universal basic healthcare insurance. 
Monna Marolt, MD