Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Obstet Gynecol. 2022 Nov 1;140(5):739-742. doi: 10.1097/AOG.0000000000004920. Epub 2022 Oct 5.
Disparities in health by race, ethnicity, and socioeconomic status within obstetrics and gynecology are well described and prompt evaluation for structural barriers. Academic medicine has a historical role in caring for marginalized populations, with medical trainees often serving as first-line clinicians for outpatient care. The ubiquitous approach of concentrating care of marginalized patients within resident and trainee clinics raises ethical questions regarding equity and sends a clear message of value that is internalized by learners and patients. A path forward is elimination of the structural inequities caused by maintenance of clinics stratified by training level, thereby creating an integrated patient pool for trainees and attending physicians alike. In this model, demographic and insurance information is blinded and patient triage is guided by clinical acuity and patient preference alone. To address structural inequities in our health care delivery system, we implemented changes in our department. Our goals were to improve access and patient experience and to send a unified message to our patients, learners, and faculty-our clinical staff, across all training levels, are committed to giving the highest standard of care to all people, regardless of insurance status or ability to pay. Academic medical centers must look internally for structural barriers that contribute to health care disparities within obstetrics and gynecology as we aim to make progress toward equity.
妇产科领域的种族、族裔和社会经济地位的健康差异已经得到了充分的描述，并促使人们对结构性障碍进行评估。学术医学在照顾边缘化人群方面发挥了历史作用，医学受训者通常是门诊护理的一线临床医生。将边缘化患者的护理集中在住院医师和受训者诊所的普遍方法引发了关于公平性的伦理问题，并向学习者和患者传达了一个明确的内在价值观。前进的道路是消除由按培训水平分层的诊所维护造成的结构性不平等，从而为受训者和主治医生创建一个综合的患者群体。在这种模式下，人口统计学和保险信息是盲目的，患者分诊仅由临床紧迫性和患者偏好来指导。为了解决我们医疗服务系统中的结构性不平等问题，我们在部门内部进行了改革。我们的目标是改善获得医疗服务的机会和患者体验，并向我们的患者、学习者和全体教职员工发出统一的信息——我们所有培训级别的临床工作人员都致力于为所有人提供最高标准的医疗服务，无论其保险状况或支付能力如何。随着我们努力朝着公平性取得进展，学术医疗中心必须从内部寻找导致妇产科领域医疗保健差异的结构性障碍。
