Eliminating Race-Based Clinical Algorithms: Progress and Challenges

The American Medical Association (AMA) recently conducted a survey on healthcare organizations’ efforts to eliminate race-based clinical algorithms and decision-making tools that inaccurately use race as a substitute for genetic or biological ancestry. The survey revealed that half of these organizations have already eliminated or are actively working towards eliminating such practices. This development is seen as a critical step towards addressing health equity and eliminating systemic biases within healthcare systems.

The survey conducted by the AMA received responses from 84 organizations, including state and territorial health associations, specialty societies, and city/county health organizations. While there was a variation in response rates among different organization types, the overall findings suggest a significant commitment to addressing race-based clinical algorithms. Notably, the Medical Society of Delaware took proactive steps to eliminate the use of race correction factors in estimated glomerular filtration rate (eGFR) calculations throughout the state. The society accomplished this by contacting all known labs and ensuring the removal of such algorithms.

The survey results also shed light on the challenges associated with achieving widespread change. The response rate from city/county health organizations was particularly low, potentially due to the absence of regular communication between these organizations and the AMA. As such, efforts are being made to establish alternative methods of engagement and data collection to ensure their perspectives are taken into account.

Furthermore, the survey found that 74% of organizations have taken actions to ground themselves in history and their local context, while 72% have prioritized equity in their strategic plans. However, members of the House of Delegates expressed frustration with the slow progress in embedding diversity, equity, and inclusion (DEI) efforts within medical societies. While some organizations have taken significant steps in this regard, there remains a disconnect between the efforts and the experiences of marginalized groups, such as the Mile High Medical Society of African American colleagues who feel excluded from their medical society.

Addressing the concerns raised by House of Delegates members, Aletha Maybank, MD, the AMA’s chief health equity officer, highlighted the importance of recognizing the progress made thus far and understanding the need for cultural evolution within organizations. She emphasized the need for courageous conversations and continuous efforts to push for equity. Acknowledging that these conversations sometimes test her own patience, Maybank emphasized the importance of perseverance in advancing toward a more inclusive and equitable healthcare system.

Another important aspect discussed during the session was the need to involve medical students and residents in DEI issues. While some students are hesitant to join organizations like the AMA due to historical concerns and past disregard for diverse voices, efforts are being made to address these reservations. The AMA’s chief academic officer, Sanjay Desai, MD, expressed the organization’s commitment to demonstrating the value of membership and engagement with the AMA. The association is actively engaging with over 70 schools, providing support and funding for initiatives that promote diversity and inclusion. By investing in partnerships and meaningful interactions with medical students, the AMA aims to diversify its membership and better represent the future physicians who will shape the organization in the years to come.

As the survey findings indicate, healthcare organizations are making genuine efforts to eliminate race-based clinical algorithms and decision-making tools. This progress marks a significant step towards addressing health equity and dismantling systemic biases within healthcare systems. However, challenges remain, including the need to engage with city/county health organizations and bridge the gap between organizational efforts and the experiences of marginalized groups. By continuing to have courageous conversations, pushing the boundaries of equity, and involving diverse voices, the medical community can collectively strive for a more inclusive and equitable future.

The survey conducted by the AMA provides valuable insights into the ongoing efforts to eliminate race-based clinical algorithms. The findings highlight the progress made by healthcare organizations in addressing health equity. By recognizing historical biases, fostering cultural evolution, and involving medical students and residents, the medical community is taking steps towards a more inclusive and equitable healthcare system. However, there is still work to be done to ensure that marginalized groups are not overlooked and that healthcare organizations consistently prioritize diversity and inclusion. Building on this momentum, the AMA and other stakeholders can continue to drive positive change and create a healthcare system that is fair and just for all.

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