Week 4: Our Commitment to Our Community

By sjmartinez • January 31, 2022

I continue to be energized as I learn more about the Department and UCLA that will inform our strategic goals. I want to share some reflections on our commitment to the diverse communities that we serve, our faculty and trainee’s commitment to health equity and the opportunities and challenges that face us.

Let me start with what I learned from my survey. This question sought to get your assessment of our Community Impact. Specifically: Are we ensuring that our missions directly impact and interact with the communities that we serve? Particularly in addressing health disparities. Do we have strong community support? (0 = strongly disagree, 5= strongly agree).

Question	0	1	2	3	4	5	Total
COMMUNITY IMPACT	14	45	95	108	103	51	416

We have work to do. Let me share a couple comments that crystallize sentiments that I have heard since my arrival.

"I think we can do better in integrating into the communities that we are expanding into. This includes advertising in ways that the community will see and respond to in order to build our name and presence, getting contracts with the local hospitals and HMOs so that we can more effectively build our practice, and accept MediCal to be able to reach out and care for the lower income patients to address health disparities."

"We have enormous geographical gaps in underserved areas, and it must change - especially as a public institution. The Venice Clinic cannot be the only clinic we hang our hat on. We need many, many more Venice Clinics in underserved areas."

"Our department has long prioritized expansion of clinical access and care for wealthy, privately insured populations and has referenced relationships with Olive View and the VA as being sufficient investments in under resourced communities. This attitude must be abandoned for us to truly realize the vision many of our faculty and trainees share and long to contribute toward - the vision of a department which serves as a powerful agent of equitable health care, the domain we have historically most neglected. Many of us believe our department is positioned to lead UCLA Health to finally become a socially responsible institution and national leader, if we intentionally commit and strategize toward this end. Thank you for your leadership and for giving us the opportunity to provide this feedback to inform the future directions of our department!"

"UCLA attracts and retains some incredible people, but I worry that we've silently promoted and accepted a corporate culture of maximizing department revenue without thinking about whether we're pulling our weight when it comes to the community health of all Angelenos. I would encourage our department to reflect on access to UCLA's tertiary care for our MediCal patients and work closely with existing faculty who have already put in considerable time and effort into thinking about how these contracting practices can change. I would also like to see a culture where folks felt more comfortable challenging the status quo and having difficult conversations, which I think is partially addressed by the EDI work being done now at the C-suite level."

"I think we can do more to provide care to our diverse, sometimes underserved communities in Los Angeles. The majority of our clinics/urgent cares are in wealthy areas of the community. Some patients prefer to seek out care at UCLA, but they need to travel quite a way (far East LA, Palmdale, etc.) as we do not have a presence close to them. A 365 urgent care in central LA or downtown would be great for accessibility."

These questions got me thinking and asking around. I learned that work is being done to improve current awareness of existing contractual relationships to improve outpatient access for Managed Medi-Cal patients. I learned that one of UCLA Health’s strategic goals for FY 2022 is to identify and develop recommendations to reduce UCLA Health-specific barriers that prevent patients with Medi-Cal from accessing ambulatory services.

So, are these competing or conflicting narratives, or a path to continue to advocate that we do more? I think the latter. We should continue to put our voices and advocacy at all levels and harness our creativity to address disparities in health care delivery in ways that are sustainable yet consistent with the core values that most of us hold dear. I am committed to this journey.

Let me share some examples of advocacy on the international scale by our faculty, as exemplified by two important publications this week. I read with interest articles by our faculty underscoring the corrosive impact of racism on health equity. In an editorial in the Journal of the American Heart Association by one of our distinguished cardiologists Dr. Karol Watson she emphasized the corrosive effect of segregation and disenfranchisement on health outcomes

And a thoughtful piece my Dr. Keith Norris and colleagues in Nature Reviews Nephrology, detailed the relationship between racism and renal disease.

Let me share a local example that speaks to our commitment of going the extra mile to ensure that the needs of our patients are being met. I learned of supply chain limitations that would have curtailed the supply of pharmaceutical grade allergy extracts for our large practice of patients who depend on these shots. This would have set back hundreds of patients across our entire network. After seeking out all potential alternatives, Dr. Rita Kachru Associate Professor and Section Chief for Clinical Immunology and Allergy gave up her vacation and marshalled the entire nursing and pharmacy team in our allergy clinics to compound all the allergy injections for the entire practice (one of the largest in California), in house, using protocols that are compliant with USP regulations! This impressive devotion to our patients is an inspiration.

My notes have triggered intense interest to spread the word about the many remarkable things that happen in our department. I have enjoyed hearing about our growing Endocrinology-Oncology program led by Drs. Melissa G. Lechner and Stephanie Smooke Praw, of our cardiology fellows winning the southern California Fellow in Training Jeopardy (on to Stanford next for the game!), multiple new grants awards to our faculty and the successful ongoing accreditation without reservations of all but one of our many training programs. I am assembling a communications team who will be working on ways to effectively disseminate these stories. As a first step, I am pleased to announce the launching of: DOM_News DOM_News@mednet.ucla.edu

Keep the stories coming, send them to DOM_News, they will be shared!

Dale

P.S.

We hosted the first (of likely many) winter refugees this week. Our son visited us from Salt Lake City. Amazing how an extra pair of hands can expedite the unpacking and collapsing of boxes, when they are empty. Our living situation gained much from his visit, in exchange for a little California sunshine. My mom turns 87-years old this week, we had a good chat yesterday and she is making plans for a visit too, although it is warmer right now, in Jamaica!

Tags: cardiology, cardiovascular diseases, clinical immunology and allergy, endocrinology-oncology, health equity, Message from the Chair, nephrology