Health Equity a VMS Priority

“I’m here to get it right, not to be right.” - Brene Brown

The Vermont Medical Society maintains its commitment to provide an inclusive membership-based community, in which all physician and physician assistants, from all demographics and belief-systems, are welcome to participate. We also work to combat all inherent bias in health care, both towards the patient and towards the clinician.

VMS leadership and membership have adopted these related policies:

• 2022 - Vermont Medical Society Supports Reproductive Access in Light of Draft Supreme Court Opinion
• 2021 - Medical Leaders Call on Scott and Lawmakers to Denounce Restrictions to Gender Care
• 2020 - Statement Condemning Police Brutality and Pronouncing Systematic Racism a Public Threat
• 2019 - Codifying Protection for Women’s Reproductive Rights
• 2019 - Support for the Humane Treatment of Migrant Families at all U.S. Borders
• 2018 - Recognizing and Addressing Bias Within the Health Care System

Brattleboro Memorial Health's Anti-Racism in Medicine Practices

VMS is honored to share examples being spearheaded at Brattleboro Memorial Hospital by Imogene Drakes Ph.D., FACHE, BMH Laboratory Director, and Becky Jones, M.D., a Brattleboro dermatologist, to update systems of care to remove biased practices and better meet the needs of all patients. Listed below are some of the changes they have advanced. Please reach out to idrakes@bmhvt.org to learn how you can make these changes in your practice.

• Vaginal Birth After Cesarean (VBAC) Algorithm: This calculation which results in Black/African American women being scheduled more frequently for C-sections was discontinued at BMH in 2018.
• Nephrology: BMH stopped using the African American GFR calculation that resulted in delay in kidney care for African Americans before the National Kidney Foundation recommended the new BKD-EPI-2021 calculation that is now being used for all races.
• The Anemic Calculation for Black mothers was discontinued by the OB/GYN. The calculation for Black prenatal mothers had meant that Black mothers were given care for anemia much later than other mothers-to-be.
• Cerner-based 10 years Cardiovascular Risk Calculator contains race as a factor: The Cardiologist at BMH does not rely on Cardiac Risk Calculators to treat patients, but he stated the other method he uses may be a barrier for care for people who need it the most since many insurances do not want to pay for the alternative method.
• Pulse-oximetry: A specific brand (Masimo) that seems to be the most appropriate for darker skin tones has been used in the BMH Emergency Room since 2014. Many other oxygen level detectors do not adequately compensate for dark skin color and so oxygen deficiency in Black people may go undetected. This disparity in detection became more noticeable during the COVID-19 pandemic when a disproportionate number of Black people died due to respiratory complications.
• For more information on reconsidering race based health algorithms, see here.
• For examples from a Philadelphia-area coalition working to end race adjustments in clinical decision support tools, see here.

Health Equity Resources

• AMA STEPS Forward™ toolkit Racial and Health Equity: Concrete STEPS for Health Systems
• AMA Health Equity Education and Resources
• Cultural Complications Curriculum – Leveraging M&M Conferences to Advance Culture
• Hanley Center for Health Leadership “In All Fairness” video series
• VDH Health Equity Resources
• VPQHC Health Equity Trainings
• Northern Vermont AHEC Quality Care is Equitable Care Series
• State of Vermont Health Equity Advisory Commission
• State of Vermont Office of Racial Equity/Racial Equity Advisory Panel
• VT Racial Equity Advisory Panel Action and Allyship Guide
• APHA Racism and Health
• WHO Health Equity

AMA Educational Resources to Advance Equity

In alignment with its commitment to inform and educate physicians on topics important to health equity, the American Medical Association (AMA) announced in fall 2021 a series of CME and educational activities aimed at addressing the root causes of inequities, including racism and other structural determinants of health. The content — featured on the AMA Ed Hub™ Health Equity Education Center and curated by the AMA’s Center for Health Equity—equips physicians and other learners with core health equity concepts needed to support them as they continue to take action and confront health injustice. Topics include the Prioritizing Equity CME video series:

• Prioritizing Equity — The Root Cause: An overview of health equity perspectives from advocates whose work is driven by the mission to address the root cause of health inequity and the social determinants of health.
• Prioritizing Equity - Accomplices and Co-Conspirators: How physicians can get actively involved in the fight for racial justice and equity.
• Prioritizing Equity - Research and Data for Health Equity: Distinguish health equity data and the challenges of quantifying health inequities and the structural and social determinants of health.
• Prioritizing Equity — Trustworthiness & Vaccines: A review of misinformation, trustworthiness, and strategies to handle vaccine hesitancy among patients and health care professionals.
• Prioritizing Equity — Mental Health and COVID-19: Covering COVID-19’s immediate and long-term effects on the mental health of minoritized and marginalized communities.