1. < Message from the Chair

State of DoM EDI from the UCLA Department of Medicine Office of Equity, Diversity and Inclusion 

The mission of the UCLA Department of Medicine Office of Equity, Diversity and Inclusion is to intentionally push us to become the exemplar department of medicine (DoM) in the nation for advancing diversity, equity and inclusion across faculty, trainees, and staff. This Black History Month, I want to take a moment to honor their work and commitment to all forms of justice, including racial justice, here in the DoM.

This year's report, led by Dr. Norris, Cristina Punzalan, MPH and our EDI Team, highlights the strides we've made over the past year to improve diversity and inclusion within the department, and the notable areas of improvement. Some strengths are as follows: 

1. 83-86% report feeling a sense of acceptance and belonging within the entire organization and workplace.
2. 85% report feeling that people of all cultures, identities, and experiences are respected and valued within the organization and workplace.

Over 80% indicated that their organization, workplace and supervisor were committed to equity.  

Notable areas of improvement based on the survey are related to fair treatment at work, fair compensation, and the allocation of unwanted additional responsibilities.

In response, Dr. Norris and team have been busy working on several important initiatives, including the following:

• Creating affinity groups such as Women in Medicine and First Gen in Medicine among others for conversation and creating connections that fosters belonging. Conducting an analysis to determine the timeliness of faculty advancement based on the UCLA Call, is associated with race/ethnicity and gender.    
• Hiring Patrick Frierson who is charged with leading EDI programming and activities for staff. 
• Hosting a 'Lunch & Learn' series for staff members across all divisions to connect with one another and informally engage with topics around EDI (click here to sign up).
• Starting an initiative that provides 1-2 small grants per division/unit for EDI related activities for faculty (click here for more info).

DoM is also engaged in:

• Reorganizing the HR system and staff job descriptions to enhance equity and transparency of classification and salary.
• Continuous evaluation and revision if necessary, of faculty salary and incentives algorithms to enhance equity and support flexibility to account for alternate work locations including community sites.

Each of our DoM EDI initiatives is part of the team's larger effort to meet a set of SMART goals and key performance indicators that they're building out to improve treatment and belonging for all members of UCLA's DoM. We are grateful for their work and are proud to honor them this February as a part of our celebration of Black History Month and how our work towards equity, including racial equity, in the DoM, is connected to larger institutional and societal goals.

DoM Physicians Going Above and Beyond for Equity and Excellence

In the vein of our broader health equity work, I honor here a few DoM physicians who are committed not only to achieving racial justice in the context of health for patients, but also racial justice among physicians.

Folasade P. May, MD, PhD, MPhil: Focus on Bringing Lifechanging Medicine to Those Who Need it Most

While Dr. May was initially drawn to the field of healthcare by patients like the ones her father was serving in West Africa, leading her to Cambridge University where she studied epidemiology and international health. She ultimately became enraptured by the science, and jumped at the chance to participate in UCLA's STAR Program to further her efforts as a physician scientist. Today, she says that "though it was not an easy path, with a lot of sleepless nights, I feel like I've found the career that I'm supposed to be in." Adding that "you just have to find your passion and run in that direction." For her, that passion still centers around people; and more specifically, as a GI doctor, getting more patients -- especially underserved patients -- to participate in life-saving colorectal cancer (CRC) screening. 

Cancer is currently the number two killer of adults in the US, but Dr. May implores that we have the tools to lower that statistic as many cases are preventable, especially when it comes to CRC. "My goal is to prevent doctors from ever having to say the words 'you have colorectal cancer," states Dr. May. And for those patients that do have polyps that develop into cancer, her goal becomes detecting it early, at stage 1, when there's a 90% cure rate. The main challenge, she explains, is that communities have unequal access to preventive care -- especially communities of color, rural communities, and low-income communities. And she adds that even when those communities do get access to care, the quality is unequal as well. This challenge is what keeps her up at night: knowing that there are cures and tools for effective intervention, but that they're not equitably getting to the populations that need this care most.

In response, Dr. May has dedicated her academic work to health services research with the specific goal of bridging that gap. "There's this obsession with coming up with cures, everyone wants to develop a cure," she says. "And while we need our basic scientists to do this critical research, we also need health services research to help us understand how to get cures and therapies to everyone who needs it, efficiently, safely, and effectively." Through quality improvement projects, implementation science, large-scale studies on prevention disparities, and awareness campaigns, Dr. May is making significant strides in moving the needle on prevention access and offers that there's no better place than the diverse city of Los Angeles and the well-resourced and community-oriented nature of UCLA to conduct this work. Dr. May also knows that this problem is a holistic one -- and that equity in the populations we serve can only fully be achieved when there's equity within the healthcare system. As a result, in addition to population research, she's helping conduct large EDI studies within the field of GI, and hopes that we can improve not only the numbers of underrepresented populations in the field of medicine, but the quality of their education and training experiences as well.

Thank you, Dr. May, for your leadership in this area.

Utibe Essien, MD, MPH, Fights to Bridge the Medication Gap for Minorities in America

In practice, striving towards pharmacoequity can take several forms and crosses all domains of medicine. Dr. Essien's focus is on eliminating disparities in stroke-preventing medications for people with atrial fibrillation -- an irregular and often very rapid heart rhythm that can increase risk of stroke, heart failure, and other cardiac complications. These stroke-preventing medications are anticoagulants, or blood thinners, that are taken orally. Dr. Essien and his team have been central to unearthing evidence of disparity in access to and use of the widely available anticoagulant warfarin. "Our work across several datasets including Medicare data, VA data, and two large atrial fibrillation registries, have shown that Black patients in particular have been less likely to be started on stroke preventing therapies with a 25-30% lower chance of Black patients getting such therapies across a range of healthcare settings." 

Now, Dr. Essien is building off of this research to sound the alarm on seemingly even wider disparities in provision of the newest form of anticoagulant therapy, known as direct oral anticoagulants (DOACs), that are proven to be a more effective and safe therapy than warfarin. And though the development and approval of DOACs are a step forward for treatment of atrial fibrillation, Dr. Essien cautions that "whenever there's a new medication, people of color often get left behind.” He points to COVID-19 as an example: "Within literal months after the discovery of this new disease," he shared, "we had new vaccines, tests, and experimental therapies like Paxlovid. And yet, we saw these really huge gaps in access for minority patients in getting access to these interventions even though they were most likely to be more impacted by Covid."

Persistent disparities in medication access were what spurred Dr. Essien to coin the term pharmacoequity, and he's since doubled down on his goal of ensuring that all patients have access to lifesaving medications. Through access research, advocacy, and policy change, Dr. Essien hopes to continue tearing down barriers to equitable medication access from insurance access to housing status, to discrimination in the health system. Growing up in Queens, NY witnessing his father -- also a physician -- tirelessly work to improve the care of his community and Black and Hispanic populations in particular, is what originally sparked his interest in medicine, and continues to propel him forward in the field of medicine, where Black physicians still only make up 6% of the US physician pool. "Yes, representation matters in general, but it especially matters for patient care," he shares, explaining how having a doctor that looks like you can really change health outcomes. "I've had patients tell me, sometimes in tears, that I'm the first Black PCP they've had," he continues. "We're working to change that."

Karol Watson, MD, PhD, Tackles Racial Health Disparities In Women’s Cardiovascular Health

The difference in CVD risk levels between Black patients and White patients is stark, with Black adults at a 1.6-2.4-fold higher risk of developing cardiovascular disease than White adults. But Dr. Watson makes clear that the disparities don't end at CVD risk; rather, they extend to a range of other higher-level inequities. For instance, she shares that "disparities in CVD is a primary driver of disparities in life expectancy between Black and White Americans. Approximately 30% of the mortality difference between Black and White men and 40% of the difference between Black and White women is driven by disparities in CVD." These statistics highlight the enormity of the stakes in CVD disparities, which is what prompted Dr. Watson to focus her efforts in cardiology, and especially women's heart health and racial disparities in CVD risk among women.

While we are still uncovering the full picture of what causes these racial disparities in heart health, thanks to Dr. Watson and other CVD disparity researchers, we now have a much better idea than in the past. "Many people mistakenly believe that "race" is the cause of these disparities," Dr. Watson explains. "But we know that race and ethnicity are social constructs which are not rooted in biology or genetics. We now understand that social factors -- which we call social determinants of health (SDOH) -- play the biggest role in determining health outcomes. Things like having enough money for basic needs, having a safe living environment, having higher levels of education, having access to safe and nutritious food and one of the most critical factors is the influence that systemic racism has on health outcomes. These factors have the greatest impacts on our health." 

Dr. Watson has explored these factors through a range of studies, including the Diabetes Prevention Program Outcomes Study and the Multi-ethnic Study of Atherosclerosis. The Diabetes Prevention Program (DPP) was a seminal research study that showed people who are at high risk for developing type 2 diabetes can prevent or delay the disease by losing weight through diet and exercise. Now, Dr. Watson and her team are building off the DPP with The Diabetes Prevention Program Outcomes Study (DPPOS), which is examining if benefits observed by the DPP can be maintained long-term and if there are benefits in terms of outcomes like cardiovascular disease, cancer, and cognitive function. The Multi-Ethnic Study of Atherosclerosis is a large epidemiology study that was started in 2000 and followed several thousand men and women from 4 race-ethnic groups to investigate the prevalence, risk factors, and progression of subclinical CVD. Dr. Watson's hope is that through continued research via studies such as these, as well as through improving representation of Black cardiologists in the US, we can make strides to close the racial gaps not just when it comes to CVD, but health and wellbeing overall.

Internal Medicine Resident Diana Lopez, MD, Selected as a Bruin Scholar!

It's no surprise, then, that Dr. Lopez was selected to receive the Bruin Scholars Award. As an Angelino born and raised in South Central LA, Dr. Lopez is the youngest of four and the first in her family to attend college and go on to medical school. She shared that her upbringing -- including witnessing the benefits of the access to mentorship and opportunities she received, compared to her siblings -- and witnessing the lack of diversity in medicine, ignited both her passion in minority health and in diversifying medicine from the start of her career. 

Since her time as a premedical student, she's worked diligently to carve her path as a primary care physician while pursuing these two passions. During her time in residency, she has been highly involved with the UCLA Minority Housestaff Organization, where she's worked on conducting community outreach to recruit low-income, first generation, and Black and Brown students into medicine and supported fellow residents in developing EDI-specific projects; in her clinical work, she's stationed at Olive View-UCLA Medical Center, a state-funded acute care hospital in the San Fernando Valley primarily providing care to underserved communities; and now, she's working on building a pipeline investment program to bring underrepresented youth into medicine -- an effort that the Bruin Scholars Award will be supporting. Dr. Lopez credits UCLA and mentors like Dr. Lovelee Brown in pushing her EDI leadership forward. "It's really amazing that UCLA is recognizing the importance of EDI work and giving us the opportunity to help our communities," Dr. Lopez shared. "Being from LA and being able to serve underserved communities here in LA, that in many ways remind me of my parents and my own upbringing is very special. Within the award there's also the opportunity build out mentorship with faculty. Primary care is difficult work, but knowing that I have those mentors and networks, make me feel more positive about my future as a PCP and the future of healthcare overall."

I am inspired.

Dale

P.S.

I want to give a shout out to Drs. Lama Abdelnour, Kim Narain, Lucinda Leung and Estelle Everett who sent me this picture on Saturday morning, taken at the end of their recent participation in the AAMC Early Career Leadership Seminar, along with this very kind note:

"Dear Dr. Abel,

We hope this email finds you well. We wanted to express our sincere gratitude for sponsoring our attendance to the AAMC Early Career Women's Leadership Seminar. We completed the program in San Diego yesterday and we are glad to report that what we have learned will undoubtedly contribute to our professional development, and we are eager to bring back valuable insights that will benefit our current and future work within the department. Thank you again for your commitment to fostering the growth and leadership of your junior faculty. 

Best regards,

Kim, Lucinda, Lama, Estelle”

YOU ARE MOST WELCOMED! We look forward to seeing your careers flourish and the contributions that you will make to our department’s future! 

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