Immerse yourself in the insightful wisdom of Dr. Rodney Hood and Dr. Randall Morgan as they explore critical facets of health equity, inclusive business alliances, and the role of community-based programs in healthcare. In this episode, we delve into the framework of The W. Montague Cobb Institute and how it spearheads initiatives to combat racial and ethnic health disparities and tackle racism in medicine.
Accompany us on an inspiring journey through their personal and professional lives, peppered with unique perspectives garnered from working across various American cities like Boston, Chicago, San Diego, and Florida. Get a behind-the-scenes look at their efforts in understanding the future priorities of the National Medical Association, fostering inclusivity, and weaving health equity into the core fabric of healthcare business ventures.
We spotlight Dr Rodney Hood's innovative "Multicultural IPA," a groundbreaking business model that champions cooperation among different ethnic groups and healthcare providers, serving as a lifeline for underserved communities. Their valuable insights sketch out a roadmap for a more egalitarian and interconnected healthcare network that can potentially revolutionize health disparity interventions.
This episode also explores the formation of the COVID Equity Task Force. A multicultural approach meant to bridge the racial disparities in health exacerbated by the pandemic, this initiative successfully engaged and influenced county and state officials, yielding tangible results in the fight against health inequities.
This episode underscores the importance of integrity, ingenuity, trust-building, and enduring alliances in achieving health equity. Positioned at the intersection of social justice and healthcare, the conversation emphasizes the necessity of modernizing traditional strategies to meet today’s challenges.
The episode concludes with a focus on empowering the next generation in the health equity movement. By leveraging new communication platforms and methodologies, they explore the importance of bridging the gap between research and community implementation—a gap where the Cobb Institute can make a tangible difference through its focus on mentoring underrepresented minorities into health equity research.
Video Recording of Cobb Symposium at NMA: https://www.facebook.com/BlackDoctor.org/videos/311280798015597
W. Montague Cobb Institute: https://www.thecobbinstitute.org/about-us
Multicultural Health Foundation: https://mhfwellness.org/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Music.
(00:14):
A very warm welcome to you on behalf of the W. Montague Cobb Institute to Cobb and Company.
The Cobb Institute was launched by the NMA in the year 2004 at Howard University
to expand the association's research and policy analysis activities.
(00:35):
In 2008, the Cobb Institute became a separate non-profit entity from the NMA
with a vision to change the landscape of population health by becoming a valued
resource for ethical, inclusive research, data-driven solutions,
and strategies pertaining to racial and ethnic health and health disparities and racism in medicine.
(00:56):
The institute is named in honor of the late William Montague Cobb,
physician, anthropologist, and a distinguished professor of medicine and anatomy.
Dr. Cobb influenced countless graduates of Howard University School of Medicine, including Dr.
Randall Morgan, who's an orthopedic surgeon and founding and current executive
director of the Cobb Institute.
(01:19):
And we'll hear more from Dr. Morgan later in this episode.
Future Cobb and Company podcast episodes will keep you up to date with the latest
findings from the Cobb Institute's Journal of Racial and Ethnic Health Disparities,
whose editor-in-chief is Dr. Cato Laurencin.
We'll also be hearing from participants and leadership from the Cobb Scholars Program.
Cobb Scholars are interdisciplinary leaders spanning clinical specialties and
(01:43):
thematic areas of interest who seek to understand the persistent inequities in the U.S.
Healthcare system and gain the frameworks, insights, and professional connections
necessary to effectively forge solutions.
The goal is to develop scholars into transformational leaders.
Cobb Scholars collaborate across sectors, clinical professions and disciplines
(02:04):
and develop high-level leadership skills through professional coaching and networking.
The Cobb Scholars are drawn from nationally underrepresented groups in biomedicine.
You very and behavioral research and are mentored by fellows and senior fellows
of the W. Montague Cobb Institute, as well as members of the Association for
Academic Minority Physicians,
(02:30):
the AAMP.
The Cobb Institute is also an active partner and grant recipient with the NIH
ALL OF US Research Program as an institutional partner of its researcher workbench
and participant in the ALL OF US Community and Provider Gateway Initiative.
The Institute is additionally committed to supporting the annual ALL OF US Researchers
(02:51):
Convention and will be reporting on progress and findings from the ALL OF US
collaboration with NIH in upcoming episodes.
Every year, Cobb Institute participates in the National Medical Association
Convention and Scientific Assembly, with the annual W.
Montague Cobb Symposium being a highlight of the conference,
along with activities which convene the Cobb Scholars Program.
(03:13):
The Cobb Symposium at the most recent NMA convention was titled,
From Hopwood to Harvard,
Anti-Affirmative Action in Higher Education Admissions Amidst Systemic Racism
and Historical Racial Inequities in Health. It featured a keynote address by Dr.
Ruth Simmons, who is senior advisor to the president of Harvard University
(03:33):
on engagement with historically black colleges and universities,
along with other excellent speakers and panelists.
And you'll find a link to a video recording of the symposium in the episode summary.
For today's episode, Cobb's founding executive director, Dr.
Randall Morgan, sits down with Dr.
Rodney Hood for a wide-ranging discussion. In addition to talking about the
(03:54):
recent Supreme Court discussion to curtail affirmative action and the context
for this year's Cobb Symposium, Dr. Morgan and Dr.
Hood reflect on their own personal experiences drawn from long and successful
careers in medicine, including experiences studying and practicing in a number
of locations across the country, including Boston, Chicago, San Diego, and Florida.
(04:16):
And they discuss their involvement with and future priorities for the National Medical Association.
Welcome to today's episode. I'm Dr.
Randall Morgan, an orthopedic surgeon based in Sarasota, Florida,
and I am the president and CEO of the W.
(04:37):
Montague Cup NMA Health Institute. Institute, and I'm joined by my good friend, Dr.
Rodney Hood, here after traveling from San Diego, California.
Welcome, Dr. Hood. It's good to see you today. Thank you, Dr.
Morgan, and thank you for inviting me, and it's been a pleasure working with
you with the NMA and the Cobb over the past decade or so.
(04:58):
When I first got into this space several decades ago, everybody talked about
health disparities, but it's nice to know that we've now learned some of the
root causes of the health disparities, lack of health equity.
And considering some of the recent events that have happened with affirmative
(05:18):
action, what has happened in the state of Florida,
I think it's more important for the Cobb and the NMA to focus on health equity
because it's not time to take a seat back, but a seat forward.
Speaking of that, tell us about your early career, where you grew up,
what influenced your thinking.
(05:39):
How did you get here? Well, I grew up in Boston, Massachusetts.
I grew up in Roxbury, which is a part of Boston, Massachusetts,
which is a very underserved area.
And so I come from humble beginnings.
And although Boston is in the north, it is one of the most segregated northern
(06:00):
cities that I've been in, where various ethnic groups lived in certain areas.
And as I grew up, I learned that I was safe in certain areas and not in others.
We're talking about the obvious racism.
I'm now in my 70s. I went to undergraduate school in Boston at Northeastern,
matriculated in pharmacy,
(06:21):
and had never really traveled much outside of Massachusetts and elected to go
to graduate school in California.
California and I got at UCSF, graduate pharmacology toxicology,
thinking of getting a PhD in pharmacology toxicology and then going on to an MD degree.
(06:44):
This was during the Vietnam War.
One of my heroes was Muhammad Ali and he was determined not to divert his attention
away from his focus through the Vietnam War.
And I felt the same way. I felt it was more important that I get an education
(07:05):
than be diverted to a war.
So that really led me, when I lost my student deferment, to actually apply to
medical school because they were still deferring for medical school.
And I wound up going to UC San Diego.
I was one of the first to graduate from UC San Diego Medical School in the 1970s,
(07:28):
and that experience was very eye-opening.
I finished my training, opened my practice, a private practice in Southeast
San Diego, which was the poor area of Southeast San Diego, met a future colleague of mine, Dr.
Richard Butcher, who was a previous president of the national medical association,
(07:50):
who taught me the importance of what I learned about the medical holy trinity
medicine, politics and finance. I got a good education at UCSD in medicine but knew
nothing about the politics or the finances of medicine which really control medicine.
And he introduced me to the national medical association and he was one of my
(08:11):
early mentors and i learned that on a national level and local level we could
actually influence policy that
would help the underserved populations that I was talking about serving.
And that led me to the Cobb Institute.
As you think about it,
Did you ever have any occasion to want to return to Boston? So yes and no.
(08:38):
Boston is my home. I grew up in a family of nine and my mother had 12 of her brothers and sisters.
So I had a lot of family in Boston and also New York.
And I enjoyed going back to Boston, but I didn't really always see the opportunities
Boston that existed outside of Boston.
(09:00):
I also grew up with kind of some negative feelings about Boston.
I call it the tale of two cities.
Boston has some of the most prestigious and number-wise universities within
the city of Boston and around Boston.
But if you went to those universities, you got some felt a very liberal education.
(09:26):
However, if you grew up in Boston, in certain areas of Boston,
it was totally different.
I would commonly get outside of Roxbury.
I would go to Fenway Park to see the Red Sox and very commonly hear the word
N, the N word, very frequently to the point sometimes I used to joke.
Sometimes I thought N was my middle name. So when I wound up in California.
(09:51):
I really enjoyed the freedom that I felt California gave me,
the exposure that California gave me, and it just gave me a different perspective.
Perspective that's interesting because now i
live in florida 18 years i'm
going on 19 after spending most of
my life in the chicagoland area chicago is similar in some ways to boston and
(10:17):
that it has the neighborhoods it has been very difficult for african-americans
in some places in Chicago to be successful. But it also...
Juxtaposed to this, has an amazing history of black people in business and in
medicine and in law and all the professions.
(10:40):
So there was integration of the people in Chicago in spite of the racism.
And has that happened in Boston?
Yeah, I think certainly Boston gave me an exposure. I talked about the racism,
but within the Black community, it was a very close-knit Black community.
(11:02):
So you felt camaraderie. I felt wanted. I felt supported.
But I also felt restrained in the sense that I realized there were limitations coming from Roxbury,
coming from a poor environment, that there were certain expectations that they assumed you had.
(11:25):
And so I think Boston gave me my core who I am.
It gave me the insight as to who I am today.
And when I did my medical practice and I got introduced to a similar community
in San Diego, where I had made my home, where I had gotten married and had children,
(11:50):
I knew that that's where I wanted to practice.
So I wanted to practice, although I wasn't ready to go back to Roxbury,
I was ready to serve the community similar to where I came from.
And that's what led me to Southeast San Diego in San Diego, where I committed
my practice in most of my businesses.
What's been unique about the state of California? You spend so much time there.
(12:15):
There are differences in the state from north to south.
What is it that has made your career so successful?
Actually, I think coming from Boston helped me deal with California better.
California is a big state.
The environments in California, depending upon whether you're in San Francisco,
(12:36):
Whether you're in the middle of California, whether you're in Los Angeles or
San Diego, it's different.
So, for instance, up north in L.A., there are significant large black populations.
In San Diego, the population was only 5 or 6 percent African-Americans,
and now a city of 1.3 and a county of 3 million.
(12:59):
That was actually very similar to Boston, where the African-Americans were only 6%, 7% in Boston.
And I realized that, yes, we needed to work with the communities where we came
from, but we also needed to develop coalitions with the other communities in order to make progress.
(13:21):
That led me to form entities called the Multicultural Health Foundation,
the Multicultural Medical Group, where a group of black physicians coalesced
and then formed coalitions with other ethnic groups, Hispanics and Asians and Caucasians.
And actually, not only did we work together in a professional way,
(13:43):
but we formed businesses together that benefited us.
And coming from a community where you know African-Americans have the worst
outcomes, that community by itself couldn't change that.
You needed to work with other communities to actually begin to change those statistics.
Well, that's interesting that you've been able to form these business alliances
(14:09):
because that means that it's a long-term alliance.
It's not just for one occasion or one crisis.
It's lifetime.
What have you learned about the Hispanic community that maybe many of us don't know?
Yeah. Well, the largest ethnic community in San Diego is the Hispanic community,
(14:36):
and then followed by the Asian and then African Americans.
And what I found out is that they had similar issues.
The causes and root causes of those issues were a little bit different,
but they had similar issues to poor access to care, to discrimination in healthcare, low expectation,
(14:57):
low income, and unemployment.
The first part of my career, I used to preach the system should do the right thing.
And it became clear to me that our system was based on profit and capitalism.
And unless you showed a value, a financial value, health equity and health disparities
(15:19):
wasn't going to go anywhere.
So, when I formed the Multicultural IPA,
it was a business venture of mostly multi-ethnic physicians to show we could
take care of a high-risk population and not only make a profit,
but the systems taking care of these patients would also do well.
(15:41):
And that actually happened with a grant we received in 2012 from the CMMI Innovation
Project, in which CMS wanted to know, this population is costing us a lot of money.
1% of Medicare dollars costs 25% of the Medicare dollars.
(16:02):
5% of the population costs 50% of the Medicare dollars. With the grant,
we had a hotspotting grant that focused on the most severe sick high utilizers.
And by putting together a community-based intervention program that included
nurses, social workers, community health workers, along with our physicians
(16:25):
in a team approach, we would go to their home. We would visit them in the hospital.
We were able to decrease costs simply by doing.
Focusing on the cost center of hospitalization, we decreased hospitalization
by about 21 percent, ER visits by about 32 percent, showed we saved the system $15 million.
(16:48):
That was so impressive that some of the systems contracted with us to interact
with their most sickest, high-risk patients.
And so we were successful now in showing that the population that everybody
wanted to avoid, that in California, because of managed care,
the state and feds mandated Medi-Cal and Medicare patients into managed care programs.
(17:14):
So these health plans could no longer avoid that population.
Once when they had them, they had to figure out a way to take care of them.
And that put us at an advantage because we had figured out a way to take care
of them in a cost-effective way.
What's the future of the interventions that you've been able to put in place in San Diego?
I think many of the health systems, not only in San Diego or California,
(17:38):
are now implementing those programs.
They're developing complex case management teams that are not just telephonic,
but are now community-based.
And the state of California just mandated that many of the health plans must
contract with community-based organizations to interact with the populations
(18:02):
that they're taking care of.
So that has started, and I think it's not only saved money, but improved quality,
improved patient satisfaction within that state. state?
Well, I've always felt that the business case for the elimination of disparities
is what's going to lead to health equity.
(18:23):
And hopeful that in other parts of the country, there can be more evidence that
there is a true business case. Yeah. I think.
California has been able to show that in pockets. I'm sure there are other parts
of the state where it doesn't work so well. But I think that's really important.
(18:44):
And the other thing that's important is the trust that's been developed between
the African-American and the Hispanic community and providers.
Yeah. And I'm not sure that's always the case either.
Are there any tips that you would suggest that can lead to sustainability?
So, first of all, there's always distrust between these communities.
(19:07):
And when I went there, when I first tried to put together, I was putting together
mostly National Medical Association, African American physicians in a group
to develop this business model.
Then we went to the other communities and said, join us. We didn't get much of a response.
Some of my close Hispanic colleagues told me, Rodney, they're not going to join
(19:32):
it because they see it as a black organization.
Exactly. So what we did was formed a separate entity called the Multicultural
IPA, where your individual practice was separate, but you contracted with this entity.
And we showed them a model where we would all benefit, not only would the practices
(19:53):
benefit when we went into risk savings,
there was savings that the hospital systems were willing to share that went
back to the providers and helped the systems expand their network to more community-based.
So it was developing a business model, listening to the providers,
(20:15):
just like blacks don't always want to join all white group and that type of thing.
But if you construct it in a way where you can still have your own identity,
but the business model still makes sense.
And that's where the multicultural IPA, that's what I think we discovered.
And that is sustainable in your view. It is definitely sustainable.
(20:38):
As a matter of fact, it's the only way that it will work. Okay.
And that a lot of it is based upon trust. This came about with COVID.
When COVID hit, reading the data, it was clear to me, I think within the first
months of COVID, I wrote an article in the San Diego Tribune ending it with,
(21:00):
when white folks catch a cold, black folks catch pneumonia,
meaning it was clear to us that the impact of COVID was going to be greater
on the black Hispanic community.
When I started the COVID Equity Task Force, I just didn't go to black physicians.
I went to the whole network using my IPA of Hispanic physicians,
(21:22):
Asian physicians, immigrant physicians.
We brought the county involved. We got the state involved and politicians.
We used to meet on a regular basis saying, hey, you got a test site up in La Jolla.
Not many of us live up there. What about down here? The state and the county
listened. They took our recommendations.
And it wasn't just the black physicians talking. It was all the physicians talking.
(21:46):
So it's a matter of trust and realizing that I think that's a lesson that the NMA could learn.
That it's not, you know, We need to focus on the African-American community,
but we also need to develop coalitions with other communities and find synergies
where we can advocate together to create programs that are going to benefit both of us.
(22:13):
Well, you and I both know as past leaders of the National Medical Association
that most of the work that we do is external to the National Medical Association.
So we're representing the National Medical Association outside of the comfort
zone of the association.
(22:55):
Mm-hmm. Thank you.
I think we underestimate the influence and respect that we have as physicians
and as black physicians. I really do.
Of all the ethnic groups, the African-Americans have the most organized medical
(23:19):
group in the country. That's my opinion.
Others have ethnic groups, but they're not as organized. Okay.
Many of the health equity advancements that have taken place in the country
have happened through the efforts of individual African-American physicians in the NMA. may.
(23:41):
And what I recognize is others recognize that to the point that I didn't realize they recognized it.
And they actually want to work with us. They just want to feel.
So it's not so much us feeling comfortable with them.
It's us making them feel comfortable working with us. And so we need to do outreach.
We need to be honest. Here are our issues.
(24:04):
Here's where you can help us. What are your issues? How can we help you?
And with COVID, we told the county, we don't want you just giving a minority
grant to some group that's going to deal with the Hispanic, Black, and Asian community.
We want you to identify specific groups within those ethnic groups to focus on those communities.
(24:25):
And for the first time, the conservative board and county in San Diego said, okay, we hear you.
They gave specific grants to the Chicano Federation.
Which was focused on the Latino community, to the UPAC, which is the Pacific
(24:45):
Asian community, and to Multicultural Health Foundation, specifically to focus
on African Americans. This was a first.
So we got $5 million just to focus on a small population of 5% in San Diego dealing with COVID.
We had a media campaign that was specifically focused on African campaign,
(25:07):
written media, TV media.
We had outreach using community health workers, mostly African-American,
interacting with African-Americans.
We involved the faith community.
And in the Hispanic community, they were doing similar things,
but using their own strategies.
And what we found was that we worked together. These groups would then come
(25:30):
together through the Multicultural Task Force and through the county,
talking about what we learned, what we didn't learn.
The county was excited about that and felt that we had developed a model that
could be taken nationally.
Sometimes our organizations as
African Americans are maybe not quite as thoughtful, shall I say. Mm-hmm.
(25:54):
About our own success and how we can make a difference.
And so now we're at this crossroads and we have these challenges that we have
to reinvent ourselves again in the quest for equity.
Where does that put the National Medical Association today?
If it learns the lessons of the past and can translate those into where we are
(26:19):
today in the future, that we need to do, in my humble opinion,
the multicultural approach.
We need to not be afraid to reach out.
We need to form coalitions. When I had the Equity Task Force one week,
I would give my presentation. And if you've ever heard my presentations,
(26:42):
they're very unapologetic Afrocentric.
Okay. I don't believe and say, well, let me give this and include this group.
And the next time I'd ask the Hispanics, give your presentation.
Let us listen to your presentation. We'd have the Asians do the same.
We'd have the immigrant community do the same.
(27:02):
They loved it. They felt welcome. So you don't have to compromise your point of view.
You just have to understand that others may have a different point of view and
you learn from each other.
And then when you go to the power source or the powers that be and they see
this coalition, they actually sit back and say, this is actually working for
(27:24):
us. I don't have to deal with them individually.
They're all on the same page. and as a result, they rewarded all of us with
significant grants to focus on our communities.
So I think that's the lesson the National Medical Association and other Black
organizations can learn, that yes, we need to continue to struggle to improve
(27:45):
our own infrastructure,
but we need to form strong coalitions that find a way to work together.
And they have to be sustainable coalitions. Absolutely. They can't be coalitions
that develop for a specific purpose at a specific time.
Yeah. It may start out that way, but I think overall you need to have a broader thing.
(28:10):
It's kind of like one of the comments from the Hispanic group,
Asian group, I forget which, was, well, African Americans have done this and this. It's our turn.
That's a common theme within the Asian or Hispanics. Black is,
you know, everybody's talking about black. What about us?
(28:31):
I said, this isn't about taking turns because if it's about turns,
African-Americans haven't finished their turn.
Okay, so it's not about terms. And it's about not trying to split up the small piece of slice of pie.
There's a whole pie out there. And it's about equity. If we need 30% of that
(28:53):
pie and you need whatever percent, we're going to help you get it.
But don't take out 30% because you think it's your turn. We've had those conversations.
And that's what I mean by being honest. I don't run from difficult conversations.
And that builds up trust.
Yes, it does. And you had one point that was just one word, grants.
(29:19):
But that's important as well. And it would seem that through these type of coalitions,
funding sources are going to be much more plentiful. Yeah.
For everyone. Yeah, for everyone. Either the folks coming to the table,
they're not going to give a small poultry grant and then have all the groups fight over that.
(29:42):
We said, no, we're not going to do that.
Here's our need. We specified what our needs are.
Here's what it's going to cost. We need you to fund that for blacks,
et cetera, rather than just saying what has been done in the past is that the
powers that be would say,
here's $10 million for a $1 billion problem.
(30:08):
And you all fight over that. No, we said, no, we need $60 million. Okay.
And here's why and here's how come. So you got to be realistic.
And you may not get everything you asked for, but at least folks are recognizing,
well, they're not throwing us all into the same pot.
(30:29):
You need to have those conversations up front with the collaborators and coalition.
That's true. And I think it's important for our organizations,
and when I say our, I mean those that represent African Americans,
to realize that whatever you do takes resources.
And there are resources that are available, but the strategy of attaining and
(30:54):
retaining those resources is very important.
And it seems that those who are most successful are those that have worked in coalition.
And so let's just talk maybe for a minute about what's going to occur today.
We have a symposium that's entitled From Hopwood to Harvard,
(31:18):
which is rather symbolic, I think, for you coming from Boston,
ending up in California and spending your professional life.
And part of the reason that I wanted to talk a little bit about California and
the California situation,
because I think it speaks to perhaps action steps that are going to have to
(31:40):
take place following the Supreme Court decision that will be discussed in a
symposium sponsored jointly by the Cobb Institute and Movement is Life this afternoon.
Afternoon what's your take on the situation at this
point what have we learned and what do we need to learn
yeah interesting people see california as the liberal sebastian where anything
(32:05):
goes yet in 1996 we had proposition 209 that actually ended affirmative action
in california so we've been dealing with that for the past 25 30 years.
And let's be real, it was a significant impact.
Personally, I'm not sure I would have been in medical school if it wasn't for affirmative action.
(32:30):
I have no problems saying that.
But when affirmative action ended, I think at first the proposition was in 1996
and the first classes that it impacted was about 1999 or 1998.
There were some studies done that showed there was a significant decrease in
(32:51):
acceptance of Blacks and Latinos, about 40% that year.
And then they did further studies to find out that it actually affected the
whole wealth gap because those individuals that weren't accepted,
some of them went to lesser colleges.
This was just the public universities. Some of them went to lesser colleges,
(33:15):
and they calculated that they were making 5% or more less than they would have
had they been able to go to the universities that they wanted to go to.
So it affected their jobs.
It affected their financial outcomes.
But over the past 20, 25 years, they've been trying different things.
(33:38):
One of the things, I think it was 2020 or 2021, the University of California
eliminated the necessity for standardized tests.
That's critical. And people always say, well, aren't standardized tests equal?
No, they're not. it's like having a standard
(33:59):
basketball rim at 10 feet it may
be it's less equitable for somebody
who's five foot than somebody who's seven foot and and so i think that's begun
to make a impact i think some of the other things you mentioned resources i
am a lifelong member of the alumni at UC San Diego,
(34:23):
and I'm part of the Black Alumni Association.
Because of the anti-affirmative action, when you give money to the university,
the university cannot specifically give it to black students or ethnic students.
So what we did was formed a foundation specifically specifically developed by
(34:47):
the black alumni of UC San Diego,
and put it in a separate foundation outside of the university.
And as black students get admitted to UCSD, those that qualify certain standards,
they get funding for the whole four years that they're there through that funding.
(35:10):
So you need to develop. There are other strategies you can use,
But one is looking at the inequitable standards and I think eliminating the standardized tests.
Aren't equitable and coming up with resource strategies that are still able
to recognize that certain students are going to need more resources is what's necessary.
(35:35):
How does the Hispanic community feel about eliminating standardized tests?
Do they feel that's an issue? And are there any language barriers that are brought
up by the Hispanic community vis-a-vis admissions.
Yeah. So I feel uncomfortable answering that and saying this is how the Hispanic,
(35:59):
because I don't know how the quote Hispanic community feels.
Hispanic community is very diverse. Okay.
You've got a significant portion of the Hispanic community, although the Hispanic
consider themselves white.
And you've got another portion that don't. And then you got those that belong
(36:20):
who are African descent belong to the Hispanic community.
So I think depending upon who you talk to, you may get different responses.
But when we look at the Hispanic community as a whole, when affirmative action,
the anti-affirmative action took place in California, their numbers went down as well.
(36:42):
And so I must believe that they also agree, or the university wouldn't have
done it, eliminate the standardized test as a requirement that is going to benefit most Hispanics. Good.
After we conclude our convention and the deliberations, not only the Cobb Symposium
(37:06):
that we know will occur today,
but sort of the aggregate of the other plenary sessions and programs.
What should be the first step that the National Medical Association takes for the future?
I think they really need to internally reassess what our resources are and how to better focus,
(37:32):
refocus those resources to combat the struggle that we know is ahead.
Head, not only in our community with affirmative action, but how that is going
to affect the lack of black physicians, the lack of male physicians.
(37:52):
It's been shown that patient satisfaction goes up when they have a cohort of
physicians that they agree with.
There is some evidence to show that even outcomes are better.
So we're concerned that with this anti-affirmative action, we're already struggling
to increase the number of providers that look like us. That's going to make it even more difficult.
(38:14):
So I think we need to focus on how are we going to address that issue.
I think the other thing I mentioned is building a coalition.
I think we need to realize that we're not in this alone.
That there are others that look like us and others that don't look like us that
realize it would benefit them as well if they helped us develop strategies.
(38:40):
So I think it's developing coalition with other entities that would help us
overcome the difficulties that I see ahead.
Both within the community as well as outside of the community.
Absolutely. With perhaps a little more specificity and more strategy.
You can't have a healthy musculoskeletal system without a healthy cardiovascular
(39:04):
system. You can't have a healthy musculoskeletal system without a healthy neurological system.
And we in the National Medical Association or Cobb are not going to be successful
without finding coalitions and resources that help us overcome these obstacles.
(39:27):
So, I think refocusing our efforts, I think there's a lot of anti-affirmative action,
there's a lot of racist policies that are going against the anti-racist policies
that we were trying to implement, and we've got to find partners that are going to overcome that.
(39:48):
I think education is important.
Dr. Morgan, you and I have been in this battle a long time, and I've been giving
lectures on health inequities for a long time.
And most lectures, they want you to come up after you tell us what the problem
(40:09):
is, what is the solution.
Sure. And I usually, in the past few years, when I come to solutions,
I usually say, you don't really want to hear what I have to say about solutions
because the individuals sitting in the audience who are usually younger,
the younger physicians, the younger nurses, the younger administrators.
(40:32):
Those are the ones that need to come up with the solution.
I can give you my experience maybe that you can learn from.
So I think we need to focus on the youth, educating them about the struggle,
and asking them for their suggestions for the future.
(40:52):
We had a session here within NMA, the leadership forum, sponsored by the past president's council.
And I participated in one of them, and it was about membership.
I think I learned more from that session because there were youngsters there
that said, well, the way we communicate,
there's a network of black physicians that use this platform called Mocha that they communicate with.
(41:21):
I never heard of that.
So they think differently, they communicate differently, and many times they operate differently.
So we need to find a way to recruit more young physicians and providers into
this struggle and have them with us develop strategies that will be successful.
(41:46):
And so with that in mind, how can the Cobb Institute and its scholars program make a difference?
Well, I think they're right on. We need young researchers to get,
because that's what the Cobb is.
It's talking about mentoring and encouraging young people of color,
(42:09):
African Americans, into health equity research.
Research and and and as we
get these youngsters in there to make the transition from
not just doing research but how do you translate that research
into a solution to the community that's
being impacted we need to bridge the gap
between research and implementation in the
(42:32):
communities where they are and and and i think that's where the cob has a space
that's critical help helping to mentor these researchers that are going to move
into that space and understand that there's a history that's caused where we are.
Well, I certainly have enjoyed this discussion and sort of reminiscing and learning
(42:56):
a lot about your experiences and the why you do what you do and the how,
how it's been successful.
And also, I think that some of the topics we've talked about today are mutually
beneficial to the National Medical Association, the National Hispanic Medical
(43:20):
Association, for sure. and Movement is life.
And by all means, the Cobb. So I appreciate so much your time.
Always your friendship.
Thank you. And we could go on for a few more hours, but I think we kind of tie
a bow around this discussion and look forward to the next. Thank you so much.
(43:43):
Thank you, Dr. Morgan. I appreciate the invitation.
Music.
Music.
(00:14):
A very warm welcome to you on behalf of the W. Montague Cobb Institute to Cobb and Company.
The Cobb Institute was launched by the NMA in the year 2004 at Howard University
to expand the association's research and policy analysis activities.
(00:35):
In 2008, the Cobb Institute became a separate non-profit entity from the NMA
with a vision to change the landscape of population health by becoming a valued
resource for ethical, inclusive research, data-driven solutions,
and strategies pertaining to racial and ethnic health and health disparities and racism in medicine.
(00:56):
The institute is named in honor of the late William Montague Cobb,
physician, anthropologist, and a distinguished professor of medicine and anatomy.
Dr. Cobb influenced countless graduates of Howard University School of Medicine, including Dr.
Randall Morgan, who's an orthopedic surgeon and founding and current executive
director of the Cobb Institute.
(01:19):
And we'll hear more from Dr. Morgan later in this episode.
Future Cobb and Company podcast episodes will keep you up to date with the latest
findings from the Cobb Institute's Journal of Racial and Ethnic Health Disparities,
whose editor-in-chief is Dr. Cato Laurencin.
We'll also be hearing from participants and leadership from the Cobb Scholars Program.
Cobb Scholars are interdisciplinary leaders spanning clinical specialties and
(01:43):
thematic areas of interest who seek to understand the persistent inequities in the U.S.
Healthcare system and gain the frameworks, insights, and professional connections
necessary to effectively forge solutions.
The goal is to develop scholars into transformational leaders.
Cobb Scholars collaborate across sectors, clinical professions and disciplines
(02:04):
and develop high-level leadership skills through professional coaching and networking.
The Cobb Scholars are drawn from nationally underrepresented groups in biomedicine.
You very and behavioral research and are mentored by fellows and senior fellows
of the W. Montague Cobb Institute, as well as members of the Association for
Academic Minority Physicians,
(02:30):
the AAMP.
The Cobb Institute is also an active partner and grant recipient with the NIH
ALL OF US Research Program as an institutional partner of its researcher workbench
and participant in the ALL OF US Community and Provider Gateway Initiative.
The Institute is additionally committed to supporting the annual ALL OF US Researchers
(02:51):
Convention and will be reporting on progress and findings from the ALL OF US
collaboration with NIH in upcoming episodes.
Every year, Cobb Institute participates in the National Medical Association
Convention and Scientific Assembly, with the annual W.
Montague Cobb Symposium being a highlight of the conference,
along with activities which convene the Cobb Scholars Program.
(03:13):
The Cobb Symposium at the most recent NMA convention was titled,
From Hopwood to Harvard,
Anti-Affirmative Action in Higher Education Admissions Amidst Systemic Racism
and Historical Racial Inequities in Health. It featured a keynote address by Dr.
Ruth Simmons, who is senior advisor to the president of Harvard University
(03:33):
on engagement with historically black colleges and universities,
along with other excellent speakers and panelists.
And you'll find a link to a video recording of the symposium in the episode summary.
For today's episode, Cobb's founding executive director, Dr.
Randall Morgan, sits down with Dr.
Rodney Hood for a wide-ranging discussion. In addition to talking about the
(03:54):
recent Supreme Court discussion to curtail affirmative action and the context
for this year's Cobb Symposium, Dr. Morgan and Dr.
Hood reflect on their own personal experiences drawn from long and successful
careers in medicine, including experiences studying and practicing in a number
of locations across the country, including Boston, Chicago, San Diego, and Florida.
(04:16):
And they discuss their involvement with and future priorities for the National Medical Association.
Welcome to today's episode. I'm Dr.
Randall Morgan, an orthopedic surgeon based in Sarasota, Florida,
and I am the president and CEO of the W.
(04:37):
Montague Cup NMA Health Institute. Institute, and I'm joined by my good friend, Dr.
Rodney Hood, here after traveling from San Diego, California.
Welcome, Dr. Hood. It's good to see you today. Thank you, Dr.
Morgan, and thank you for inviting me, and it's been a pleasure working with
you with the NMA and the Cobb over the past decade or so.
(04:58):
When I first got into this space several decades ago, everybody talked about
health disparities, but it's nice to know that we've now learned some of the
root causes of the health disparities, lack of health equity.
And considering some of the recent events that have happened with affirmative
(05:18):
action, what has happened in the state of Florida,
I think it's more important for the Cobb and the NMA to focus on health equity
because it's not time to take a seat back, but a seat forward.
Speaking of that, tell us about your early career, where you grew up,
what influenced your thinking.
(05:39):
How did you get here? Well, I grew up in Boston, Massachusetts.
I grew up in Roxbury, which is a part of Boston, Massachusetts,
which is a very underserved area.
And so I come from humble beginnings.
And although Boston is in the north, it is one of the most segregated northern
(06:00):
cities that I've been in, where various ethnic groups lived in certain areas.
And as I grew up, I learned that I was safe in certain areas and not in others.
We're talking about the obvious racism.
I'm now in my 70s. I went to undergraduate school in Boston at Northeastern,
matriculated in pharmacy,
(06:21):
and had never really traveled much outside of Massachusetts and elected to go
to graduate school in California.
California and I got at UCSF, graduate pharmacology toxicology,
thinking of getting a PhD in pharmacology toxicology and then going on to an MD degree.
(06:44):
This was during the Vietnam War.
One of my heroes was Muhammad Ali and he was determined not to divert his attention
away from his focus through the Vietnam War.
And I felt the same way. I felt it was more important that I get an education
(07:05):
than be diverted to a war.
So that really led me, when I lost my student deferment, to actually apply to
medical school because they were still deferring for medical school.
And I wound up going to UC San Diego.
I was one of the first to graduate from UC San Diego Medical School in the 1970s,
(07:28):
and that experience was very eye-opening.
I finished my training, opened my practice, a private practice in Southeast
San Diego, which was the poor area of Southeast San Diego, met a future colleague of mine, Dr.
Richard Butcher, who was a previous president of the national medical association,
(07:50):
who taught me the importance of what I learned about the medical holy trinity
medicine, politics and finance. I got a good education at UCSD in medicine but knew
nothing about the politics or the finances of medicine which really control medicine.
And he introduced me to the national medical association and he was one of my
(08:11):
early mentors and i learned that on a national level and local level we could
actually influence policy that
would help the underserved populations that I was talking about serving.
And that led me to the Cobb Institute.
As you think about it,
Did you ever have any occasion to want to return to Boston? So yes and no.
(08:38):
Boston is my home. I grew up in a family of nine and my mother had 12 of her brothers and sisters.
So I had a lot of family in Boston and also New York.
And I enjoyed going back to Boston, but I didn't really always see the opportunities
Boston that existed outside of Boston.
(09:00):
I also grew up with kind of some negative feelings about Boston.
I call it the tale of two cities.
Boston has some of the most prestigious and number-wise universities within
the city of Boston and around Boston.
But if you went to those universities, you got some felt a very liberal education.
(09:26):
However, if you grew up in Boston, in certain areas of Boston,
it was totally different.
I would commonly get outside of Roxbury.
I would go to Fenway Park to see the Red Sox and very commonly hear the word
N, the N word, very frequently to the point sometimes I used to joke.
Sometimes I thought N was my middle name. So when I wound up in California.
(09:51):
I really enjoyed the freedom that I felt California gave me,
the exposure that California gave me, and it just gave me a different perspective.
Perspective that's interesting because now i
live in florida 18 years i'm
going on 19 after spending most of
my life in the chicagoland area chicago is similar in some ways to boston and
(10:17):
that it has the neighborhoods it has been very difficult for african-americans
in some places in Chicago to be successful. But it also...
Juxtaposed to this, has an amazing history of black people in business and in
medicine and in law and all the professions.
(10:40):
So there was integration of the people in Chicago in spite of the racism.
And has that happened in Boston?
Yeah, I think certainly Boston gave me an exposure. I talked about the racism,
but within the Black community, it was a very close-knit Black community.
(11:02):
So you felt camaraderie. I felt wanted. I felt supported.
But I also felt restrained in the sense that I realized there were limitations coming from Roxbury,
coming from a poor environment, that there were certain expectations that they assumed you had.
(11:25):
And so I think Boston gave me my core who I am.
It gave me the insight as to who I am today.
And when I did my medical practice and I got introduced to a similar community
in San Diego, where I had made my home, where I had gotten married and had children,
(11:50):
I knew that that's where I wanted to practice.
So I wanted to practice, although I wasn't ready to go back to Roxbury,
I was ready to serve the community similar to where I came from.
And that's what led me to Southeast San Diego in San Diego, where I committed
my practice in most of my businesses.
What's been unique about the state of California? You spend so much time there.
(12:15):
There are differences in the state from north to south.
What is it that has made your career so successful?
Actually, I think coming from Boston helped me deal with California better.
California is a big state.
The environments in California, depending upon whether you're in San Francisco,
(12:36):
Whether you're in the middle of California, whether you're in Los Angeles or
San Diego, it's different.
So, for instance, up north in L.A., there are significant large black populations.
In San Diego, the population was only 5 or 6 percent African-Americans,
and now a city of 1.3 and a county of 3 million.
(12:59):
That was actually very similar to Boston, where the African-Americans were only 6%, 7% in Boston.
And I realized that, yes, we needed to work with the communities where we came
from, but we also needed to develop coalitions with the other communities in order to make progress.
(13:21):
That led me to form entities called the Multicultural Health Foundation,
the Multicultural Medical Group, where a group of black physicians coalesced
and then formed coalitions with other ethnic groups, Hispanics and Asians and Caucasians.
And actually, not only did we work together in a professional way,
(13:43):
but we formed businesses together that benefited us.
And coming from a community where you know African-Americans have the worst
outcomes, that community by itself couldn't change that.
You needed to work with other communities to actually begin to change those statistics.
Well, that's interesting that you've been able to form these business alliances
(14:09):
because that means that it's a long-term alliance.
It's not just for one occasion or one crisis.
It's lifetime.
What have you learned about the Hispanic community that maybe many of us don't know?
Yeah. Well, the largest ethnic community in San Diego is the Hispanic community,
(14:36):
and then followed by the Asian and then African Americans.
And what I found out is that they had similar issues.
The causes and root causes of those issues were a little bit different,
but they had similar issues to poor access to care, to discrimination in healthcare, low expectation,
(14:57):
low income, and unemployment.
The first part of my career, I used to preach the system should do the right thing.
And it became clear to me that our system was based on profit and capitalism.
And unless you showed a value, a financial value, health equity and health disparities
(15:19):
wasn't going to go anywhere.
So, when I formed the Multicultural IPA,
it was a business venture of mostly multi-ethnic physicians to show we could
take care of a high-risk population and not only make a profit,
but the systems taking care of these patients would also do well.
(15:41):
And that actually happened with a grant we received in 2012 from the CMMI Innovation
Project, in which CMS wanted to know, this population is costing us a lot of money.
1% of Medicare dollars costs 25% of the Medicare dollars.
(16:02):
5% of the population costs 50% of the Medicare dollars. With the grant,
we had a hotspotting grant that focused on the most severe sick high utilizers.
And by putting together a community-based intervention program that included
nurses, social workers, community health workers, along with our physicians
(16:25):
in a team approach, we would go to their home. We would visit them in the hospital.
We were able to decrease costs simply by doing.
Focusing on the cost center of hospitalization, we decreased hospitalization
by about 21 percent, ER visits by about 32 percent, showed we saved the system $15 million.
(16:48):
That was so impressive that some of the systems contracted with us to interact
with their most sickest, high-risk patients.
And so we were successful now in showing that the population that everybody
wanted to avoid, that in California, because of managed care,
the state and feds mandated Medi-Cal and Medicare patients into managed care programs.
(17:14):
So these health plans could no longer avoid that population.
Once when they had them, they had to figure out a way to take care of them.
And that put us at an advantage because we had figured out a way to take care
of them in a cost-effective way.
What's the future of the interventions that you've been able to put in place in San Diego?
I think many of the health systems, not only in San Diego or California,
(17:38):
are now implementing those programs.
They're developing complex case management teams that are not just telephonic,
but are now community-based.
And the state of California just mandated that many of the health plans must
contract with community-based organizations to interact with the populations
(18:02):
that they're taking care of.
So that has started, and I think it's not only saved money, but improved quality,
improved patient satisfaction within that state. state?
Well, I've always felt that the business case for the elimination of disparities
is what's going to lead to health equity.
(18:23):
And hopeful that in other parts of the country, there can be more evidence that
there is a true business case. Yeah. I think.
California has been able to show that in pockets. I'm sure there are other parts
of the state where it doesn't work so well. But I think that's really important.
(18:44):
And the other thing that's important is the trust that's been developed between
the African-American and the Hispanic community and providers.
Yeah. And I'm not sure that's always the case either.
Are there any tips that you would suggest that can lead to sustainability?
So, first of all, there's always distrust between these communities.
(19:07):
And when I went there, when I first tried to put together, I was putting together
mostly National Medical Association, African American physicians in a group
to develop this business model.
Then we went to the other communities and said, join us. We didn't get much of a response.
Some of my close Hispanic colleagues told me, Rodney, they're not going to join
(19:32):
it because they see it as a black organization.
Exactly. So what we did was formed a separate entity called the Multicultural
IPA, where your individual practice was separate, but you contracted with this entity.
And we showed them a model where we would all benefit, not only would the practices
(19:53):
benefit when we went into risk savings,
there was savings that the hospital systems were willing to share that went
back to the providers and helped the systems expand their network to more community-based.
So it was developing a business model, listening to the providers,
(20:15):
just like blacks don't always want to join all white group and that type of thing.
But if you construct it in a way where you can still have your own identity,
but the business model still makes sense.
And that's where the multicultural IPA, that's what I think we discovered.
And that is sustainable in your view. It is definitely sustainable.
(20:38):
As a matter of fact, it's the only way that it will work. Okay.
And that a lot of it is based upon trust. This came about with COVID.
When COVID hit, reading the data, it was clear to me, I think within the first
months of COVID, I wrote an article in the San Diego Tribune ending it with,
(21:00):
when white folks catch a cold, black folks catch pneumonia,
meaning it was clear to us that the impact of COVID was going to be greater
on the black Hispanic community.
When I started the COVID Equity Task Force, I just didn't go to black physicians.
I went to the whole network using my IPA of Hispanic physicians,
(21:22):
Asian physicians, immigrant physicians.
We brought the county involved. We got the state involved and politicians.
We used to meet on a regular basis saying, hey, you got a test site up in La Jolla.
Not many of us live up there. What about down here? The state and the county
listened. They took our recommendations.
And it wasn't just the black physicians talking. It was all the physicians talking.
(21:46):
So it's a matter of trust and realizing that I think that's a lesson that the NMA could learn.
That it's not, you know, We need to focus on the African-American community,
but we also need to develop coalitions with other communities and find synergies
where we can advocate together to create programs that are going to benefit both of us.
(22:13):
Well, you and I both know as past leaders of the National Medical Association
that most of the work that we do is external to the National Medical Association.
So we're representing the National Medical Association outside of the comfort
zone of the association.
(22:55):
Mm-hmm. Thank you.
I think we underestimate the influence and respect that we have as physicians
and as black physicians. I really do.
Of all the ethnic groups, the African-Americans have the most organized medical
(23:19):
group in the country. That's my opinion.
Others have ethnic groups, but they're not as organized. Okay.
Many of the health equity advancements that have taken place in the country
have happened through the efforts of individual African-American physicians in the NMA. may.
(23:41):
And what I recognize is others recognize that to the point that I didn't realize they recognized it.
And they actually want to work with us. They just want to feel.
So it's not so much us feeling comfortable with them.
It's us making them feel comfortable working with us. And so we need to do outreach.
We need to be honest. Here are our issues.
(24:04):
Here's where you can help us. What are your issues? How can we help you?
And with COVID, we told the county, we don't want you just giving a minority
grant to some group that's going to deal with the Hispanic, Black, and Asian community.
We want you to identify specific groups within those ethnic groups to focus on those communities.
(24:25):
And for the first time, the conservative board and county in San Diego said, okay, we hear you.
They gave specific grants to the Chicano Federation.
Which was focused on the Latino community, to the UPAC, which is the Pacific
(24:45):
Asian community, and to Multicultural Health Foundation, specifically to focus
on African Americans. This was a first.
So we got $5 million just to focus on a small population of 5% in San Diego dealing with COVID.
We had a media campaign that was specifically focused on African campaign,
(25:07):
written media, TV media.
We had outreach using community health workers, mostly African-American,
interacting with African-Americans.
We involved the faith community.
And in the Hispanic community, they were doing similar things,
but using their own strategies.
And what we found was that we worked together. These groups would then come
(25:30):
together through the Multicultural Task Force and through the county,
talking about what we learned, what we didn't learn.
The county was excited about that and felt that we had developed a model that
could be taken nationally.
Sometimes our organizations as
African Americans are maybe not quite as thoughtful, shall I say. Mm-hmm.
(25:54):
About our own success and how we can make a difference.
And so now we're at this crossroads and we have these challenges that we have
to reinvent ourselves again in the quest for equity.
Where does that put the National Medical Association today?
If it learns the lessons of the past and can translate those into where we are
(26:19):
today in the future, that we need to do, in my humble opinion,
the multicultural approach.
We need to not be afraid to reach out.
We need to form coalitions. When I had the Equity Task Force one week,
I would give my presentation. And if you've ever heard my presentations,
(26:42):
they're very unapologetic Afrocentric.
Okay. I don't believe and say, well, let me give this and include this group.
And the next time I'd ask the Hispanics, give your presentation.
Let us listen to your presentation. We'd have the Asians do the same.
We'd have the immigrant community do the same.
(27:02):
They loved it. They felt welcome. So you don't have to compromise your point of view.
You just have to understand that others may have a different point of view and
you learn from each other.
And then when you go to the power source or the powers that be and they see
this coalition, they actually sit back and say, this is actually working for
(27:24):
us. I don't have to deal with them individually.
They're all on the same page. and as a result, they rewarded all of us with
significant grants to focus on our communities.
So I think that's the lesson the National Medical Association and other Black
organizations can learn, that yes, we need to continue to struggle to improve
(27:45):
our own infrastructure,
but we need to form strong coalitions that find a way to work together.
And they have to be sustainable coalitions. Absolutely. They can't be coalitions
that develop for a specific purpose at a specific time.
Yeah. It may start out that way, but I think overall you need to have a broader thing.
(28:10):
It's kind of like one of the comments from the Hispanic group,
Asian group, I forget which, was, well, African Americans have done this and this. It's our turn.
That's a common theme within the Asian or Hispanics. Black is,
you know, everybody's talking about black. What about us?
(28:31):
I said, this isn't about taking turns because if it's about turns,
African-Americans haven't finished their turn.
Okay, so it's not about terms. And it's about not trying to split up the small piece of slice of pie.
There's a whole pie out there. And it's about equity. If we need 30% of that
(28:53):
pie and you need whatever percent, we're going to help you get it.
But don't take out 30% because you think it's your turn. We've had those conversations.
And that's what I mean by being honest. I don't run from difficult conversations.
And that builds up trust.
Yes, it does. And you had one point that was just one word, grants.
(29:19):
But that's important as well. And it would seem that through these type of coalitions,
funding sources are going to be much more plentiful. Yeah.
For everyone. Yeah, for everyone. Either the folks coming to the table,
they're not going to give a small poultry grant and then have all the groups fight over that.
(29:42):
We said, no, we're not going to do that.
Here's our need. We specified what our needs are.
Here's what it's going to cost. We need you to fund that for blacks,
et cetera, rather than just saying what has been done in the past is that the
powers that be would say,
here's $10 million for a $1 billion problem.
(30:08):
And you all fight over that. No, we said, no, we need $60 million. Okay.
And here's why and here's how come. So you got to be realistic.
And you may not get everything you asked for, but at least folks are recognizing,
well, they're not throwing us all into the same pot.
(30:29):
You need to have those conversations up front with the collaborators and coalition.
That's true. And I think it's important for our organizations,
and when I say our, I mean those that represent African Americans,
to realize that whatever you do takes resources.
And there are resources that are available, but the strategy of attaining and
(30:54):
retaining those resources is very important.
And it seems that those who are most successful are those that have worked in coalition.
And so let's just talk maybe for a minute about what's going to occur today.
We have a symposium that's entitled From Hopwood to Harvard,
(31:18):
which is rather symbolic, I think, for you coming from Boston,
ending up in California and spending your professional life.
And part of the reason that I wanted to talk a little bit about California and
the California situation,
because I think it speaks to perhaps action steps that are going to have to
(31:40):
take place following the Supreme Court decision that will be discussed in a
symposium sponsored jointly by the Cobb Institute and Movement is Life this afternoon.
Afternoon what's your take on the situation at this
point what have we learned and what do we need to learn
yeah interesting people see california as the liberal sebastian where anything
(32:05):
goes yet in 1996 we had proposition 209 that actually ended affirmative action
in california so we've been dealing with that for the past 25 30 years.
And let's be real, it was a significant impact.
Personally, I'm not sure I would have been in medical school if it wasn't for affirmative action.
(32:30):
I have no problems saying that.
But when affirmative action ended, I think at first the proposition was in 1996
and the first classes that it impacted was about 1999 or 1998.
There were some studies done that showed there was a significant decrease in
(32:51):
acceptance of Blacks and Latinos, about 40% that year.
And then they did further studies to find out that it actually affected the
whole wealth gap because those individuals that weren't accepted,
some of them went to lesser colleges.
This was just the public universities. Some of them went to lesser colleges,
(33:15):
and they calculated that they were making 5% or more less than they would have
had they been able to go to the universities that they wanted to go to.
So it affected their jobs.
It affected their financial outcomes.
But over the past 20, 25 years, they've been trying different things.
(33:38):
One of the things, I think it was 2020 or 2021, the University of California
eliminated the necessity for standardized tests.
That's critical. And people always say, well, aren't standardized tests equal?
No, they're not. it's like having a standard
(33:59):
basketball rim at 10 feet it may
be it's less equitable for somebody
who's five foot than somebody who's seven foot and and so i think that's begun
to make a impact i think some of the other things you mentioned resources i
am a lifelong member of the alumni at UC San Diego,
(34:23):
and I'm part of the Black Alumni Association.
Because of the anti-affirmative action, when you give money to the university,
the university cannot specifically give it to black students or ethnic students.
So what we did was formed a foundation specifically specifically developed by
(34:47):
the black alumni of UC San Diego,
and put it in a separate foundation outside of the university.
And as black students get admitted to UCSD, those that qualify certain standards,
they get funding for the whole four years that they're there through that funding.
(35:10):
So you need to develop. There are other strategies you can use,
But one is looking at the inequitable standards and I think eliminating the standardized tests.
Aren't equitable and coming up with resource strategies that are still able
to recognize that certain students are going to need more resources is what's necessary.
(35:35):
How does the Hispanic community feel about eliminating standardized tests?
Do they feel that's an issue? And are there any language barriers that are brought
up by the Hispanic community vis-a-vis admissions.
Yeah. So I feel uncomfortable answering that and saying this is how the Hispanic,
(35:59):
because I don't know how the quote Hispanic community feels.
Hispanic community is very diverse. Okay.
You've got a significant portion of the Hispanic community, although the Hispanic
consider themselves white.
And you've got another portion that don't. And then you got those that belong
(36:20):
who are African descent belong to the Hispanic community.
So I think depending upon who you talk to, you may get different responses.
But when we look at the Hispanic community as a whole, when affirmative action,
the anti-affirmative action took place in California, their numbers went down as well.
(36:42):
And so I must believe that they also agree, or the university wouldn't have
done it, eliminate the standardized test as a requirement that is going to benefit most Hispanics. Good.
After we conclude our convention and the deliberations, not only the Cobb Symposium
(37:06):
that we know will occur today,
but sort of the aggregate of the other plenary sessions and programs.
What should be the first step that the National Medical Association takes for the future?
I think they really need to internally reassess what our resources are and how to better focus,
(37:32):
refocus those resources to combat the struggle that we know is ahead.
Head, not only in our community with affirmative action, but how that is going
to affect the lack of black physicians, the lack of male physicians.
(37:52):
It's been shown that patient satisfaction goes up when they have a cohort of
physicians that they agree with.
There is some evidence to show that even outcomes are better.
So we're concerned that with this anti-affirmative action, we're already struggling
to increase the number of providers that look like us. That's going to make it even more difficult.
(38:14):
So I think we need to focus on how are we going to address that issue.
I think the other thing I mentioned is building a coalition.
I think we need to realize that we're not in this alone.
That there are others that look like us and others that don't look like us that
realize it would benefit them as well if they helped us develop strategies.
(38:40):
So I think it's developing coalition with other entities that would help us
overcome the difficulties that I see ahead.
Both within the community as well as outside of the community.
Absolutely. With perhaps a little more specificity and more strategy.
You can't have a healthy musculoskeletal system without a healthy cardiovascular
(39:04):
system. You can't have a healthy musculoskeletal system without a healthy neurological system.
And we in the National Medical Association or Cobb are not going to be successful
without finding coalitions and resources that help us overcome these obstacles.
(39:27):
So, I think refocusing our efforts, I think there's a lot of anti-affirmative action,
there's a lot of racist policies that are going against the anti-racist policies
that we were trying to implement, and we've got to find partners that are going to overcome that.
(39:48):
I think education is important.
Dr. Morgan, you and I have been in this battle a long time, and I've been giving
lectures on health inequities for a long time.
And most lectures, they want you to come up after you tell us what the problem
(40:09):
is, what is the solution.
Sure. And I usually, in the past few years, when I come to solutions,
I usually say, you don't really want to hear what I have to say about solutions
because the individuals sitting in the audience who are usually younger,
the younger physicians, the younger nurses, the younger administrators.
(40:32):
Those are the ones that need to come up with the solution.
I can give you my experience maybe that you can learn from.
So I think we need to focus on the youth, educating them about the struggle,
and asking them for their suggestions for the future.
(40:52):
We had a session here within NMA, the leadership forum, sponsored by the past president's council.
And I participated in one of them, and it was about membership.
I think I learned more from that session because there were youngsters there
that said, well, the way we communicate,
there's a network of black physicians that use this platform called Mocha that they communicate with.
(41:21):
I never heard of that.
So they think differently, they communicate differently, and many times they operate differently.
So we need to find a way to recruit more young physicians and providers into
this struggle and have them with us develop strategies that will be successful.
(41:46):
And so with that in mind, how can the Cobb Institute and its scholars program make a difference?
Well, I think they're right on. We need young researchers to get,
because that's what the Cobb is.
It's talking about mentoring and encouraging young people of color,
(42:09):
African Americans, into health equity research.
Research and and and as we
get these youngsters in there to make the transition from
not just doing research but how do you translate that research
into a solution to the community that's
being impacted we need to bridge the gap
between research and implementation in the
(42:32):
communities where they are and and and i think that's where the cob has a space
that's critical help helping to mentor these researchers that are going to move
into that space and understand that there's a history that's caused where we are.
Well, I certainly have enjoyed this discussion and sort of reminiscing and learning
(42:56):
a lot about your experiences and the why you do what you do and the how,
how it's been successful.
And also, I think that some of the topics we've talked about today are mutually
beneficial to the National Medical Association, the National Hispanic Medical
(43:20):
Association, for sure. and Movement is life.
And by all means, the Cobb. So I appreciate so much your time.
Always your friendship.
Thank you. And we could go on for a few more hours, but I think we kind of tie
a bow around this discussion and look forward to the next. Thank you so much.
(43:43):
Thank you, Dr. Morgan. I appreciate the invitation.
Music.
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