Keith A. Reynolds

The American Medical Association (AMA) has adopted a new policy aimed to increase diversity in the physician workforce.

, the move is part of the organization’s commitment to racial justice and equity and builds on the AMA’s strategic plan. The policy was adopted during the organization’s Special Meeting of its House of Delegates.

“Studies show that racial, ethnic and gender diversity among health professionals promotes better access to health care, improves health care quality for underserved populations, and better meets the health care needs of our increasingly diverse population,” said AMA Board of Trustee Member Jesse M. Ehrenfeld, MD, MPH, says in the release. “ Yet, our physician workforce does not adequately reflect the actual racial, ethnic or gender makeup of the patients in the communities we serve. A critical step in moving forward, we must call out the lasting negative impact that the Flexner Report, and other harmful past actions by the medical profession, has had on today’s physician workforce. We must address and reconcile these lasting harms to ensure that future physicians are aware of structural factors that are impeding their patient’s health outcomes, and continue efforts to ensure a diverse physician workforce that meets the needs of our patients.”

The provisions of the policy are below as they appear in the release:

Recognize some people have been historically underrepresented, excluded from, and marginalized in medical education and medicine because of their race, ethnicity, disability status, sexual orientation, gender identity, socioeconomic origin, and rurality, due to racism and other systems of exclusion and discrimination

Commit to promoting truth and reconciliation in medical education as it relates to improving equity

Recognize the harm caused by the Flexner Report to historically Black medical schools, the diversity of the physician workforce, and the outcomes of minoritized and marginalized patient populations

Work with appropriate stakeholders to commission and enact the recommendations of a forward-looking, cross-continuum, external study of 21st century medical education focused on reimagining the future of health equity and racial justice in medical education, improving the diversity of the health workforce, and ameliorating inequitable outcomes among minoritized and marginalized patient populations

Encourage the development of evidence-informed programs to build role models among academic leadership and faculty for the mentorship of students, residents, and fellows underrepresented in medicine and in specific specialties

Encourage physicians to engage in their communities to guide, support, and mentor high school and undergraduate students with a calling to medicine

Encourage medical schools, health care institutions, managed care and other appropriate groups to adopt and utilize activities that bolster efforts to include and support individuals who are underrepresented in medicine by developing policies that articulate the value and importance of diversity as a goal that benefits all participants, cultivating and funding programs that nurture a culture of diversity on campus, and recruiting faculty and staff who share this that goal

Continue to study and provide recommendations to improve the future of health equity and racial justice in medical education, the diversity of the health workforce, and the outcomes of marginalized patient populations

Encourage the U.S. Department of Education and Department of Labor to develop policies and initiatives in support of students from marginalized backgrounds that 1) decrease the educational opportunity gap; 2) increase participation in high school Advanced Placement courses; and 3) increase the high school graduation rate

Advocate for funding to support the creation and sustainability of Historically Black College and University (HBCU), Hispanic-Serving Institution (HSI), and Tribal College and University (TCU) affiliated medical schools and residency programs, with the goal of achieving a physician workforce that is proportional to the racial, ethnic, and gender composition of the United States population

Work with appropriate stakeholders to study reforms to mitigate demographic and socioeconomic inequities in the residency and fellowship selection process, including but not limited to the selection and reporting of honor society membership and the use of standardized tools to rank applicants, with report back to the House of Delegates

Establish a task force to guide organizational transformation within and beyond the AMA toward restorative justice to promote truth, reconciliation, and healing in medicine and medical education

This article was originally published on Medical Economics®. 

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The policy is part of the organization’s commitment to racial justice and equity.

New diversity policy from AMA

A new analysis identifies “serious problems” in the privacy practices of health-related mobile applications (mHealth apps).

, physicians should be aware of the inconsistent privacy practices of mHealth apps available on the Google Play storefront and be able to articulate them to patients when determining the benefits and risks in using them.

The researchers used a suite of app collection and analysis tools to carry out the analysis of nearly 21,000 mHealth apps available in the Google Play store accessible in Australia, a proxy for the worldwide Google Play marketplace, the study says.

They found that 88 percent of the apps could access and possibly share personal data, though the data transmission was detected in less than 4 percent of the apps. The authors note that the transmission obtained through automated testing was a low bound of the real data shared by the apps. More than 87 percent of the data collection practices were carried out on behalf of third parties, according to the analysis.

About 70 percent of data collection operations in apps are tied to 50 prominent services, with Google-owned services being the most common. The authors note this is likely due to the dominance of Google’s analytics and advertising services, as well as the choice of the Google Play marketplace as the source of the dataset.

While the analyzed data collection appears routine, it is not transparent as 28.1 percent of the mHealth apps offered no privacy policy text while 256 percent of user data transmissions violated the stated privacy policies. These transmissions include sensitive user information such as geolocations and passwords, according to the analysis.

“Such privacy risks should be articulated to patients and could be made part of app usage consent,” the analysis says. “We believe the trade-off between the benefits and risks of mHealth apps should be considered for any technical and policy discussion surrounding the services provided by such apps.”

Physicians should be aware of the privacy issues when determining the pros and cons of these apps.

Privacy issues in mobile health apps

The public trusts physicians more than hospitals and the healthcare system as a whole, but barriers still remain between patients and their doctors.

 from NORC at the University of Chicago, 84 percent of the general public trust doctors compared to 72 percent who trust hospitals and 64 percent who trust the healthcare system as a whole. The same was seen among doctors, with 94 percent saying they trust doctors within their practice and 85 percent saying they trust those outside of their practice, while only 60 percent say they trust hospitals.

The data is based on a survey of 600 physicians from late-January to early-February and a survey of 2,069 American adults from late-December to late-January.

The presentation says that 78 percent of the general public trust in their primary physician. This trust is more pronounced among older and higher-income respondents. It is also more pronounced among white respondents (82 percent) followed by Asian respondents (79 percent), Black respondents (71 percent), and Hispanic respondents (68 percent).

Most patients, 85 percent, say their choice in physician is based on coverage followed by 69 percent who based it on convenience and 64 percent who based their choice on recommendation. Only 33 percent based their choice on the physician’s age, 29 percent on their gender, and 18 percent based on race or ethnicity, according to the presentation.

Meanwhile, the data shows physicians are overestimating their patients’ ability to stick to treatment recommendations with 96 percent of doctors believing their patient are able to fill prescriptions and 93 percent believing they can follow treatment recommendations compared to only 81 percent of the public who say they are able to do these things. This is most obvious when it comes to scheduling appointments, with 90 percent of physicians who believe their patients can compared to 76 percent of the public who say they can, the presentation says.

, and the full public survey can be found 

This article was originally posted on Medical Economics®.

Trust is down in hospitals and the health system as a whole.\

Barriers between patients' trust and their doctors

The COVID-19 pandemic saw physicians adapting in order to keep their doors open as lockdowns and shelter-in-place orders dropped patient volumes precipitously.

 from the Kaiser Family Foundation, telehealth was widely used to help fill the gap. The report looked at telehealth utilization by Medicare beneficiaries between the summer and fall of 2020.

Among patients with a regular source of care, 64 percent or 33.6 million say their provider currently offers telehealth appointments. This is up from 18 percent who said their care provider offered telehealth appointments before the pandemic, yet 23 percent of beneficiaries say they don’t know if their physician offers it. The share of patients who don’t know is even greater, 30 percent, when they live in rural areas, according to the report.

Nearly half, 45 percent, of the beneficiaries whose regular source of care currently provides telehealth appointment have taken advantage of the offering between July and fall of 2020m meaning 27 percent, or 15 million, of all community-dwelling beneficiaries had a telehealth appointment during that period, the report says.

Beneficiaries younger than 65 who qualify for Medicare due to a long-term disability (53 percent), those enrolled in both Medicare and Medicaid (55 percent), Black (52 percent), and Hispanic (52 percent) were more likely to have had a telehealth appointment, according to the report.

A majority, 56 percent, of Medicare beneficiaries who have had a telehealth visit have accessed that care using only a telephone while smaller portions used video only or a combination of the two (28 percent and 16 percent respectively). The phone-only option was more popular with beneficiaries enrolled in both Medicare and Medicaid (67 percent), those aged 75 and older (65 percent), those living in rural areas (65 percent), and Hispanic beneficiaries (61 percent), the report says.