Mind the Gap: Working to Reduce Healthcare Disparities in Pediatric Rheumatology

Looking broadly at pediatric rheumatology research, Dr. Woo noted that limitations exist with respect to recruiting an appropriately diverse group of patients that represents the many strata of society. In essence, there is the true, affected population for any specific pediatric rheumatologic disease and then there is the final research population of individual studies. The former is much larger than the latter because the final research population may not include patients who are untreated or are not treated at a specific research center, those who are excluded due to the selection bias of the research team and/or those who are hesitant to participate in research due to the burden of living with rheumatic disease, the burden of being part of a study and/or other reasons.

Dr. Woo concluded by proposing goals for the field of pediatric rheumatology research. These goals include achieving a high degree of intentionality in how to consider race and ethnicity as part of the interpretation of research data and directly addressing disparities and inequities in care rather than identifying them without taking action to improve the situation.

Concerns for Clinical Care

Dr. Akinsete

The session’s second speaker was Alisha Akinsete, MD, a pediatric rheumatology fellow at the Hospital for Special Surgery, New York. She focused on strategies for mitigating disparities in pediatric rheumatology clinical care.

Dr. Akinsete laid out a rational and step-based approach for mitigation. Her approach includes identifying and monitoring disparities, investigating causes for disparate health outcomes, partnering with susceptible populations to develop interventions, testing interventions for efficacy in populations of interest and evaluating the efficacy of interventions’ efficacy in reducing disparities.

Next, Dr. Akinsete called attention to the current pediatric rheumatology workforce shortage, which is expected to worsen in coming years. Can we expand this workforce while ensuring it also increases in diversity? According to Dr. Akinsete, achieving this goal includes improving clinician retention, which may include financial support for diversity, equity and inclusion work, increased opportunities for individualized mentorship and community engagement geared toward minority groups underrepresented in the rheumatology profession. Other areas of focus include improving recruitment by increasing exposure to rheumatology at historically black colleges and universities, encouraging pediatric rheumatology programs to apply for diversity supplements from the National Institutes of Health and reducing bias during the interview process for prospective medical students, residents and fellows.

On the topic of bias, Dr. Akinsete explained that all individuals, including physicians, have subconscious biases that may influence how they practice medicine and treat different patients. To combat the sometimes deleterious effects subconscious bias may have on clinical care, Dr. Akinsete recommended every doctor seek to: