>> GOOD AFTERNOON, EVERYONE.
THANK YOU FOR COMING.
I'M STEPHANIE GOFF, ONE OF THE
MEMBERS OF THE GREAT TEACHERS
COMMITTEE HERE AT THE CLINICAL
CENTER.
I'VE GOT SOME SORT OF
INTRODUCTORY REMARKS ABOUT THE
PROGRAM FIRST, AND THEN ABOUT
OUR INVITED SPEAKER, DR.
CAMPBELL.
WELCOME TO TODAY'S GROUND
ROUNDS, THE ACTIVITY CODE IS
57874, YOU CAN TEXT THIS TO THE
PHONE NUMBER ON THE SLIDE TO GET
CME CREDIT FOR THIS LECTURE.
WE INVITE YOU TO PROVIDE
FEEDBACK BY SCANNING THE QR
CODE.
FOR THOSE APPLYING YOU'LL
RECEIVE A LINK I HAVE E-MAIL, TO
PROVIDE FEEDBACK AND SUBMIT
SUGGESTIONS FOR FUTURE GRAND
ROUNDS TOPICS.
FOLLOWING THE PRESENTATION, WE
WILL TAKE QUESTIONS FROM THE
MICROPHONES IN THE AISLES BUT WE
WILL ALSO HAVE QUESTIONS
AVAILABLE DURING THE LECTURE IF
YOU'RE WATCHING ONLINE, THOSE
WILL FEED DIRECTLY TO ME AND
WE'LL ASK DR. CAMPBELL AS TIME
PERMITS AT THE CONCLUSION OF THE
PRESENTATION.
THE GRAND ROUNDS IS A SPECIAL
PROGRAM WITHIN OUR CLINICAL
CENTER GRAND ROUNDS PROGRAM, AS
CONCEIVED BY THE FIRST COMMITTEE
CHAIR OF THE GREAT TEACHERS
COMMITTEE, DR. PAUL PLOTS TO
INVITE LEADERS TO PRESENT ON
TOPICS AND IDEAS ABOUT WHICH
THEY ARE PASSIONATE, TO SHARE
REFLECTIONS AND INSPIRE YOUNG
INVESTIGATORS IN PURSUIT OF
CAREERS OF BIOMEDICAL RESEARCH.
SPEAKER IS ANDRE CAMPBELL, WHOM
I KNOW FROM OUR SHARED HISTORY
AT COLUMBIA, A PROFESSOR AT
UNIVERSITY OF CALIFORNIA, SAN
FRANCISCO, BACHELOR OF ARTS
DEGREE IN BIOLOGY FROM HARRD
HARVARD,
MEDICAL DEGREE FROM UNIVERSITY
OF CALIFORNIA, SAN FRANCISCO,
GENERAL SURGERY AT COLUMBIA
UNIVERSITY MEDICAL CENTER, PART
OF THE UCSF FACULTY BASED AT THE
SAN FRANCISCO GENERAL HOSPITAL
FOR 30 YEARS, AN ADJUNCT
PROFESSOR OF SURGERY AT USU
ACROSS THE STREET, SERVICING
WALTER REED.
DR. CAMPBELL IS ONE OF THE MOST
DECORATED SURGICAL EDUCATORS AT
UCSF, RESEARCH INCLUDES ICU CARE
OF TRAUMA PATIENTS, ACUTE LUNG
INJURY AFTER TRAUMA, ABDOMINAL
COME
COMPARTMENT SYNDROME, HE
DIRECTED SURGICAL CRITICAL CARE
FELLOWSHIP AT UCSF FOR 24 YEARS,
TRAINED MANY FELLOWS WHO
PRACTICE TOM, SURGICAL CRITICAL
CARE, ACUTE CARE SURGERY AROUND
THE WORLD.
HIS EDUCATIONAL ACCOMPLISHMENTS
HAVE BEEN CELEBRATED LOCALLY AND
NATIONALLY.
HE WAS RECOGNIZED AS A FOUNDING
MEMBER OF THE HAILEY DEBOSS
ACADEMY OF MEDICAL EDUCATORS,
ENDOWED CHAIR OF SURGICAL
EDUCATION AT UCSF, AWARDED SAN
FRANCISCO GENERAL HOSPITAL HEART
AND HEROES AWARD FOR
CONTRIBUTIONS TO THE HOSPITAL,
AND THE CITY AND COUNTY OF SAN
FRANCISCO.
HE WAS RECIPIENT OF THE
ZUCKERBERG SAN FRANCISCO GENERAL
HOSPITAL EQUITY AWARD, DR. ANDRE
CAMPBELL AWARD NAMED IN HIS HIS
FOR THE PRINCIPLES OF EQUITY AT
THE HOSPITAL.
MEMBER OF THE MERGE COLLEGE OF
SURGEONS COMMITTEE ON TRAUMA FOR
15 YEARS, CENTRAL COMMITTEE FOR
FIVE, AMERICAN COLLEGE OF
SURGEONS BOARD OF GOVERNORS,
SECRETARY OF THE BOARD OF
GOVERNORS ON THE EXECUTIVE
COMMITTEE.
CURRENTLY PRESIDENT OF THE
NORTHERN CALIFORNIA CHAPTER OF
AMERICAN COLLEGE OF SURGEONS,
ALSO PRESIDENT OF THE UCSF GOLD
HEADED CANE SOCIETY, MEMBER OF
THE AMERICAN COLLEGE OF SURGEONS
ACADEMY OF MASTER SURGICAL
EDUCATORS.
RECENTLY WAS AWARDED HONORARY
FELLOWSHIP IN BRAZILIAN COLLEGE
OF SURGEONS, RECOGNIZED BY THE
GOVERNOR OF CALIFORNIA,
CALIFORNIA STATE LEGISLATURE,
STATE CONTROLLER, MAYOR OF SAN
FRANCISCO WHO PROCLAIMED THAT
NOVEMBER 2, 2023, WAS DR. ANDRE
CAMPBELL DAY IN SAN FRANCISCO,
IN ADDITION HE HAS WRITTEN OVER
100 MANUSCRIPTS, ABSTRACTS,
BOOKS CHAPTER.
THE TITLE TODAY IS "DISPARITIES
IN TRAUMA CARE" AND I'M THRILLED
TO PRESENT OUR SPEAKER TODAY DR.
ANDRE CAMPBELL.
[APPLAUSE]
>> IT'S GREAT TO BE HERE THIS
MORNING, THANK YOU SO MUCH.
I REALLY APPRECIATE THAT
GENEROUS INTRODUCTION, DR. GOFF.
THAT'S ABSOLUTELY AMAZING.
SO, I'VE NEVER THOUGHT I WOULD
BE IN THE HALLOWED HALLS OF NIH
DURING MY CAREER, IT'S A
TREMENDOUS HONOR TO BE HERE AND
TO BE TALKING TO YOU ABOUT
SOMETHING NEAR AND DEAR TO MY
HEART, TRAUMA CARE AND
DISPARITIES IN TRAUMA CARE.
I'LL GO THROUGH A TOUR OF WHAT
I'M GOING TO TALK ABOUT IN A BIT
BUT IT'S AN HONOR.
THANK YOU FOR INVITING.
NO DISCLOSURES, YOU'VE HAD A LOT
OF GREAT TEACHERS, I'LL SAY A
COUPLE THINGS.
ONE IS MY CURRENT CHAIR OF
SURGERY, SO WHEN I GO BACK, YOU
DID IT, I DID IT, I COULD HAVE
AN EYEBALL TO EYEBALL WITH HER
ABOUT THAT, AND DR. BERTAGNOLLI
HAS BEEN ONE OF THE GREAT NIH
TEACHERS OVER A NUMBER OF YEARS.
I THANK DR. GOFF, I GOT TO KNOW
HER, SHE AND I TRAINED AT
COLUMBIA UNIVERSITY MEDICAL
CENTER IN NEW YORK, ALSO KNOWN
AS COLUMBIA PRESBYTERIAN IN THE
PAST, WE GOT TO KNOW EACH OTHER
THROUGH THE SURGICAL SOCIETY, A
GROUP OF SURGEONS WHO HAD
COMPLETED THEIR TRAINING AT
COLUMBIA OVER THE YEARS, SHE
FINISHED IN A DIFFERENT ERA THAN
I DID, BUT WE'RE ALL BOUND TO
TREMENDOUS EXPERIENCE WE HAD
TAKING CARE OF PEOPLE IN
MANHATTAN DURING THOSE MANY
FORMATIVE YEARS, SO IT'S REALLY
AN HONOR.
AGAIN, THANK YOU SO MUCH FOR
INVITING ME HERE TO SPEAK TODAY.
I'M GOING TO GO THROUGH A LITTLE
BIT.
I WORK AT SAN FRANCISCO GENERAL,
DOESN'T LOOK LIKE THAT ANYMORE,
SOME BUILDINGS ARE STILL UP,
I'LL SHOW YOU PICTURES.
SAN FRANCISCO GENERAL HAS BEEN
AFFILIATED WITH UNIVERSITY OF
CALIFORNIA, SAN FRANCISCO FOR
150 YEARS.
I'M ON THE FACULTY BUT BASED AT
SAN FRANCISCO GENERAL HOSPITAL.
IT'S AN IMPORTANT PART OF THE
PUBLIC HEALTH MISSION OF CITY
AND COUNTY OF SAN FRANCISCO, WE
CARE FOR 100,000 PATIENTS, WHICH
IS ABOUT 1/8 THE SIZE OF SAN
FRANCISCO, NUMBER OF SAN
FRANCISCO IS 800,000, WE HAVE
100,000 PEOPLE WHO ARE CARED AT
AT OUR CLINICS AND MAIN
HOSPITAL.
THIS IS THE 1940s, THE MAIN
STREET THERE, THE BUILDINGS IN
THE FRONT IS THE OLD HOSPITAL,
BACK IS TUBERCULOSIS, AND THEN A
NURSING FACILITY, IN THE 1940s
AND '50s.
HOSPITAL CURB DOESN'T EXIST
BECAUSE 101 WAS NOT BUILT AT
THAT TIME THERE.
THIS IS WHAT WE LOOK LIKE NOW.
THIS IS ABOUT 20 YEARS AGO
BEFORE WE BUILT THE NEW
BUILDING.
THE GRAY BUILDING IS THE NEW OLD
HOSPITAL, AND THAT'S THE OLD,
OLD HOSPITAL THAT DATES AFTER
THE FIRE IN SAN FRANCISCO, EARLY
1900s, THAT'S WHAT IT LOOKED
LIKE.
201 WE OPENED UP THE
STATE-OF-THE-ART HOSPITAL, YOU
MAY REMEMBER THAT CALIFORNIA HAS
ABOUT 500 EARTHQUAKES A YEAR SO
WHAT HAPPENS AFTER THE GREAT
EARTHQUAKE IN SOUTHERN
CALIFORNIA, NORTH RIDGE, THEY
HAD TO REDESIGN MAJOR HOSPITALS
IN CALIFORNIA, OUR HOSPITAL WAS
BUILT ON 115 BALL BEARINGS, A
BUILDING INSIDE A BUILDING, CAN
MOVE THREE FEET IN ANY
DIRECTION, ENOUGH RESOURCES TO
KEEP FOR THREE DAYS, IT'S A
PRETTY AMAZING FACILITY.
IT LOOKS GREAT, LIKE A
SPACESHIP, LOOKS WONDERFUL, BUT
THE PROBLEM IS THAT ALL THAT
SPACE, WE LOST THAT SPACE, WE
WON ARCHITECTURAL AWARDS, BUT
THERE'S NOT A LOT OF SPACE FOR
PATIENTS.
I KNOW WE HAVE THE CEO HERE
TODAY SO HE'S ALL ABOUT
PATIENTS, WE HAVE GREAT AWARDS
BUT DON'T HAVE SPACE FOR PEOPLE
OR US THERE.
THIS IS NOW WITH WITH THE
EXCEPTION OF THE RESEARCH
BUILDING BECAUSE OF THE RULES,
THEY HAD TO BUILD AGAIN, ALL
RESEARCHERS ARE THERE.
YOU MAY NOTICE UCSF IS THE
NUMBER ONE -- RECEIVED THE
LARGEST AMOUNT OF MONEY FROM NIH
OTHER THAN ANY OTHER PUBLIC
INSTITUTION IN THE UNITED
STATES, WE'RE NUMBER 2 BEHIND
HARVARD IN TERMS OF MONEY FROM
NIH, FORTUNATE TO HAVE A LOT OF
GREAT RESEARCHERS AT OUR PLACE
THERE.
THAT'S WHAT PRIDE HALL LOOKS
LIKE, I'M GOING TO TALK A LOT
ABOUT AT FIRST COVID AND HOW THE
DISPARITIES OF COVID AFFECTED
POPULATION IN THE UNITED STATES,
AROUND THE WORLD.
I'M GOING TO THEN TALK ABOUT
OUTCOMES IN TRAUMA CARE, AND
TALK A BIT ABOUT DIVERSITY IN
MEDICINE, ALSO PATHWAY ISSUES IN
MEDICINE, PIPELINE ISSUES IN
MEDICINE, THAT'S WHAT I'M GOING
TO TALK ABOUT TODAY.
THESE ARE TOPICS NEAR AND DEAR
TO MY HEART, THEY HAVE HAD
TREMENDOUS IMPACT ON MY PATIENTS
AS I CARE FOR THEM IN THE CITY
AND COUNTY OF SAN FRANCISCO.
WHAT COVID TAUGHT US, I THINK
THAT WE SORT OF HAVE TO REVISIT
THIS EVERY TIME THERE'S A MAJOR
EPIDEMIC OR PANDEMIC OR, YOU
KNOW, TRAUMA, WHICH IS NOW
DECLARED, THANK GOD, BY THE
SURGEON GENERAL AS A PUBLIC
HEALTH EMERGENCY THAT THERE'S
CERTAINLY DISPARITIES THAT EXIST
IN TERMS OF OUTCOMES.
SO, FIRST WHAT WE NOTICE IS THAT
A LARGE PART OF THE PATIENTS
BEING AFFECTED BY COVID WERE
PEOPLE OF COLOR, IN TERMS OF
PEOPLE DYING BOTH IN NEW YORK
AND OTHER PLACES, AT THE
BEGINNING OF THE PANDEMIC THERE.
THERE WAS A LOT OF -- WE DIDN'T
HAVE A LOT OF DATA AT FIRST BUT
THEN THE DATA STARTED COMING IN.
THEN WHAT HAPPENED WAS THE
AWAKENING AROUND THE GEORGE
FLOYD MURDER, WHAT HAPPENED AT
THE BEGINNING OF THE PANDEMIC,
AND WHAT HAPPENED WITH THAT.
YOU KNOW, STUDENTS IN MANY CASE
LED THE WAY WITH WHITE COATS FOR
BLACK LIVES, AND A LOT OF
PHYSICIANS STOOD UP FOR
SOMETHING THAT WAS REALLY
IMPORTANT TO MAKE SURE WE KNEW
THAT EVERYBODY WAS GETTING CARED
FOR THE SAME WAY.
SO INITIALLY DIDN'T HAVE ANY
DATA ABOUT COVID BUT BEGAN TO
COME IN, AS WE SAW THERE WAS A
HUGE DISPARITY IN AMOUNT OF
PEOPLE GETTING AFFECTED AND
AMOUNT OF PEOPLE WHO WERE NATIVE
AMERICAN, LATINX, AND AFRICAN
AMERICAN WHO WERE GETTING COVID
AND IN FACT DYING.
THIS WAS DATA COUPLE YEARS OLD,
1 IN 900 BLACK AMERICANS DIED
FROM COVID, THAT NUMBER HOVERS
AROUND WHAT IT IS STILL TODAY,
TWICE THE AVERAGE IN WHITE
NATION POPULATIONS.
MY INTRODUCTION TO THE COVID
PANDEMIC IS ONE OF MY FRIENDS
CALLED ME, A SURGEON NOW
RETIRED, HIS WIFE WAS A NURSE.
THIS HAPPENED JUST AFTER MARDI
GRAS, HAD GONE TO A PARTY FOR --
IT WAS A PARTY FOR THE BIRTH OF
A CHILD, AND SHE CAME BACK AND
THERE WAS FOUR PEOPLE GOT SICK,
SHE WAS THE ONE WHO WENT TO THE
HOSPITAL AND DIED IN THE
HOSPITAL WHEN HER HUSBAND WAS
TRYING TO GET TO HER, FROM
COVID.
SHE JUST DIED BEFORE THEY COULD
FIGURE OUT WHAT TO DO WITH HER,
WHICH THAT HAPPENED IN
LOUISIANA, RIGHT AFTER THE MARDI
GRAS, IN 2020.
SHE THIS IS SOME DATA HERE, A
BIG EFFECT ON CHILDREN.
AND A LOT OF THE CONFIRMED CASES
WERE CHILDREN, SO TREMENDOUS
IMPACT ON UNDERREPRESENTED
POPULATION, THAT'S HOW I GOT
INVOLVED AS PART OF ADVOCATING
FOR MAKING SURE PEOPLE KNEW THIS
WAS SOMETHING THAT WAS A BIG
PROBLEM AND IN COMMUNITIES OF
COLOR, BUT AS WE FOUND OUT THAT
IT WAS DISPROPORTIONATELY
AFFECTING PEOPLE OF COLORS IN
MEDICINE, WHEN IT CAME TO
VACCINE RECIPIENTS, THE VACCINE
WAS NOT BEING DISTRIBUTED IN
EQUITABLE FASHION IN THE UNITED
STATES WHICH WAS SOMETHING THAT
TOOK A WHILE TO REMEDY THAT
SITUATION.
WE KNOW COVID IS A SYSTEMIC
DISEASE, THROMBOSIS AFFECTS
HEART, LUNGS, KIDNEY, GI TRACT.
MY FRIENDS WROTE ARTICLES, THIS
IS ONE ABOUT THE VASCULITIS THAT
GOES WITH IT.
SOMETHING THAT WAS QUITE
IMPORTANT AS WE BEGAN TO
UNDERSTAND WHAT WAS GOING ON.
YOU PROBABLY REMEMBER EVERYBODY
WAS ASKED TO LEAVE THE HOSPITAL
EXCEPT FOR MORE SENIOR PEOPLE
WHICH I DIDN'T QUITE UNDERSTAND
THAT BECAUSE WE WERE MOST
VULNERABLE, BUT DID WHAT WE HAD
TO DO TO TAKE CARE OF FOLKS WITH
THAT.
AND WE SAW THERE WAS TREMENDOUS
DISPARITY.
THIS CAME OUT A COUPLE YEARS
AGO, STILL DISPROPORTIONATELY
AFFECTING PATIENTS OF COLOR.
YOU REMEMBER ALL THE
REFRIGERATION TRUCKS OUTSIDE
BUILDINGS, DIFFERENT HOSPITALS,
HOW TERRIBLE THAT WAS.
WE DIDN'T LEARN A LOT FROM OUR
FIRST PANDEMIC, INFLUENZA NOW
100 YEARS AGO, THERE ARE
MULTIPLE DIPS, PRIMARY, DELTA,
OMICRON WAVE.
I WENT TO A REUNION LAST WEEK, A
FRIEND SAID, I HAVE COVID.
I SAID, OKAY.
I SAID, WELL, YOU KNOW, IT WAS
ONLY THE SECOND TIME.
I HAD IT FOUR TIMES EVEN THOUGH
I WEAR MASKS AND PROTECTION, SIX
VACCINES, I STILL HAVE IT, SO
THINGS WE'RE STILL LEARNING
ABOUT THAT.
A NUMBER OF PEOPLE HAVE LONG
COVID, PROBLEMS WITH IT.
SO WE'RE STILL TRYING TO
UNDERSTAND ITS IMPACT.
WE DIDN'T LEARN A LOT OF LESSONS
I THINK FROM 100 YEARS AGO BUT
HAVE THE TECHNOLOGIES BETTER,
THE VACCINE, THE VACCINE DENIERS
AND EVERYTHING ELSE, AS PEOPLE
APPRECIATE SCIENCE WE NEED TO
MAKE SURE WE SPREAD THE WORD
THIS IS SO IMPORTANT THAT PEOPLE
GET VACCINATED WHEN THEY CAN AND
AS SOON AS I GET BACK I'LL GET
MY VACCINE, MY 7th VACCINE
FOR COVID AND I'LL GIVE AS MANY
AS THEY GIVE OUT WITH MY FLU
SHOT WHICH I ALWAYS GET.
THIS CAME OUT WITH RACIAL
DISPARITIES, PROBLEMS IN THE
UNITED STATES, AND ALL OVER THE
WORLD.
THIS IS INDIA, BRAZIL, MASSIVE
AMOUNT OF DEATH ASSOCIATED WITH
THAT, A SCARY TIME FOR ALL OF
US.
THOSE WHO CAME IN, PRACTICING
MEDICINE IN COVID, ISOLATED.
MEDICAL STUDENTS BASICALLY
COULDN'T COME TO SCHOOL WITH
THAT.
I THINK IT TAKES THE LESSON, I'M
GOING TO TRANSITION FROM LESSONS
WE LEARNED FROM COVID TO SOME OF
THE THINGS I'VE LEARNED FROM
ADVOCACY.
WE'LL TALK ABOUT ADVOCACY A BIT,
SURGICAL PRACTICE.
THIS IS SOMETHING, BECAUSE OF MY
PRACTICE OF SURGERY, I'M A
TRAUMA SURGEON, THAT MEANS I
TAKE CARE OF PEOPLE INJURED ALL
THE TIME.
I BASICALLY TRAINED DURING THE
1990s, AND THE AMOUNT OF
MURDERS AND KILLINGS IN NEW YORK
WHERE I TRAINED WAS QUITE HIGH.
WE HAD OVER 2,000 MURDERS IN NEW
YORK THE LAST YEAR I WAS THERE,
AND I WENT TO SAN FRANCISCO AND
THE MURDER RATE WAS THERE QUITE
HIGH.
A IRED THAT OF THE -- A THIRD OF
PEOPLE I TOOK CARE OF WERE
VICTIMS OF VIOLENCE.
I WANT TO SHARE WITH YOU AN
EXPERIENCE RELATED TO A MASS
SHOOTING THAT HAPPENED.
THIS WAS THE YouTube
SHOOTING, PART BECAUSE OF THE
RESPONSE TO WHAT HAPPENED
BECAUSE I WENT VIRAL WHEN THIS
HAPPENED WITH THAT.
THIS IS A PICTURE OF THE YOUNG
WOMAN, HAD BEEN MAKING MONEY ON
YouTube, BASICALLY THEN SHE
GOT UPSET BECAUSE THEY CUT HER
INCOME STREAM, SHE WENT TO THE
HEADQUARTERS AND STARTED
SHOOTING PEOPLE INCLUDING
HERSELF.
I WAS DOING ELECTIVE SURGERY
THAT DAY, THERE WAS A MASS
CASUALTY.
WE HAVE NOTES SAYING MASS
CASUALTY COMING IN, EVERYBODY
RUNS DOWN.
OF COURSE I TRIED TO CALL MY
PARTNER, AND MY PARTNER IS NOT
AVAILABLE BECAUSE HE'S AT THE
MASS CASUALTY.
SO THEN I WENT DOWN THERE.
WE HAD MULTIPLE VICTIMS.
CHEST INJURIES, SOME INJURED NOT
SO BAD, READY TO DO LIKE WE
ALWAYS ARE WITH THAT.
SHOOTER WAS DEAD AT THE SCENE.
MEDIA PRESENT IN LARGE NUMBERS.
IT STRUCK ME HOW THERE WERE SO
MANY MEDIA PEOPLE THERE, JUST
ALL OF THEM, HUNDREDS OF THEM
ALL OVER THE PLACE.
THERE WAS MEDIA TRUCKS AND
EVERYTHING ELSE.
WE JUST HAD A MASS SHOOTING THE
WEEK BEFORE THAT HAPPENED AT A
BARBERSHOP, SIX VICTIMS.
AFTER THAT I DIDN'T SEE ANYBODY
THERE.
SO THEY ASKED ME TO SPEAK TO THE
MEDIA, AND AS I WALKED OUT OF
THE DRIVEWAY, THEY SAID YOU
CAN'T SAY THIS, YOU CAN'T SAY
THAT, YOU CAN'T SAY THIS, SORT
OF SAID, OKAY, CARRIED LIVE ON
CNN, MSNBC, BBC, OF COURSE THEY
SAID FOX NEWS, I SAID I DIDN'T
WANT TO BE CARRIED ON FOX NEWS.
I DIDN'T MIND ANYTHING ELSE BUT
DIDN'T WANT TO BE CARRIED ON
THAT.
I'M GOING TO SHOW YOU THE VIDEO
NOW AND WE CAN TALK ABOUT THE
IMPACT AS THAT HAD -- LET'S SEE
DO YOU WANT TO HIT IT FOR ME?
>> THIS IS A TERRIBLE DAY IN THE
UNITED STATES, ONCE AGAIN WE
HAVE A MULTIPLE CASUALTY
SITUATION THAT'S CONFRONTED US
HERE AT THE ZUCKERBERG SAN
FRANCISCO GENERAL HOSPITAL.
WHEN SOMETHING LIKE THIS
HAPPENS, THEN YOU GUYS COME OUT.
REALITY IS WE HAVE TO DEAL WITH
THIS ALL THE TIME, WITH THE
FAMILIES, THE INJURIES, WE HAVE
TO DEAL WITH THIS CONSTANTLY.
GUN VIOLENCE HAPPENS EVERY DAY
IN THE UNITED STATES, SAN
FRANCISCO, BAY AREA, HAPPENS ALL
OVER THE COUNTRY.
I DON'T SEE YOU GUYS OUT HERE
BECAUSE I'D LIKE TO MAKE SURE
PEOPLE KNOW THAT WE GOT A
SERIOUS PROBLEM THAT WE NEED TO
ADDRESS.
I DON'T HAVE ALL THE ANSWERS BUT
I CAN SAY AT LEAST WE'RE HAVING
A DISCUSSION ABOUT IT NATIONALLY
WHICH IS A GOOD THING BUT THIS
IS A REAL PROBLEM.
>> I DON'T THINK I SAID ANYTHING
CONTROVERSIAL THERE, RIGHT?
I THOUGHT WHAT I SAID WAS LEVEL
HEADED.
OF COURSE I GOT HATE MAIL, DEATH
THREATS, PEOPLE SCREAMING SAYING
I WANT TO TAKE THEIR GUNS AWAY.
I DIDN'T SAY ANY OF THAT.
I SAID WE HAVE A PROBLEM AND WE
NEED TO THINK ABOUT IT, RIGHT?
IN A MATURE FASHION.
I WAS DESCRIBED AT WEARY, ILL
ITEM PEFERRED, -- ILL TEMPEREDG
ON INTENSE MEDIA PRESENCE THAT I
DON'T SEE EVERY DAY.
EVERY DAY WHEN PEOPLE ARE
INJURED, I DIDN'T REALLY SEE
THAT, AND THAT STRUCK ME ABOUT
THAT.
OTHER PICTURES WERE LIKE, 30 OR
40 PEOPLE SURROUNDING ME ASKING
ME QUESTIONS.
THAT'S SOMETHING THAT REALLY
STRUCK ME.
I DIDN'T SAY ANYTHING
CONTROVERSIAL.
BUT THEN THEY DID.
NOW, I HAVE A LOT OF EXPERIENCE
TALKING TO THE MEDIA, I'VE BEEN
DOING IT A LONG TIME.
IN THE LAST FEW YEARS I'VE BEEN
ON NATIONAL MEDIA LIKE, YOU
KNOW, ABOUT 90 TIMES OR SO.
I ALSO GOT INVITED TO THE WHITE
HOUSE DURING THE SAFER
COMMUNITIES ACT SIGNING BECAUSE
OF SOME OF THE WORK I'VE DONE
WITH THAT.
I HAVE A LOT OF EXPERIENCE
DEALING WITH THESE THINGS.
THIS WAS SOMETHING THAT
SURPRISED ME, HOW DIFFICULT THEY
WERE IN TERMS OF THE WAY THEY
ADDRESSED WHAT I SAID.
AND THIS IS ME VENTING MY
SPLEEN, BUT THERE WAS A LOT OF
RACIAL OVERTONES BECAUSE I'M
OUTSPOKEN AFRICAN AMERICAN MAN,
AND I WAS BASICALLY SAYING WHAT
THE TRUTH WAS BECAUSE PEOPLE
DIDN'T WANT TO HEAR WHAT I HAD
TO SAY.
FOR ME IT WAS A MOMENT WHERE I
STEPPED UP AND SAID I HAD TO SAY
SOMETHING, AND THIS IS WHAT I
SAID, THE RESULT I CREATED
SOMETHING THAT WENT VIRAL SO I
HAD HUNDREDS OF THOUSANDS OF
VIEWERS ALL OVER THE WORLD, MY
FRIENDS ALL CALLING ME BASICALLY
SAYING GREAT JOB, THEN GETTING
NASTY E-MAILS AND LETTERS AND
CALLS, YOU'RE TALKING ABOUT
THINGS YOU SHOULDN'T BE TALKING
ABOUT, GO BACK TO THE OPERATING
ROOM, THAT'S JUST THE LEAST OF
SOME THINGS I HAD.
THIS IS SOME OF THE MEDIA THAT
WENT ALONG WITH THE FIRESTORM
THAT HAPPENED WITH THAT.
I DO THAT TO SAY NO MATTER WHERE
YOU'RE DOING IF YOU GET A CHANCE
TO SPEAK UP TO DO SOMETHING
SOMETHING NEAR AND DEAR TO YOUR
HEART, FINALLY WE'RE BEGINNING
TO 9/11 MAKE SOME CHANGES IN
TERMS OF TRAUMA.
I'LL TALK LATER ABOUT
DISPARITIES AND OUTCOME IN
TRAUMA, SOME THINGS YOU CAN DO
ABOUT IT.
THIS IS SOMETHING THAT HAS BEEN
OUT FOR A LONG TIME, JUST SAID
ABOUT ISSUES, DISPARITIES ACROSS
ALL CLINICAL SETTINGS, CANCER,
TRAUMA, WHATEVER AREA IT IS, IN
TERMS OF, YOU KNOW, ISSUES
RELATED TO ASTHMA AND CHILDREN
AND SO FORTH.
SO MANY AREAS THAT THERE'S BEEN
UNEQUAL TREATMENT, IT'S
ASSOCIATED WITH HIGHER
MORTALITY.
SO THAT'S BEEN AROUND FOR OVER
20 YEARS THAT WE'VE BEEN TALKING
ABOUT THAT.
I SUGGEST RECOMMENDATIONS, THIS
WAS A PROCESS, LOOKING AT
STRUCTURAL VARIABLES, OUTCOME
VARIABLES, STRUCTURED WAY OF
DOING THINGS.
SO PART INVOLVES PATIENT
EDUCATION, INTEGRATING
CROSS-CULTURE EDUCATION,
INCREASING PROPORTION OF
UNDERREPRESENTED PHYSICIANS AND
ETHNIC MINORITIES IN THE HEALTH
POPULATION, THINGS THAT WE CAN
DO, ORGANIZED FASHION, THIS CAME
OUT ABOUT 20 YEARS AGO IN THE
LITERATURE.
WHY DOES DIVERSITY MATTER FOR
HEALTH?
I ALLUDED EARLIER TO THIS,
PHYSICIANS OF COLOR CAN HAVE
MAJOR IMPACT ON PATIENTS OF
COLOR, BLACK DOCTORS MORE LIKELY
TO WRITE ADDITIONAL NOTES ABOUT
THEIR SUBJECTS, OUTCOMES IN
CARDIOVASCULAR DISEASE REDUCE
REDUCTION AND GAP IN DEATH FROM
CARDIOVASCULAR DISEASE.
CHOLESTEROL SCREENINGS GO UP,
FLU SHOTS MORE LIKELY, SO IT
DOES MATTER.
THIS IS EVIDENCE THAT CAME OUT
OF A PAPER PUBLISHED A COUPLE
YEARS AGO SO DIFFERENCE,
DIVERSITY DOES MATTER WITH THAT.
DISPARITIES, SHORTER LIFE
EXPECTANCIES, THERE'S INCREASED
HIGHER INCIDENTS OF CANCER,
BIRTH DEFECTS, CARDIOVASCULAR
DISEASE, ASTHMA, DIABETES,
STROKE, SEXUALLY TRANSMITTED
DISEASE AND MENTAL ILLNESS,
SOMETHING WE KNOW, SOMETHING WE
WILL TALK LATER ON ABOUT THAT.
ISSUES RELATED TO LOW INCOME,
POOR EDUCATION, SOME BIOLOGICAL
DIFFERENCES, CULTURAL ISSUES,
QUALITY CARE, RACIAL
DISCRIMINATION, WHICH ARE ALL
THINGS.
IN ORDER TO BEGIN TO APPROACH
THIS THERE HAS TO BE A
MULTI-FACETED APPROACH.
I'LL TALK ABOUT STRUCTURAL
RACISM IN A LITTLE BIT.
THINGS LIKE IMPROVING ACCESS,
THAT DOES WORK.
THINGS LIKE INCREASING PUBLIC
HEALTH FUNDING, DIVERSIFYING THE
WORKFORCE IS ANOTHER APPROACH.
MORE TARGETED RESEARCH SO WE CAN
UNDERSTAND WHY IS THERE A
DIFFERENCE IN THE OUTCOMES, YOU
KNOW, WE THINK WE TREAT
EVERYBODY THE SAME WAY, AND WE
DO WHEN THEY HIT THE DOOR BUT
WHY IS THERE A DIFFERENCE IN
TERMS OF OUTCOMES WITH THAT
RELATED TO PREEXISTING
CONDITIONS, WHAT IS IT RELATED
TO, MAKING SURE WE'RE TREAT
PEOPLE IN A CULTURALLY COMPETENT
FASHION.
MAKE SURE YOU'RE ABLE TO
COMMUNICATE WHEN YOU GO IN, IN A
LANGUAGE THAT YOU HAVE.
SAN FRANCISCO GENERAL WE SPEAK
30 OR 40 LANGUAGES EVERY DAY,
MAKING SURE WE HAVE ADEQUATE
TRANSLATION TO MAKE SURE
PATIENTS UNDERSTAND SO THEY CAN
BASICALLY GET BETTER CARE.
THIS IS A PAPER THAT CAME OUT
LOOKING AT OUTCOMES AND TRAUMA
CENTERS DESIGNATED, RIGHT, IN
TERMS OF PATIENTS WITH BRAIN
INJURY AND FOUND LATINX AND
BLACK PATIENTS LESS LIKELY TO BE
DISCHARGED TO REHAB, RELATIVE TO
WHITE PATIENTS, FUNCTIONAL
DIFFERENCE IN ASIAN PATIENTS,
LIKELY TO GO TO REHAB, PROPERLY
INSURED, DIFFERENCE IN OUTCOMES
THE WAY PEOPLE ARE DISCHARGED,
WE HAVE TO KEEP WORKING ON
TRYING TO MAKE SURE THAT WE MAKE
STRIDES FORWARD IN TERMS OF
CARING FOR PATIENTS WHO HAVE
BEEN INJURED OR WHO HAVE SOME
OTHER DISEASE PROCESS.
THESE ARE SOME OTHER AREAS OF
THINGS, TALKING ABOUT BREAST
CANCER, I THINK YOU KNOW THIS
AREA, I JUST HEARD A GREAT TALK
BY LISA NEWMAN, WHO IS A SURGEON
WHO LOOKED AT LINKED BETWEEN
GENES IN WEST AFRICAN PATIENTS
WITH TRIPLE-NEGATIVE BREAST
CANCER AND BREAST CANCER IN THE
UNITED STATES, AND OUTCOMES
RELATED TO THAT.
SHE'S BEEN SPENDING 20 YEARS
WORKING ON THAT, RESEARCH
RELATED TO THAT, DIFFERENCES IN
PANCREATIC CANCER OUTCOMES FOR
PATIENTS, DIVERSE PATIENTS TOO.
AND WE BASICALLY CONTRIBUTED
SOME OF THIS.
THIS IS A THING WE DID A COUPLE
YEARS AGO LOOKING AT OUTCOMES,
SOCIAL DETERMINANTS OF HEALTH,
WHERE YOU LIVE, WHERE YOU GREW
UP, WHETHER OR NOT YOU'RE
EMPLOYED, ARE YOU IN A FOOD
DESERT, EVEN RECOGNIZING NOW
THAT EVEN WITHIN A CITY, YOU
KNOW, LIKE WASHINGTON, IF YOU
LIVE IN AN AREA HEAVILY
UNDERREPRESENTED PATIENTS, THAT
TRANSIT TIMES TO THE HOSPITAL
ARE LONGER THAN OTHER PLACES,
WITH THAT, MAYBE IT'S ALSO THEY
ARE WORKING ON TRYING TO FIGURE
OUT WHETHER OR NOT IT'S RELATED
TO OUTCOMES TOO WITH THAT.
NOW, WE'VE BEEN TALKING ABOUT
FIREARM VIOLENCE BEING DECLARED
A PUBLIC HEALTH EMERGENCY FOR
MANY YEARS, ME AND MANY OTHERS,
THE SURGEON GENERAL CAME OUT
WITH A REPORT WITH THAT.
I WAS FORTUNATE TO BE INVITED TO
WHITE COATS AT THE WHITE HOUSE A
FEW WEEKS AGO, WHERE WE TALKED
ABOUT -- A FEW MONTHS AGO NOW,
WHERE WE TALKED ABOUT THAT, I
GOT A CHANCE TO TALK TO HIM
ABOUT THAT.
I DIDN'T REALIZE HE WAS WORKING
ON THIS BUT IT CAME OUT JUST A
FEW MONTHS AFTER THAT, A MONTH
OR TWO AFTER WE DID THAT.
ALSO REGIONAL FACTORS, GUN
OWNERSHIP, LARGE IMPACT, AFRICAN
AMERICAN POPULATION.
THIS IS SOMETHING THAT'S
REALLY -- THAT WE'LL HAVE TO
COME TO GRIPS WITH THIS ISSUE.
THERE'S A LOT OF STUFF GOING ON,
LOCAL LEVEL, BECAUSE OF THE
BRADY GROUP AND THE OTHER GROUPS
THAT ARE GOING ON, GABY
GIFFORDS' GROUP AND OTHERS
TRYING TO CHANGE THE LAWS
LOCALLY, WE'VE DONE A LOT OF
THINGS LOCALLY BUT NATIONALLY
REMAINS A PROBLEM WITH AVAILABLE
GUNS FOR PEOPLE IN THE ITS.
A LITTLE BIT ABOUT THIS, THIS IS
NOW ON A GRANULAR LEVEL LIKE DO
SURGEONS FEEL THAT THERE'S
DISPARITY IN HEALTHCARE
OUTCOMES?
THE ANSWER IS ABOUT A THIRD OF
US SEE THAT.
ONLY 4% REPORT THEY WITNESS SUCH
DISPARITIES.
NOW, IT'S CLEAR FROM LITERATURE
I SHOWED AND OTHERS YOU KNOW
ABOUT DISPARITIES ARE REAL.
I'LL GO THROUGH SOME THINGS JUST
TALKING ABOUT THAT IN A BIT BUT
RECOGNIZING IT HAPPENED, IT'S A
REAL PROBLEM, WE NEED TO MAYBE
CHANGE OUR PRACTICE, ADDRESS OUR
PRACTICE TO FIGURE OUT HOW WE
CAN MAKE A DIFFERENCE.
THIS IS MORE STUFF RELATED TO
ISSUES RELATED TO MORTALITY, YOU
CAN SEE THE HOMICIDE RATE HERE
IS MUCH HIGHER.
GUN VIOLENCE DEATH RATE IS ABOUT
40,000 A YEAR OR SO.
THERE'S A LARGE PART THAT ARE
SUICIDE, BUT THEN THE SIDE THAT
GETS THE -- THE HOMICIDE RATE
GETS MORE ATTENTION BUT
DISPROPORTIONATELY AFFECTS
AFRICAN AMERICANS IN THE UNITED
STATES, YOU KNOW, OVERALL.
SO THIS IS JUST HOMICIDE, HIV
DISEASE, DISEASE OF THE HEART.
THIS IS IN YOUNG PEOPLE, WHAT
THE CAUSE OF DEATH IS.
YOU CAN SEE WHAT CAUSES OF DEATH
ARE IN WHITE VERSUS BLACK
PATIENTS HERE.
THERE ARE A LOT OF TRENDS IN
TERMS OF RACIAL DISPARITIES,
TRAUMA CENTERS, THIS IS TEN-YEAR
STUDY AND THEY FOUND WITH PROVEN
OUTCOMES THE GAP IN QUALITY HAS
NOT NARROWED OVER TEN YEARS, SO
EVEN THOUGH WE'RE RECOGNIZING,
TRYING TO DO THINGS, THERE'S NOT
A LOT OF NARROWING OF THE GAP.
BUT THERE'S AWARENESS THAT'S
GROWING.
THIS IS A SURVEY HERE, AWARENESS
OF ETHNIC, RACIAL DISPARITIES,
OUTCOMES, FACTORS ACKNOWLEDGING
ACTION, A SURVEY OF GENERAL
SURGEONS, LESS THAN 50%
INSTITUTIONAL EFFORTS TO ADDRESS
THIS ISSUE, LESS THAN 25%
REPORTED ADDRESSING IT IN THEIR
PRACTICE.
SO I THINK THAT THIS NUMBER,
THIS IS AN OLDER PAPER NOW BUT
THIS IS SOMETHING THAT WE'RE
BEGINNING TO ADDRESS IN OUR
PRACTICE BECAUSE WE'RE
UNDERSTANDING THERE'S
DIFFERENCES IN OUTCOMES, WE'RE
DOING IT, YOU KNOW, AT OUR
PLACE, AS MANY OF YOU ARE DOING
IT AROUND THE COUNTRY ALSO.
SO THIS IS SOMETHING THAT WHEN
THIS CAME OUT, THIS WAS REALLY
QUITE CONTROVERSIAL BECAUSE
THESE ARE KIDS, KIDS GET
STRAITED -- TREATED THE SAME BT
THEY FOUND THE BLACK CHILDREN
HAD SIGNIFICANTLY INCREASED
PREMORBIDTIES, TRAUMA AND
VIOLENCE, I THINK YOU KNOW, IF
YOU DON'T KNOW YOU SHOULD KNOW,
NUMBER ONE CAUSE OF DEATH IN
CHILDREN IN THE UNITED STATES IS
GUN VIOLENCE.
NUMBER ONE CAUSE.
NOW, THAT SHOULD GIVE US PAUSE.
IT'S NOT INFECTIOUS DISEASE.
IT'S NOT COVID.
IT'S NOT THAT.
IT IS GUN VIOLENCE.
I THINK THIS IS SOMETHING THAT
WE NEED TO LOOK AT OURSELVES AND
SAID ARE WE WILLING TO ACCEPT A
SOCIETY WHERE CHILDREN DIE AT
HIGHER RATE THAN ANY OTHER
COUNTRY IN THE WORLD.
THAT'S SOMETHING THAT YOU THINK
EVEN AFTER PARKLAND, SANDY HOOK,
LAS VEGAS, IT GOES DOWN, TEXAS,
YOU KNOW, EVERY DAY WHEN YOU
HEAR ABOUT IT YOU THINK THERE
WOULD BE AN OUTCRY WITH THAT BUT
THERE'S NOT.
I THINK WE HAVE TO KEEP ON
WORKING ON RAISING
CONSCIOUSNESS, MAKING SURE
PEOPLE ARE AWARE, SPEAKING OUT
WHEN WE CAN.
NO DIFFERENCE IN DEATH BUT
BLACKS MORE LIKELY GO TO
INPATIENT REHAB, QUITE
CONTROVERSIAL, HIGHER LENGTH OF
STAY, ICU COST, THE WHOLE THING
WITH THAT, MORE FUNCTIONAL
DEFICITS IN TERMS OF WALKING,
FREEDING, EXPRESSIONAL DEFECTS.
THIS WAS SOMETHING PEOPLE WERE
QUITE UPSET ABOUT WHEN PRESENTED
BY A GROUP AT THE AMERICAN
ASSOCIATION OF SURGERY AND
TRAUMA, OUR BIGGEST TRAUMA
MEETING IN THE COUNTRY EVERY
YEAR.
THIS IS LOOKING AT INSURANCE
RATES, PREDICTING DISPARITIES,
AFTER TRAUMA, AND AFRICAN
AMERICAN, HISPANICS, UNINSURED
HAD WORSE OUTCOMES, INSURANCE
HAD STRONGER ASSOCIATE WITH
MORTALITY, THINGS WE KNOW ARE
HAPPENING.
THIS IS WHAT HAPPENS AFTER
TRIAGE, IT CONTINUES THAT WE SEE
THERE'S DIFFERENT THINGS THAT
RELATED TO THAT.
IF YOU STEP BACK AND LOOK AT THE
PROBLEM THERE IS, THERE ARE A
LOT OF WAYS TO LOOK AT IT,
ACCESS TO CARE, PATIENT FACTORS,
SOME YOU CAN CONTROL, PROVIDER
THINGS, WHY DO DISPARITIES
HAPPEN LIKE THIS.
YOU HAVE TO THINK IN GLOBAL
TERMS TRYING TO FIGURE OUT WHEN
YOU TRY TO GET TO SOLUTIONS TO
THIS, YOU KNOW, WITH THAT.
SO IN TERMS OF SOLUTIONS, I'LL
GO THROUGH SOME THINGS TALKING
ABOUT SOLUTIONS THAT CAN MAKE A
DIFFERENCE, GOING INTO SOME
ISSUES RELATED TO TRAINING,
TALKING ABOUT THE LAST SIX IN MY
TALK THERE.
IN TERMS OF LOOKING AT IMPROVED
OUTCOMES, LOOK AT ISSUES RELATED
TO SOCIAL DETERMINANTS OF
HEALTH, SOME OF WHICH WE CANNOT
AND CAN CONTROL, MORBIDITY, RISK
FACTORS WITH THAT.
THERE ARE POSITIVE TRENDS IN
TERMS OF OUTREACH PROGRAMS,
SOCIAL PROGRAMS TO HELP WITH
THAT, INVESTMENT IN EDUCATION,
OVER THE LONG TERM.
MAKING SURE PEOPLE OF COLOR
PARTICIPATE IN THE POLICY AND
DECISIONS, HAVE ACCESS TO CARE,
WHEN THEY DO THINGS.
SO THINGS THAT HAPPEN WITH
MEDICAID EXPANSION, THIS WAS
SOMETHING THAT WE ALL WERE QUITE
EXCITED ABOUT, WHEN THE
AFFORDABLE CARE ACT CAME WITH
THAT.
MY PATIENT POPULATION IN SAN
FRANCISCO GENERAL BEFORE THE
AFFORDABLE CARE ACT CAME OUT WE
HAD 50% OF PATIENTS NO PAY, AND
THAT NUMBER WENT FROM 50% DOWN
TO 5%, AND THE REST HAD MEDICAL,
OUR VERSION OF MEDICAID, THAT
MADE IMPROVEMENTS IN THE WAY
PEOPLE SOUGHT CARE, CANCER
SCREENINGS, ET CETERA, THAT MADE
A DIFFERENCE IN MAKING CHANGES.
OTHER SYSTEMS WERE DISPARITIES
HAVE BEEN WORKED ON, AS THE
ISSUES AND THE TRICARE SYSTEM
FOR MILITARY, IN TERMS OF
IMPROVED SCREENING, THAT
BASICALLY EQUAL ACCESS BASICALLY
BEGAN TO BRING DOWN DISPARITIES
THAT EXISTED THAT I REPORTED ON
A LITTLE BIT EARLIER AND THAT
YOU KNOW ALREADY.
THAT'S ANOTHER WAY, ANOTHER
SYSTEM WAY TO LOOK AT THINGS TO
TRY TO IMPROVE.
SO THIS IS A CALL TO ACTION.
THIS IS RESEARCH, ROAD MAP TO
TARGETING AND LIMITING HEALTH
CARE, IDENTIFYING THINGS,
GETTING DATA, DEFINING THINGS,
CONDUCTING RESEARCH, ANALYZING
DATA, TRYING TO SCALE UP AND
SUSTAIN.
WHAT THE COLLEGE OF SURGEONS IS
GETTING READY TO DO WHICH IS A
GOOD PLACE TO BE, AND I'M ON
WHAT'S CALLED NOW THE -- USED TO
BE CALLED ANTI-RACISM TASK FOR,
BUT IT'S NOW CALLED THE
INCLUSIVE ACCESS COMMITTEE,
WE'RE BEGINNING TO EMBED OUTCOME
IN TERMS OF TRAUMA CENTER
VERIFICATION, IN TERMS OF OTHER
VERIFICATIONS FOR CANCER, AND
THE LIKE, CONVERTING QUALITY
INDICATORS RELATED TO
DISPARITIES SO YOU ARE THEN
MAKING SURE WE'RE COLLECTING
DATA TO MAKE SURE THAT WE CAN
MAKE A DIFFERENCE NATIONWIDE TO
DO THAT.
THERE'S SOME TALK THE JOINT
COMMISSION WILL BEGIN TO EMBED
THINGS INTO THEIR STANDARDS
ALSO, WITH DOING THAT.
AND THIS WAS ANOTHER PAPER THAT
JUST CAME OUT A COUPLE YEARS AGO
LOOKING AT WHAT YOU CAN DO IN
TERMS OF WHY THEY EXIST, WE KNOW
WHY THEY EXIST BUT INCREASING
DIVERSITY THE HEALTHCARE WORK
FORCE, THE COMMUNITY AROUND THEM
IS ANOTHER WAY TO DO THAT,
REALLY BEING AWARE OF WHAT THE
SOCIAL DETERMINANTS OF HEALTH.
PLACES NOW WHEN THEY PRESENT
MORBIDITY AND MORTALITY THEY
LOOK AT ISSUES RELATED TO SOCIAL
DETERMINANTS OF HEALTH, WHAT ARE
THE ACCESS POINTS THE PATIENTS
HAVE, WHAT THEY CAN DO,
BASICALLY THEN CREATE MEANINGFUL
CHANGE, WHEN YOU'RE LOOKING AT
THE OUTCOMES WITH THAT.
I'M GOING TO TURN TO THE PATIENT
FOR THE POPULATION IN THE UNITED
STATES AND TALK ABOUT ISSUES
RELATED TO TRAINING MODEL IN
SURGERY.
THIS IS THE STATE OF THE
POPULATION IN THE UNITED STATES,
YOU'RE AWARE OF THESE NUMBERS,
BUT THINGS ARE CHANGING WITH
THAT.
THIS IS THE PERCENTAGE OF
RACIAL/ETHNIC BREAK DOWN OF THE
PATIENTS SO YOU CAN SEE AFRICAN
AMERICANS ARE 12% OF THE
POPULATION, ONLY 3% OF
PHYSICIANS.
THIS IS AN EXAMPLE NOW WHAT'S
GOING ON IN TERMS OF TENURED
FACULTY.
THE REPORT CAME OUT TWO YEARS
AGO, THERE WERE 10 TENURED
AFRICAN AMERICAN WOMEN FULL
PROFESSORS IN THE WHOLE UNITED
STATES.
I KNOW MOST OF THEM.
IN TERMS OF MEN, FULL
PROFESSORS, PEOPLE OF MY RANK,
THERE'S ABOUT 80.
I KNOW PROBABLY 3/4 OF THEM
BECAUSE OF THE THINGS, PROGRAMS
I'VE BEEN INVOLVED WITH THAT.
SMALL NUMBERS OF TENURED FACULTY
WHO FACE A BIGGER BURDEN WITH
THAT, WHETHER OR NOT IT'S BLACK,
HISPANIC, OR OTHERWISE.
RESIDENT NUMBERS, SLOWLY
INCREASING.
WE BASICALLY HAVE -- WE'VE MADE
SOME CHANGES, WE MADE SOME
INROADS, I'LL SHOW YOU THINGS
WE'RE DOING TO CHANGE THINGS IN
OUR PLACE AND OTHER PLACES ARE
DOING THE SAME THING.
YOU'VE SEEN THE LEAKY PIPELINE
HERE, THE OTHER TERM FOR IT,
BECAUSE PIPELINE HAS NEGATIVE
CONNOTATION, NEGATIVE PATHWAY TO
LEADERSHIP, THESE ARE REAL
NUMBERS OF PEOPLE CHAIRS IN THE
UNITED STATES.
THAT NUMBER HAS CHANGED.
IN SURGERY, I KNOW ALL OF THEM.
THAT NUMBER IS QUITE SMALL WITH
THAT.
SO THE OTHER THING THAT'S GOING
ON WITH THAT IS THAT WE HAVE A
PROBLEM IN SURGERY.
THE PROBLEM WITH SURGERY IS THAT
WE HAVE AN ATTRITION RATE THAT'S
QUITE HIGH.
AT BASELINE WE DO NOT FINISH 20%
OF PEOPLE WHO START IN OUR
PROGRAM.
NOW, IF WE WERE RUNNING A
COMPANY LIKE AMAZON OR WHATEVER
COMPANY THERE WAS, AND WE SAID
20% OF PEOPLE FAILED, AT A
BASELINE, THAT WOULD BE A REAL
PROBLEM.
NOW, WHAT'S EVEN WORSE,
ATTRITION RATE FOR PEOPLE OF
COLOR IS MUCH HIGHER.
THAT NUMBER IS CLOSER TO 35% IN
TERMS OF NOT FINISHING FIVE OR
SEVEN YEAR PROGRAM.
ATTRITION RATE IS HIGHER IN
ORTHOPEDICS, 12 TIMES THE NORM.
GENERAL SURGERY IT'S 6 OR 7
TIMES.
THIS IS A REAL PROBLEM THAT'S
THERE.
THERE'S NOT ENOUGH STUDENTS, AND
HOW DO WE TURN THE DRIBBLE INTO
MORE.
I THINK MORE, THESE ARE THINGS
THAT CAN BE DONE.
IT'S JUST TO LET YOU KNOW WHAT
PEOPLE ARE DOING.
MORE LIKELY TO PRACTICE IN
PRIMARY CARE, WORKING IN
IMPOVERISHED AREA THAN WHITE
PHYSICIANS, LIKELY TO PRACTICE
IN UNDERSERVED HEAR.
BLACK PHYSICIANS, AMERICAN
INDIAN, HISPANIC AND WHITE.
NUMBERS OF STUDENTS IN MEDICAL
SCHOOLS HAVE GONE UP
SIGNIFICANTLY WHICH IS GREAT
OVERALL, RECOGNIZING WE'LL NEED
MORE OF A WORKFORCE GOING
FORWARD BUT THE NUMBERS OF BLACK
AND LATINO NUMBERS OF STUDENTS
HAVE GONE DOWN, YOU KNOW, OVER
THIS PERIOD OF TIME.
THIS IS NOW 13-YEAR PERIOD.
THIS IS DATA FOR THE AAMC.
ONE OF THE FACTORS ACCOUNTING
FOR THAT FAMILY INCOME, IT'S
EXPENSIVE.
I THINK IT'S $90,000 A YEAR AT
OUR PLACE FOR MEDICAL SCHOOL,
MAY BE MORE WHERE SOME STUDENTS
IN THE AUDIENCE ARE FROM.
NOW NEW SCHOOLS NOW COMING OUT
THAT ARE FREE OF TUITION BUT
THAT TAKES A $1 BILLION
INVESTMENT, IT'S HUGE, AND
THAT'S NOT GOING TO REALLY
HAPPEN WITH THAT.
ONE OF THE THINGS MORE STRIKING
HERE, THIS STATEMENT, TAKES A
BACHELOR'S DEGREE TO MAKE A
MEDICAL STUDENT, WE KNOW THAT.
READING PROFICIENCY AT AGE 8 TO
MAKE A DOCTOR AT AGE 28A
PROFOUND STATEMENT.
IT GOES RIGHT TO THE HEART OF
WHAT'S GOING ON, THAT THERE'S A
BREAKDOWN IN THE WAY THAT
EDUCATION GOES IN DIFFERENT
COMMUNITIES, PARTICULARLY
AFRICAN AMERICAN COMMUNITIES.
RATIONALE IS INCREASING OF U.S.
POPULATION OVERALL, INCREASE
NUMBER OF PEOPLE
UNDERREPRESENTED IN MEDICINE,
PROBLEMS OF HEALTH DISPARITIES I
TALKED ABOUT ACROSS THE BOARD,
INCREASED NEED FOR PHYSICIANS,
URM ACCOUNT FOR SIGNIFICANT
FRACTION OF 18 TO 24 YEARS OLDS,
THERE'S CLEARLY A RATIONALE FOR
THAT.
THIS PAPER CAME OUT BY SOCIETY
OF BLACK ACADEMIC SURGEONS, WHAT
IT WAS, IT WAS A COHORT STUDY
LOOKING AT PEOPLE PROGRESSING
FROM PROFESSOR UP TO CHAIR.
WHAT THEY IDENTIFIED FACTORS,
INTERSECTIONAL, RECRUITMENT AND
RETENTION OF TRAINEES, IT'S
IMPORTANT THAT WE RETAIN
TRAINEES AS WE BEGIN TO IMPROVE
THIS PIPELINE ISSUE THAT WE HAVE
WITH THAT.
THIS IS A STUDY LOOKING AT
BENCHMARKS IN TERMS OF SUCCESS.
THEY LOOKED AT CVs, PEOPLE IN
SOCIETY OF ACADEMIC SURGEONS,
AND OTHER SOCIETIES, THEY FOUND
THAT THEY ATTAINED THINGS,
ATTAINED GOALS AND SUCCESS RIGHT
JUST AS MUCH AS EVERYONE ELSE,
SO THAT WAS SOMETHING THAT WAS
INTERESTING.
THIS IS, AGAIN, REFLECTING THE
PIPELINE.
I'LL DRILL DOWN LOOKING AT THAT.
SO 3%, ALL ORTHOPEDIC RESIDENTS
BLACK, 5.9% OF PEDIATRIC, AND
THIS TALKS ABOUT DISMISSAL RATE,
QUITE HIGH, BOTH IN SURGERY AND
ORTHOPEDICS OVERALL SO YOU START
AT A SMALL NUMBER, ANOTHER
GRAPHIC FROM DR. McDADE, AAMC,
RATES ON THE RIGHT WITH THAT.
SO LESSER IN OTHER AREAS BUT
MUCH HIGHER IN OTHERS WITH THAT,
AND IN SURGERY WE'RE SIX TIMES,
ORTHOPEDICS, YOU CAN SEE 15
TIMES THE RATE, SO THIS IS A
REAL PROBLEM WE HAVE.
PART OF WHAT WE'VE BEEN DOING
WITH SOCIETY FOR BLACK ACADEMIC
SURGEONS WHERE I HAD THE HONOR
TO SERVE AS PRESIDENT MAKING
SURE WE REACH OUT TO MAKE SURE
WE SUPPORT ALL OF OUR RESIDENT
TRAINEES ALONG THE WAY WITH
THAT.
THIS IS GIVING AN IDEA OF THE
NUMBERS IN TERMS OF BLACK FOLKS,
BLACK FACULTY WHO ARE GOING UP
THE FOOD CHAIN AND BECOMING FULL
PROFESSORS.
THE SUPREME COURT DECISION SORT
OF BANNED AFFIRMATIVE ACTION, IN
CALIFORNIA THEY BANNED IT 27
YEARS AGO, WE'VE BEEN ABLE TO
CONTINUE THE WORK WE'RE DOING
EVEN THOUGH IT TOOK A LITTLE
WHILE TO FIGURE IT OUT, LOOKING
MORE HOLISTICALLY AT WAYS TO
RECRUIT PEOPLE TO MAKE SURE.
BUT I THINK THERE ARE A LOT OF
STATEMENTS, THIS IS KETANJI
BROWN JACKSON, BUT WE BANNED IT
IN CALIFORNIA BUT WE'VE BEEN
ABLE TO WORK THROUGH THAT AS WE
MOVE ALONG.
THERE ARE A LOT OF FORCES OUT
THERE DOING THINGS.
WE PUBLICIZE THE GREAT, WE'RE SO
HAPPY ABOUT INTERNS COMING IN,
SO EXCITED ABOUT THAT.
THE NUMBER ONE MEDIA INFLUENCE
IN THE WHOLE WORLD, ELON MUSK,
ZERO PERCENT, THAT GETS TWEETED
MILLIONS OF TIMES WITH THAT,
ENDING WOKENESS, THERE'S A
PUSHBACK IN TERMS OF DOING
THINGS.
INSTEAD OF CELEBRATING HOW
WONDERFUL THAT PICTURE IS,
THERE'S A HUGE PUSHBACK EVEN BY
SOMEONE WHO HAS NO BUSINESS
DRAWING ON THAT ISSUE WITH THAT.
SO THIS IS WHAT WE'VE DONE AT
OUR PLACE, 27 YEARS AFTER PROP
2, WE'VE BEEN ABLE TO BRING IN
THE BEST OF THE BEST, THE BEST
OF THE BEST LOOKS LIKE THE
POPULATION IN CALIFORNIA.
BUT IT TAKES A LOT OF WORK, A
LOT OF SUPPORT TO DO THIS.
WE NOW HAVE MORE AFRICAN
AMERICANS AND LATINOS THAN EVER
IN OUR PROGRAM, IN THE HISTORY,
THEY ARE ALL UNBELIEVABLY
OUTSTANDING PEOPLE, DOING GREAT
WORK WITH THAT.
THIS IS THE CALL TEAM AT SAN
FRANCISCO GENERAL HOSPITAL.
THIS WAS THE FIRST TIME THIS
EVER HAPPENED, IN THE 150 YEARS
OF THE HOSPITAL WHERE THE
ATTENDING ON THE RIGHT, FELLOW
IS NEXT, SENIOR RESIDENT, JUNIOR
RESIDENT, THEY ARE ALL AFRICAN
AMERICAN WOMEN, SO WE HAD TO
JUST CELEBRATE HOW WONDERFUL
THAT IS.
THAT WE'RE BEGINNING TO CHANGE,
THINGS THAT NEVER HAPPENED
BEFORE WITH THAT.
ARE WE GOING TO LOSE MOMENTUM
BECAUSE WE'RE WORRIED ABOUT
THIS, YOU KNOW, AS WE GO
FORWARD, AND WHAT WE HAVE TO
UNDERSTAND THIS IS A FIGHT MANY
OF US HAVE BEEN DEALING WITH FOR
30 OR 40 YEARS OF OUR CAREER
MAKING SURE WE PUSH FORWARD.
THERE WILL BE ROAD BLOCKS,
PEOPLE SAY NO, YOU CAN'T DO
THIS, BUT YOU FIGURE OUT A WAY
TO DO IT THE RIGHT WAY.
I THINK I MAY HAVE MENTIONED
EARLIER, TALKING TO STUDENTS,
ENTIRE 90-YEAR HISTORY OF UCSF
SURGERY THERE'S BEEN 16 AFRICAN
AMERICANS GRADUATED, THERE'S
EIGHT RESIDENTS A YEAR WE
GRADUATE, THAT'S GOING BACK TO
THE 1930s AND '40s WHEN WE
STARTED.
SO WE'RE BEGINNING TO MAKE
INROADS BUT THIS IS SOMETHING
THAT'S GOING TO TAKE A LOT OF
WORK WITH DOING THAT.
THIS IS SURGICAL SPECIALTIES,
THE CONCLUSION THERE'S MINIMAL
POSITIVE PROGRESS, GENERAL
DIVERSITY, SPECIALTIES,
CONTINUING TO ADVOCATE WITH
MENTORSHIP, SCHOLARSHIP
PROGRAMS, SUPPORTING PEOPLE.
THIS CAME OUT OF THE JOURNAL OF
SURGICAL RESEARCH.
THIS IS A FRAMEWORK BECAUSE WHAT
YOU DO IS BRING PEOPLE IN, YOU
WANT TO MAKE SURE THEY ARE
SUCCESSFUL.
AND THAT REQUIRES A FAIR AMOUNT
OF SUPPORT BECAUSE THERE'S A
NUMBER OF INSTITUTIONAL ELEMENTS
THAT PUSH BACK ON SUCCESS WITH
THAT SO THINGS ACGME HAS DONE,
ENSURING THAT LEADERSHIP
APPOINTEES ARE DIVERSE, PROGRAM
LEADERSHIP, MAKING SURE THEY ARE
REPRESENTED IN TERMS OF
UNDERREPRESENTED GROUPS.
PROVIDE SAFE SPACE FOR
DISCUSSION AND ISSUES THAT COME
UP WITH THAT.
FACULTY AND HOUSE STAFF, MAKE
SURE YOU BE AWARE OF
GASLIGHTING.
IN SURGERY AT LEAST, IF SOMEONE
IS MAYBE STRUGGLING WHAT HAPPENS
THERE TENDS TO BE A GROUP THING
PROCESS WITH THEM, MAKING SURE
YOU WORK TO GET RID OF THAT.
MAKE SURE YOU BASICALLY HELP
SUPPORT THEM SO THAT THEY ARE
SUCCESSFUL.
MAKE SURE FOR THE BLACK TRAINEES
THEY PROTECT PERSONAL
WELL-BEING, SEEK MENTORSHIP AND
SUPPORT AS THEY GO ALONG,
SOMETHING WE WORKED ON THERE,
CLEARLY DEFINED MISSION, IN
TERMS OF EACH DEPARTMENT WAS
DOING THAT.
TARGETING MENTORSHIP,
SPONSORSHIP, SUPPORT, GETTING
PEOPLE INVOLVED IN NATIONAL
GROUPS, IF YOU DON'T HAVE ENOUGH
SUPPORT WHERE YOU'RE AT.
THIS IS SOMETHING WE PUBLISHED
LAST YEAR, JUST AS A WAY, IT'S A
TOOLKIT, IF YOU WILL, TO MAKE
SURE PEOPLE ARE SUPPORTED.
AT OUR PLACE WE'VE BEEN
OUTSTANDING IN TERMS OF
RECRUITING WOMEN IN SURGERY
BECAUSE WE'VE HAD A WOMAN CHAIR.
I MENTIONED THAT EARLIER.
ABOUT 55% OF OUR SURGICAL
RESIDENTS ARE WOMEN.
NATIONALLY THAT NUMBER IS 30%
BUT WE'RE FORTUNATE BECAUSE
WE'VE HAD OUTSTANDING WOMEN
LEADERS, OUTSTANDING DIVISION
CHIEFS THAT ARE WOMEN, PROVIDING
A TREMENDOUS AMOUNT OF ROLE
MODELING FOR THE RESIDENTS WHO
ARE IN TRAINING.
I'M GOING TO CONCLUDE THINGS AND
I'M HAPPY TO ANSWER QUESTIONS
AFTERWARDS.
I USE COVID AS A FRAMEWORK ABOUT
DISPARITIES AND WHAT HAPPENED,
SO FRESH IN OUR MIND AND STILL
CONTINUES AS WE DO THAT.
AMPLIFIED PREEXISTING
DISPARITIES IN TRAUMA, CANCER,
OTHER AREAS WITH THAT, BUT
PIPELINE ISSUES IN MEDICINE ARE
SERIOUS BUT THERE ARE WAYS TO
BEGIN TO APPROACH THE PIPELINE
PATHWAY ISSUES, IMPERATIVE TO
HAVE A DIVERSE WORKFORCE BUT I
THINK THE CHALLENGES ARE REALLY
BIG BUT THEY ARE WITHIN REACH.
WE HAVE TO BE CREATIVE AS WE GO
FORWARD WITH THINGS, AND WITH
THAT I'LL JUST THANK YOU FOR
YOUR TIME TODAY.
IT'S BEEN A TREMENDOUS HONOR TO
SPEAK TODAY AT NIH AT GREAT
TEACHERS CONFERENCE.
THANK YOU SO MUCH.
[APPLAUSE]
>> THANKS FOR THE TALK, DR.
CAMPBELL.
MY QUESTION HAS TO DO WITH THE
NUMBER OF MEDICAL SCHOOL
APPLICATIONS, SO I DIDN'T SEE
THAT COVERED IN THE TALK.
I'M AWARE THAT MEDICAL SCHOOLS
HAVE TAKEN SOME STEPS TO TRY TO
CREATE MORE DIVERSITY IN THE
CLASSES, BUT AS I TALK WITH THE
FOLKS ACROSS THE STREET, FROM
SERVICES UNIVERSITY WHERE YOU
AND I BOTH SHARE ADJUNCT
PROFESSORSHIPS, AND ALSO --
>> I'M NOT A TWO STAR GENERAL.
I WISH I WAS.
>> AND THEN ALSO AT THE PLACE
WHERE I WENT TO MEDICAL SCHOOL,
INDIANA UNIVERSITY, IT WAS --
THERE WAS JUST INCREASING
COMPETITION OVER RELATIVELY
SMALL GROUP OF STUDENTS.
AND SO THE MEDICAL SCHOOLS WERE
A LITTLE BIT FRUSTRATED IN THEIR
EFFORTS TO TRY TO INCREASE
DIVERSITY.
SO TELL ME, TELL US, WHAT THE
STATUS IS OF THE NUMBER OF
MEDICAL SCHOOL APPLICANTS FROM
UNDERREPRESENTED MINORITIES NOW.
>> AT OUR PLACE -- THANK YOU FOR
THAT QUESTION, SIR.
AT OUR PLACE WE'VE ACTUALLY HAD
THE OPPOSITE EFFECT.
WE'VE INCREASED THE NUMBER OF
UNDERREPRESENTED IN MEDICINE,
THAT'S BEEN INTENTIONAL.
WE'VE BEEN AGGRESSIVE WITH
RECRUITMENT, OUTREACH, REACHING
OUT TO HBCUs AND OTHER PLACES.
HAVE TO BE EXTREMELY INTENTIONAL
WHEN DOING THAT.
OUR NUMBERS, EVEN THOUGH ALL
THESE THINGS ARE GOING ON
NATIONALLY, WE'VE INCREASED THE
NUMBERS.
BUT IT IS SOMETHING WE HAVE TO
DO.
OUR DEAN OF ADMISSIONS IS REALLY
PROGRESSIVE.
SHE'S JUST PRESIDENT OF THE
AMERICAN HEART ASSOCIATION, YOU
KNOW, YOU MAY KNOW HER BUT SHE'S
TERRIFIC.
SHE'S REALLY BEEN DEDICATED TO
THE MISSION, AS OUR DEAN WITH
THAT, THE WHOLE FACULTY WITH
THAT.
THIS PERMEATES WITH THE FACULTY,
MEDICAL SCHOOL, THROUGH
ADMISSIONS PROCESS, THAT'S ONE
WAY TO CONTINUE TO DO THAT.
IT IS A STRUGGLE BECAUSE THE
NUMBERS OF APPLICATIONS HAVE
GONE UP.
IT GOES UP AND DOWN EACH YEAR.
SOMETIMES IT GOES UP, SOMETIMES
DOWN, DEPENDING HOW LONG PEOPLE
WANT TO TRAIN TO BE DOCTORS.
BUT IT IS A CHALLENGE.
YOU HAVE TO BE INTENTIONAL ABOUT
DOING THAT AT THE STUDENT LEVEL.
WE HAVE AS A MEDICAL SCHOOL UCSF
BEEN SUCCESSFUL IN TERMS OF
DIVERSIFYING THE STUDENT
POPULATION BUT WE'VE NOT BEEN
SUCCESSFUL WITH THE RESIDENCY
TRAINING PROGRAM.
WE'RE NOW BEGINNING TO WORK ON
THAT ALSO.
AND OUR GME OFFICE HAS BEEN
HELPING US WITH TECHNIQUES TO DO
THINGS.
WE HAVE DIFFERENT SUBCOMMITTEES
TO HELP WITH THAT.
GOING TO THE PLACES WHERE WE
COULD GET STUDENTS ATTRACTED SO
SMA, LATINO ELEMENTS WE'VE BEEN
TRYING TO DO OUTREACH TO
CONFERENCES NATIONALLY TO LET
STUDENTS KNOW WHERE TO COME FOR
GME, BUT CERTAINLY IN MEDICAL
LEVEL THERE'S CHALLENGES WITH
THAT.
THANK YOU.
>> ONE QUESTION FOR YOU,
BUILDING OFF OF WHAT HE JUST
ASKED, I FEEL LIKE BEING LATINO
IN MEDICINE, I FEEL LIKE IT
STARTS LIKE YOU'RE SAYING PEOPLE
APPLYING TO MEDICAL SCHOOL BUT
WHEN YOU APPLY TO MEDICAL SCHOOL
IT'S ABOUT LIKE WHO IS ON THE
ADMISSION BOARD, WHO IS
REVIEWING APPLICATION THAT CAN
HELP YOU GET THERE, AND SO LIKE
WHEN IT COMES TO WHEN WE DO GET
TO MEDICAL SCHOOL AND THINK
ABOUT CAREERS, HOW WE CONTINUE
TO PUSH FOR MORE OF US,
UNDERREPRESENTED, TO PURSUE
ACADEMICS, LEADERSHIP IN
ACADEMIA, EVEN MORE SO PURSUE
FIELDS OF PRIMARY CARE,
PASSIONATE ABOUT WHATEVER YOU'RE
PASSIONATE ABOUT, A LOT OF TIMES
YOU MENTIONED THE PRIME PROGRAM
IN CALIFORNIA, U.C. SYSTEMS, WE
PUSH FOR PRIMARY CARE A LOT OF
TIMES AS UNDERREPRESENTEDS, WHAT
WE CARE ABOUT, WE'RE ALSO NEEDED
IN SPACES OF SURGICAL
SPECIALTIES, ACADEMIA, SPACES OF
LEADERSHIP.
CAN YOU TALK MORE HOW WE
CONTINUE TO PUSH OUR PEOPLE TO
GO INTO THOSE SPACES BECAUSE WE
NEED TO SIT ON THOSE COMMITTEES,
ON THAT LEADERSHIP, CREATE
CHANGE FROM INSIDE.
THANK YOU.
>> IS THERE A QUESTION?
>> HOW DO WE DO THAT, HOW DO WE
PUSH MORE OF US?
>> OKAY, I GOT YOU.
THANK YOU, I APPRECIATE THAT.
I THINK THIS IS -- I THINK THAT
I JUST READ SOMETHING THEY
ESTIMATED IT WOULD TAKE BY 2050
AT THE RATE WE'RE GOING TO
BASICALLY HAVE THE DIVERSITY AND
MEDICINE MATCH THE GENERAL
POPULATION BECAUSE THE
POPULATION IS SLOWLY BECOMING
MUCH MORE DIVERSE AND CERTAINLY
CALIFORNIA WILL PROBABLY LEAD
THE WAY.
WE NEED TO TAKE IN MIND AS WE O
FORWARD.
THE CHALLENGES, THE THING THAT
IMPRESSED ME, I HAD A COFFEE
HOUR WITH STUDENTS, DIVERSE
STUDENTS YOU HAVE HERE AT NIH,
YOU'RE PRETTY AMAZING, I'LL
COMPLIMENT YOU BECAUSE YOU'RE
THE BOSS, RIGHT?
FOR SUPPORTING THE PROGRAM.
I SENT STUDENTS TO THE PROGRAM
THAT MANY OF YOU ARE IN, THAT'S
A GOOD WAY BECAUSE YOU GET A
CHANCE TO SEE WHAT IT'S LIKE
NONE -- WHAT IT'S LIKE TO BE A
RESEARCHER IN MEDICINE, THE ROLE
MODEL THING IS IMPORTANT, SEE
SOMEONE LIKE YOU, CAN YOU
POTENTIALLY DO THAT.
WE TALKED ABOUT I'M FIRST
GENERATION, I KNOW WHAT THAT'S
LIKE, THE STRUGGLES, YOU DON'T
SEE ANYBODY WHO LOOKS LIKE YOU,
OCCASIONALLY YOU DO, REACH OUT
AND TALK TO THEM AND SEE IF THEY
CAN SUPPORT YOU BUT THERE'S A
LOT OF YOU AND THERE'S NOT A LOT
OF US, SO -- WE JUST HAVE TO
KEEP MOVING FORWARD TRYING TO
MAKE A POSITIVE IMPACT ON
THINGS.
>> I HAD A QUESTION SPECIFICALLY
ABOUT ONE FIGURE THAT REALLY
SHOOK ME.
I TOOK A PICTURE SO I COULD LOOK
UP THE ARTICLE LATER.
IT WAS THE ONE ABOUT UNINTENDED
ATTRITION IN SURGICAL RESIDENTS
AND THERE ARE ARROWS POINTING TO
SPECIFICALLY ORTHO, THORACIC,
VASCULAR, AS COMPARED TO OTHER
SURGICAL SUBSPECIALITIES LIKE
ENT OR PLASTICS.
WONDERING YOUR TAKE WHY THAT IS
SO HIGH IN ORTHO, THORACIC,
VASCULAR, DO YOU HAVE HYPOTHESES
WHETHER THAT'S CULTURE,
FELLOWSHIP MATCH, ANY OTHER
FACTORS YOU MIGHT THINK?
>> SO THOSE AREAS IN SURGERY
ARE -- FOR LACK OF BETTER WORD
THERE'S MORE HAZING THAT GOES ON
IN THOSE SUBSPECIALITIES.
AND CERTAINLY IN ORTHOPEDICS
THEY BRING YOU IN BUT THEY MAY
NOT WANT TO FINISH YOU, YOU
KNOW, WITH THAT.
THE ATTRITION RATE I THINK IS
RELATED TO THE FACT THAT THEY DO
NOT CREATE A SUPPORTIVE
ENVIRONMENT FOR THE RESIDENTS TO
BE IN.
IF YOU DON'T FEEL SUPPORTED, IF
YOU'RE WORKING HARD I MEAN I
THINK MANY OF US IN RESIDENCY
TRAINING IS NOT EASY.
SURGEONS KNOW THAT.
YOU KNOW, IT'S NOT EASY AT ALL.
IT TAKES A LOT OUT OF YOU.
IF YOU FEEL LIKE YOU'RE THERE BY
YOURSELF BECAUSE A LOT OF THE
RESIDENTS WHO GET INTO TROUBLE
FEEL LIKE THEY ARE NOT
SUPPORTED, FEEL LIKE THEY ARE BY
THEMSELVES, AS A RESULT OF THAT
THEN YOU'LL HEAR ABOUT THEM
BEING DISMISSED AFTERWARDS
BECAUSE THEY DON'T FEEL
SUPPORTED.
THERE'S SEVERAL FOLKS NATIONALLY
TRYING TO ADDRESS THIS.
THE PROBLEM IS THAT YOU BRING
PEOPLE IN, YOU KNOW, THE WHOLE
THING ABOUT D.E.I. EFFORTS, YOU
SORT OF BRING THEM IN BUT YOU
HAVE TO MAKE SURE THEY ARE
COMFORTABLE.
IF YOU SAY THINGS TO THEM THAT
ARE RACIST OR THINGS THAT ARE
SEXIST OR THINGS THAT DON'T
INCLUDE THEM, MAKE YOU FEEL
OTHER THAN, YOU'RE LIKE WELL,
I'M WORKING THIS HARD, WHY
SHOULD I CONTINUE?
YOU START DOUBTING YOURSELF WITH
THAT.
THERE'S ENVIRONMENTAL THINGS.
THE ENVIRONMENTAL THINGS, THOSE
CAN BE FIXED BECAUSE IF THEY
CREATE ENVIRONMENT THAT'S
SUPPORTIVE YOU'LL BE SUCCESSFUL,
THEY ARE NOT CREATING THAT
ENVIRONMENT, IN FACT THEY ARE
MAKING IT HOSTILE AND NEED TO BE
CALLED OUT.
DR. McDADE IS AT THE AAMC, HE
SHARED THAT SLIDE, HE SAID SHARE
IT WIDELY.
YOU LOOK AT THAT, THIS IS A REAL
PROBLEM.
YOU DON'T HAVE TO BE A
STATISTICIAN TO SAY THAT NUMBER
IS WAY MORE, IT STICKS OUT Y --
AND WHY IS THAT?
WE HAVE TO STOP THE HAZING,
CHANGE THE CULTURE.
THINGS HAVE GOTTEN BETTER BUT WE
STILL HAVE A LONG WAY TO GO.
>> THANK YOU AGAIN, DR.
CAMPBELL.
I THINK NOT A LOT OF US HERE ARE
SURGEONS BUT I THINK ANYTHING
THAT YOU'RE IN, WHETHER IT'S A
LAB OR BRANCH, THERE'S A
HIERARCHY INVOLVED.
THERE ARE PROBABLY DIFFERENT
OPPORTUNITIES FOR ALLYSHIP AS
YOU MOVE FROM JUNIOR TO SENIOR
STAGE.
CAN YOU TALK ABOUT MORE WAYS
PEOPLE CAN PROMOTE EQUITY AT
DIFFERENT LEVELS IN THEIR
CAREER?
>> I THINK ONE OF THE THINGS
THAT'S INTERESTING THAT'S
HAPPENING, AT LEAST IN SURGERY,
WE'RE BEGINNING TO FORM --
THERE'S A LOT OF AFFINITY
GROUPS, THE OLDEST ONE IS
ASSOCIATION OF WOMEN SURGEONS,
WHICH A FANTASTIC GROUP, SOCIETY
OF BLACK ACADEMIC SURGEONS, A
NEW ONE, WE'VE BEEN OUT 35
YEARS, THAT WE'VE BEEN IN
EXISTENCE, LATINO SURGICAL
ASSOCIATION, ASIAN ACADEMIC
SURGEONS ASSOCIATION, AND NOW
THERE'S A NEW SURGERY
ASSOCIATION.
WE FOUND THERE'S A LOT OF
INTERSECTIONALITY BETWEEN
STRUGGLES WE ALL FACE, AND WE
NEED TO WORK TOGETHER AND WE'VE
BEEN DOING THAT IN TERMS OF
DOING RECRUITMENT SESSIONS.
YOU KNOW, WE HAD A BOOTH FOR A
NUMBER OF YEARS, ALL OF US WERE
REPRESENTED, WE WERE ABLE TO
REACH OUT AND HELP EACH OTHER.
THE STRUGGLES EVERYONE FACES,
WHATEVER YOUR ETHNIC BACKGROUND
IS, OR YOUR SEXUALLY
PREFERENCES, WE'RE STILL
FIGHTING THE SAME ISSUES.
AND I THINK IF WE WORK TOGETHER,
WE WORK BETTER.
I THINK IT'S BEEN GREAT WE'VE
BEEN WORKING TOGETHER AS A GROUP
TO HELP SUPPORT, YOU KNOW, THE
STRUGGLE BECAUSE THE STRUGGLE
DOESN'T JUST AFFECT ONE GROUP.
IT AFFECTS ONE, IT AFFECTS ALL
OF US.
THE ALLYSHIP STARTED A LOT WHERE
WE'RE NOW WORKING TOGETHER,
HELPING EACH OTHER, PARTICIPATE
IN EACH OTHER'S MEETINGS, DOING
THOSE KIND OF THINGS.
THAT'S A BIG PLUS BECAUSE IF YOU
SEE THERE'S NOW A GROWING GROUP
OF PEOPLE, THAT WILL SUPPORT
YOU, THAT'S SOMETHING THAT'S
IMPORTANT.
THANK YOU FOR THAT QUESTION.
>> ONE MORE QUESTION.
>> THANK YOU AGAIN, DR.
CAMPBELL, FOR MAKING IT ALL THE
WAY WE'RE AND SPEAKING TO US
STUDENTS.
I WANT TO ASK IF YOU HAVE ANY
ADVICE ON HOW TO GO AROUND THIS
RECENT ISSUE LIKE SINCE THE
AFFIRMATIVE ACTION HAS BEEN
REVERSED ON SCHOOLS, AREN'T EVEN
PROVIDING US DATA WHAT THE
LATINO ADMISSION RATES ARE,
BLACK ADMISSION RATES, I WANTED
TO ASK LIKE WHAT CAN WE DO AS
STUDENTS TO INCREASE THE
ADMISSION RATES BECAUSE JUST
FROM SEEING LIKE WITH OUR OWN
EYES LIKE THERE HAS BEEN A
SIGNIFICANT DECREASE IN
ADMISSION RATES OF MINORITY
GROUPS, EVEN AT MY OWN SCHOOL,
I'VE SEEN A DRASTIC DECREASE,
WONDERING IF THERE'S A WAY WE
CAN GO AROUND THIS ISSUE, WHAT
ADVICE DO YOU HAVE FOR US AS
STUDENTS TO FIGHT FOR THIS
PROBLEM?
THANK YOU.
>> I THINK AS STUDENTS YOU SORT
OF FEEL SOMETIMES YOU'RE
POWERLESS BUT THE REALITY IS
YOU'RE VERY EMPOWERED.
WE HAD A GROUP OF STUDENTS
STARTED WHITE COATS FOR BLACK
LIVES.
BASICALLY STARTED WHAT WAS A
NATIONAL MOVEMENT, IN TERMS OF
SETTING OF RACIAL INJUSTICES,
WITH THE WAY THAT AFRICAN
AMERICANS WERE TREATED BY THE
POLICE AND OTHERS, AND I THINK
THAT WAS A HUGE THING.
THEY GOT RECOGNIZED BY THE STATE
OF CALIFORNIA BECAUSE OF WHAT
THEY DID BY THE ASSEMBLY GROUP.
SO I THINK WHAT YOU CAN DO IS
YOU CAN REACH BACK TO DO THINGS.
I THINK ABOUT THIS, YOU ASKED
THAT QUESTION, I THOUGHT ABOUT
WHEN I WAS AT HARVARD, I WOULD
GO TO NEW YORK AND VISIT HIGH
SCHOOLS TO TRY TO GET MORE
STUDENTS , WHEN I WAS MEDICAL
SCHOOL I TRIED TO GET TO
MEETINGS, WE FORMED A GROUP, I
WAS ONE OF THE FOUNDING MEMBERS
TO TRY TO HELP INCREASE THEIR
AWARENESS AND ISSUES RELATED TO
AFRICAN AMERICANS THERE.
NOW I'M SORT OF NOW PART OF THE
COMMITTEE THAT SELECTS
RESIDENTS, I'M TRYING TO
BASICALLY MAKE SURE THAT PEOPLE
HEAR THE ISSUES THAT FOLKS HAD
BECAUSE THERE'S A LOT OF -- I'VE
DONE A LOT OF TRAINING, IMPLICIT
BIAS, WE HAVE A LOT OF IMPLICIT
BIASES, RECOGNIZING YOU HAVE
THESE ISSUES, MAYBE WE CAN
CHANGE THINGS IN TERMS OF
ATTITUDES.
GOING OUT.
TRYING TO BE AGGRESSIVE.
WE FOUND WE WOULD INTERVIEW
PEOPLE, SELECT PEOPLE,
INTERVIEWED, WHEN IT CAME TIME
TO RANKING WERE NOT DOING THINGS
THE RIGHT WAY.
AND BASICALLY KEPT BEATING A
DRUM.
YOU'VE GOT TO MAKE SURE IF WE'RE
GOING TO DO IT LET'S LOOK AT THE
WHOLE SPECTRUM.
YOU HAVE TO BE WITHIN, YOU KNOW,
THE RANK RANGE TO BRING PEOPLE
IN.
BY DOING THAT WE BASICALLY WERE
ABLE TO CHANGE THE WAY THAT WE
DO THINGS BUT GOING OUT DOING
THINGS, STUDENTS, RECRUITMENT,
AT OUR LEVEL THINGS WE CAN DO
BUT I HAVE TO BE MINDFUL THAT I
THINK IF YOU THINK ABOUT THIS,
DIVERSITY MAKES THINGS BETTER.
AND PEOPLE JUST HAVE TO
UNDERSTAND THAT BECAUSE EVEN
GROUPS IN CORPORATE AMERICA
UNDERSTAND THAT WHEN YOU HAVE
DIVERSE GROUPS THEY WORK BETTER
BUT MAKING SURE WE KEEP BRINGING
MORE PEOPLE INASMUCH AS WE CAN
WHEREVER YOU'RE AT, DOING WHAT
YOU CAN AT THE SCHOOL YOU'RE AT
TO MAKE A DIFFERENCE.
>> THANK YOU ALL FOR COMING.
>> THANK YOU.
[END OF PROGRAM]