Dismantling Structural Barriers: Resident Clinics Refocused on Equity. Issue 5 (5th November 2022)

• Record Type: Journal Article
• Authors: McClurg, Asha Belle; Arora, Kavita Shah; Schiff, Lauren D.; Carey, Erin T.; Neal-Perry, Genevieve Scott
• Is Part Of: Obstetrics and gynecology. Volume 140:Issue 5(2022)
• Page Start: 739
• Page End: 742
• Publication Date: 2022-11-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/AOG.0000000000004920
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : The care of marginalized patients has been systematically concentrated within resident clinics, contributing to inequity and signaling value that is internalized by learners and patients. Abstract : Disparities in health by race, ethnicity, and socioeconomic status within obstetrics and gynecology are well described and prompt evaluation for structural barriers. Academic medicine has a historical role in caring for marginalized populations, with medical trainees often serving as first-line clinicians for outpatient care. The ubiquitous approach of concentrating care of marginalized patients within resident and trainee clinics raises ethical questions regarding equity and sends a clear message of value that is internalized by learners and patients. A path forward is elimination of the structural inequities caused by maintenance of clinics stratified by training level, thereby creating an integrated patient pool for trainees and attending physicians alike. In this model, demographic and insurance information is blinded and patient triage is guided by clinical acuity and patient preference alone. To address structural inequities in our health care delivery system, we implemented changes in our department. Our goals were to improve access and patient experience and to send a unified message to our patients, learners, and faculty—our clinical staff, across all training levels, are committed to giving the highest standard of care to all people, regardless of insurance status or ability to pay. Academic medical centers must look internally for structural barriers that contribute to health care disparities within obstetrics and gynecology as we aim to make progress toward equity.