Questions and Answers

2006 Champions of Health Professions Diversity Award Honorees

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José A. Arévalo, MD: Q & A

Q: Why is it important to diversify the health workforce?

A: There are some huge differences in patients’ willingness to accept therapies and in their abilities to understand certain therapies and prioritize them in their lives. Until we can begin to understand how those issues affect how we communicate with that population, then we will still be left with this gap. I think increasing the number of individuals from various cultures who understand and have the ability to communicate more effectively will help us in the long run to provide high-quality care.

Q: Is it challenging to attract ethnic minorities to the health professions?

A: I think it is a little bit more challenging today than it was a few years ago. When I was applying to medical school, there were more opportunities for economic grants and scholarships for students who needed them. The economy is getting tighter and tighter; there aren’t those kinds of resources that were available at one time. I also think that the overall political climate has shifted away from supporting socially responsive programs. This has led to more barriers for certain populations who in the past had a better chance.

Q: What are the important issues affecting health care today?

A: All health care providers struggle with questions about emerging electronic technologies—whether to invest now and how to best use these tools to improve both the quality of care and the quality of service. We know that a lot of Latino physicians are in small-group practices where these questions can become important. The other issue is financing. We continue to have challenges like the 4 percent reduction in Medi-Cal that occurred last year, which was reversed after a lot of lobbying and a lot of advocating. Medi-Cal payments to physicians are the lowest in the country, and any decrease in funding to physicians who provide services to Medi-Cal populations will result in those physicians no longer being able to absorb these costs. As it is, most physicians currently take a hit when they see patients who have Medi-Cal.

Q: Are you the only one in your family in a health profession?

A: My mom was a very strong proponent of local health remedies, and as a child, I became interested in what she did. In a sense, I looked to my mom as my role model. I would watch her and the way she was trusted by the community as a resource for health care. She had a traditional view of health care and used herbs and home remedies to treat people. She never charged; neighbors would just ask for her opinion. Even as a young woman, she was viewed in our community as a healer even though she wasn’t the old grandmotherly type.

Rolland C. Lowe, MD: Q & A

Q: How should health care delivery change?

A: We need to adopt a view that is more global, more macro. As a doctor, you must work with the community itself so they can be an advocate for you. Take Chinatown as an example. The reason why today we can stand tall in our health-delivery system for this community is because the community recognizes that we are a part of them. When I think about it, most doctors of this generation think more of “me” than “we.” I see that as the big challenge – how to get this generation to think more of the “we” than the “me,” because if they don’t, they will have difficulty providing the care.

Q: As an ethnic physician, do you feel any special obligation to the community?

A: Very much so. We all want to narrow the health disparities in the United States. How do we do that? By working with the community at large, and by educating the people we work with to develop a louder legislative voice, so that the community can help improve health care. Ethnic-minority physicians, because we are respected in the community for our one-on-one service, need to extend that trust to be sure that the community can work together to be better advocates for their own care.

Q: Is it a challenge to get physicians to come back into the community?

A: In the Chinese community, the first barrier is a language problem. A lot of young doctors grew up in the suburbs, and their Chinese is at second- or third-grade level. It is very hard for them to communicate to patients in Chinese, especially since there are complicated matters where people's lives depend on their understanding. If they come back to Chinatown and speak only second- or third-grade Chinese, they get laughed at. They figure, “Why don’t I just practice in the broader community where my English is pretty good?” The second barrier is that it is hard to get started in private practice today when everybody is in a health plan. How can I help a young doctor when they first come in here and they don’t belong to the health plan panel?

Q: What does “serving community” mean to you?

A: When people say they want to serve their community, I ask them, “What is your community?” For my dad’s generation, it was China. When you talk to my generation from the '60s and '70s, we say, “Chinatown is my community.” When you ask my children’s generation, they have this nebulous Pan-Asian, Pacific Islander, Bay Area-something that they cannot really grab onto very well. So whenever you talk to people and say, “We want you to help your community,” you have to know in what context each generation defines its community.

Patricia Pratt: Q & A

Q: What do you hope others will learn from any recognition you receive?

A: There are frequently so many resources we fail to acknowledge because they do not come in the form of an MD or a PhD or a JD or whatever “D” we are dealing with. It is important, especially with what we have been able to do recently with community involvement, to partner with people who receive services rather than making decisions for them. We have to not just throw money into a situation, but throw dignity into a situation. I would like to see this used as an opportunity to get more parents on board, to give them more resources. We have to work with them. We are just one conduit to help them produce good citizens of the future.

Q: If you could influence the government, where would you put the resources to encourage more diversity in the health care professions?

A: I would put the resources into younger children. We have to do things for those currently in the pipeline to help them succeed in getting through higher education and professional training. We also must capture youngsters before their peer group does. When you have children coming from situations where parents are the “working poor,” where families do not have proper health care, and where the educational system produces low performance, then you have a myriad of problems that need resolution at the very beginning.

Q: What do you think is the current medical school environment for students of color?

A: The trend is definitely toward a more hostile environment overall. When I first started working to help UCLA to increase minority-physician populations, we had around 10 to 11 percent minority enrollment in the medical school. By 1998, we had 35 percent. The door was open, they were coming in and they were well-prepared. The passing of Proposition 209 in 1996 did not have an immediate impact upon UCLA because of our well-established pipeline to medicine for minority and disadvantaged students. However, 209 foretold our present political situation. I see the doors closing. More people of influence are saying, “We have done enough. Civil rights happened. Affirmative action happened. We need to take the best and the brightest of everyone and forget about leveling the playing field.” What is overlooked is that which makes us the best is the quality of human beings that come in through minority pathways.

Q: Are there members of your family who inspired you?

A: One of the proudest things in my background is that I got to know my great-grandmother, who was emancipated from slavery. She died when I was five, but every summer, my grandmother would take me to visit her. My great-grandmother had 16 children and 10 of them lived. All of them could read and write at a time in Mississippi when they could have been killed for being able to read and write. She had a lot of influence on me.