the American Association of Colleges of Osteopathic Medicine

This analysis was prepared by Venable LLP, on behalf of AACOM.

On Thursday, May 2, 2024, the Senate Health, Education, Labor and Pensions Committee held a full committee hearing discussing what Congress can do to address the severe shortage of minority healthcare professionals and the maternal health crisis. View the full hearing here.

WITNESSES

Panel 1:

The Honorable Laphonza Butler, U.S. Senator for the State of California, U.S. Senate
The Honorable Michael C. Burgess, MD, U.S. Representative for the 26th Congressional District of Texas, U.S. House of Representatives

Panel 2:

Yolanda Lawson, MD, President, National Medical Association
Samuel Cook, MD, Resident, Morehouse School of Medicine
Michael Galvez, MD, Pediatric Hand Surgeon, Valley Children's Hospital
Jaines Andrades, DNP, AGACNP-BC, Nurse Practitioner, Baystate Health
Brian Stone, MD, FACS, Jasper Urology Associates

OPENING STATEMENTS

In his opening statement, Chairman Bernie Sanders (I-VT) highlighted the urgent need to address two critical healthcare crises in America. Firstly, he emphasized the severe shortage of black, Latino, and Native American doctors and medical professionals. Sanders underscored the disparity in representation, citing statistics that reveal only 5% of all doctors, less than 4% of dentists, and just 6% of nurses in America are black, despite comprising nearly 14% of the population. He similarly noted the low representation of Latino and Native American healthcare professionals compared to their population percentages. Chairman Sanders stressed the importance of diverse medical personnel for improved health outcomes among minority communities, citing studies showing enhanced care and increased life expectancy when patients are treated by healthcare providers from similar backgrounds. Secondly, Chairman Sanders addressed the alarming rate of maternal deaths in America, particularly among black, Latina, and Native American women. He highlighted statistics indicating the disproportionately high maternal mortality rate compared to other wealthy nations, emphasizing the dire situation faced by minority women. Sanders proposed several solutions, including increasing class sizes at Historically Black Colleges and Universities (HBCUs), passing legislation such as the Black Maternal Health Momnibus Act, and boosting funding for programs like Women, Infants, and Children and the National Health Service Corps. Additionally, he advocated for making medical school tuition-free to ensure access to education for all aspiring healthcare professionals. Chairman Sanders concluded by expressing optimism about the growing support for tuition-free medical education and called for a serious discussion on these pressing healthcare issues.
In his opening statement, Ranking Member Bill Cassidy (R-LA) emphasized the pressing need to address shortages of physicians and healthcare workers, particularly in underserved areas, which he noted would affect the delivery of healthcare across all communities. Ranking Member Cassidy highlighted Louisiana's projected shortage of physicians, ranking third worst among states by 2030. He drew attention to the disparities in minority representation within the healthcare system, citing statistics that revealed black doctors account for only 8% of all physicians despite comprising 13.6% of the population, while Hispanic or Latino doctors account for 7.2% despite being 19.1% of the population. Ranking Member Cassidy also pointed out the nuanced discrepancy among minority groups, noting that Asian doctors, while representing 22.2% of all physicians, make up only 6.3% of the population. He stressed the importance of addressing access to opportunities, highlighting initiatives such as Xavier University's partnership with Ochsner Health to open a medical school aimed at serving underserved populations. Additionally, Ranking Member Cassidy emphasized the importance of upskilling for nurses to enhance the capabilities of the healthcare workforce. He acknowledged the challenges in ensuring healthcare system inclusivity and mentioned the discussion on maternal mortality, particularly its disproportionate impact on black women. He emphasized the need for further progress and discussed bipartisan legislation such as the Connected Maternal Online Monitoring Services (Connected MOM) Act, aimed at improving access to healthcare for pregnant women at risk of complications.
In her opening statement, Senator Laphonza Butler (D-CA) acknowledged Representative Lauren Underwood (D-IL-14), Senator Cory Booker (D-NJ), Representative Alma Adams (D-NC-12), and Vice President Kamala Harris (D) for their leadership in elevating the black maternal health crisis and championing related legislation. She underscored the urgent need for attention to the dire state of maternal health in the United States, citing alarming statistics, including the country's highest rate of maternal mortality among high-income nations and the steady rise in maternal mortality rates despite a decline in the birth rate. Senator Butler emphasized the disproportionate impact of the crisis on communities lacking access to essential maternal healthcare, with one-third of U.S. counties designated as maternity care deserts. She highlighted the significantly higher maternal mortality rates among Black and Native Indigenous communities compared to White communities and stressed the stark underrepresentation of Black and Brown populations within the healthcare field. Senator Butler urged the committee to focus not only on physicians but also on the full spectrum of reproductive health professionals, including doulas and nurse midwives, to address the maternal health crisis comprehensively. She praised existing models, such as the Martin Luther King Community Hospital in Los Angeles, for their integrated approach to maternal healthcare. Senator Butler advocated for the passage of the Black Maternal Health Momnibus Act, which comprises thirteen bills aimed at combating the crisis and addressing disparities in maternal health outcomes.
In his opening statement, Representative Michael Burgess (R-TX-26) drew on his extensive medical background, including nearly three decades of practice in obstetrics, to recommend solutions to the maternal health crisis. Representative Burgess highlighted his commitment to maternal healthcare. He recounted his experiences at Parkland Memorial Hospital in Dallas, Texas, where he witnessed the importance of proper care and attention to patients. Representative Burgess emphasized the need for accurate data collection on maternal mortality rates and shared his legislative efforts to address disparities in maternal health outcomes. He discussed his involvement in various bipartisan legislative initiatives, including the Preventing Maternal Deaths Reauthorization Act and the Maternal Health Quality Improvement Act. Representative Burgess also underscored the significance of Maternal Mortality Review Committees in identifying causes of maternal deaths and improving health outcomes. He highlighted the extension of postpartum coverage in Texas and stressed the importance of bipartisan collaboration to reduce disparities and improve healthcare outcomes. Representative Burgess concluded by emphasizing the need for Congress to evaluate existing programs and engage with community and physician-led efforts to address healthcare challenges effectively.
In her opening statement, Dr. Lawson explained that African Americans have lower life expectancies and are generally unhealthier than their white counterparts, irrespective of their socioeconomic status. Research demonstrates that such inequities in health outcomes have existed since federal recordkeeping began, and Dr. Lawson was dismayed to note that these disparities cannot be explained by socioeconomic status. To address these disparities, Dr. Lawson advocated for the implementation of an equitable health policy and structural change in the medical system. This includes increasing the number of non-white healthcare providers. According to Dr. Lawson, patients from racially minoritized backgrounds who are treated by healthcare providers who share the same race or ethnicity as them consistently experience better health outcomes. She summarized this phenomenon succinctly: “Patients can have better health outcomes when their doctors look like them.” Dr. Lawson also called for more funding and resources for the National Health Service Corps and HBCU medical schools to expand the pipeline of minority health professionals.
Dr. Samuel David Cook, a PGY-3 Internal Medicine Resident Physician at the Morehouse School of Medicine, shared in his opening statement his personal journey from growing up in the Bronx to pursuing a career in medicine. Dr. Cook emphasized the need to address the shortage of black doctors in the American workforce and outlined the challenges faced by underrepresented minorities in accessing medical education. He highlighted the critical role of HBCUs in fostering diversity in medical education and stressed the financial burden of medical school debt on students of color. Dr. Cook underscored the importance of cultural competence in medical practice and advocated for increased funding for HBCU medical colleges to support the recruitment and retention of black and Brown physicians. He shared anecdotes illustrating the impact of racial biases in healthcare and urged Congress to take immediate action to address these disparities. Dr. Cook concluded by calling for bipartisan support for legislation aimed at funding and protecting HBCU medical schools to ensure a diverse and culturally competent healthcare workforce for the future.
In his opening statement, Dr. Michael Galvez advocated for his Latino community and the underrepresented Latino physicians in the medical field. He emphasized the importance of language and cultural proficiency in providing high-quality care to diverse patient populations. Dr. Galvez highlighted the disparity in representation of Latino physicians in the workforce—despite being the largest minority group in the U.S., Latinos represent only 6.9% of the physician workforce, a contrast to their almost 20% representation of the nation’s population and nearly 40% in the states of California and Texas. By 2050, the Latino population will comprise one-third of the U.S. population. He outlined several recommendations for Congress, including expanding funding for pathway programs, prioritizing language proficiency in medical school admissions, and funding loan repayment programs to attract physicians to underserved areas. Dr. Galvez called for a concerted effort to increase diversity in the medical profession to better serve the needs of the growing Latino population and address the public health crisis facing underserved communities.
Dr. Jaines Andrades, a nurse practitioner at Baystate Medical Center in Massachusetts, shared her journey from high school in Springfield to her current position, emphasizing the crucial role of mentorship and financial support in her education and career. She highlighted the need for robust college and career planning to make students, especially those in lower-income areas, aware of healthcare as an attainable career option. Dr. Andrades advocated for programs like the Baystate Springfield Educational Partnership, which provides early professional mentorship for minority youth. She also suggested making community colleges tuition-free and offering state and federal grants to reduce the financial burden of education for minority students pursuing careers in healthcare. Dr. Andrades emphasized that supporting the education of minority students in healthcare is a wise investment that addresses workforce shortages and provides economic stability to individuals and their families.
In his opening statement, Dr. Stone recounted his experience as a urologist serving a diverse group of people across rural and inner-city settings. Despite differences in geography, Dr. Stone noted that both urban and rural settings suffer from the same health disparities and trouble accessing quality care. He believes this problem will only be exacerbated by the lack of diverse healthcare professionals entering the workforce. Dr. Stone claimed that recruitment for African Americans to medical schools peaked in 1994, and a 2018 Pew Research study found that the poor foundation of STEM education in K–12 schools was the root cause of the recruitment problems faced by medical schools. Dr. Stone again echoed the sentiments shared by his colleagues that black patients have better health outcomes when treated by black physicians. To bring more physicians from different racial and ethnic backgrounds into the healthcare workforce, Dr. Stone called for Congress to help expand the size of medical schools, expand the size of residency programs, alleviate the financial burden of seeking a medical degree, and get students interested in medicine earlier in their education.

QUESTION AND ANSWER

Chairman Sanders shared an anecdote about a black Howard University student whose concerns were not taken seriously by a white physician. He asked the panelists to explain why it is so important for patients to be treated by providers that share similar racial and ethnic backgrounds. Dr. Lawson responded that being treated by a physician with a similar background leads to better trust between the physician and patient, which facilitates better communication and adherence to prescribed therapies. Dr. Cook answered that it is easier to understand and relate to a patient when they come from a similar background. Dr. Galvez says that increased “cultural competency,” including speaking the same language, prevents important medical advice from getting lost in translation. Dr. Andrades and Dr. Stone gave similar responses. Next, Chairman Sanders noted that many medical students leave medical school saddled with debt and that this tends to be even more difficult for medical students of color to overcome since they more frequently come from lower-income communities. He asked Dr. Lawson to discuss the financial burden of attending medical school and how it affects the pipeline of minority physicians. Dr. Lawson replied that the financial burden of medical school makes it “almost impossible” for many potential doctors to get their degree. She added that many minority students require scholarships to attend, and she emphasized the importance of these types of resources for disadvantaged students.
Ranking Member Cassidy expressed deep concern about the high incidences of prostate cancer amongst African Americans. He asked Dr. Stone to explain the challenges African Americans face after being diagnosed with prostate cancer. Dr. Stone noted that African American patients struggle to get enrolled into clinical trials and that the data used to inform clinical trials often comes from white patients. He claimed that research has shown that different cultural groups metabolize medicines at different rates, and that despite this, dosage recommendations tend to be based on how white patients metabolize the medicine. Dr. Stone is engaging with faith-based communities to increase participation in clinical trials by diverse populations. Next, Ranking Member Cassidy asked Dr. Andrades how to inspire underserved students to enter the medical field. Dr. Andrades highlighted the importance of having role models that look like you, and she spoke to her own experience of being inspired by a fellow Puerto Rican nurse who encouraged her to upskill and become a nurse practitioner.
Senator Bob Casey (D-PA) urged Congress to invest in the nation’s children in order to spur interest in the medical profession. He then turned to Dr. Lawson and reaffirmed the importance of having a diverse medical workforce. He asked Dr. Lawson to explain why it is important, particularly with respect to maternity care, to have a diverse workforce. Senator Casey also asked Dr. Lawson to provide information on the importance of doulas and midwives in promoting maternal health. Dr. Lawson responded that doulas provide “excellent” support to women during the birthing process, including after birth by conducting postpartum check-ins. She added that doulas help build a sense of trust with women, which leads to increased communication about needs. Senator Casey then highlighted the importance of community colleges in expanding the health professional workforce, and he asked Dr. Galvez how community colleges could be better leveraged to diversify and grow the health professional workforce. Dr. Galvez called community colleges an “untapped resource” and explained that these institutions provide students with mentorship and guidance to help put them on a successful career trajectory.
Senator Roger Marshall (R-KS) claimed that it has been his life’s work to reduce maternal mortality rates in the U.S. He cited several startling statistics. In 2023, there were 684 maternal deaths, down from 1,205 in 2021. While this rate reflects the hard work of providers across the country, Senator Marshall was dismayed that the leading causes of maternal deaths were substance-use disorder and suicide. Shockingly, over half of these deaths occur a week after a mother gives birth. To solve this problem, Senator Marshall suggested that the Committee continue its work to expand access to community health centers (CHCs), which he believes have great potential to improve maternity care and health. Senator Marshall also mentioned that he and his wife were both products of community colleges and the importance these institutions have in bolstering the U.S. healthcare workforce.
Senator Tim Kaine (D-VA) highlighted critical provisions within the American Rescue Plan, which included a provision to allow states to provide Medicaid postpartum coverage for up to a year. This was an increase from the previous 60-day limit. As a result of this, Senator Kaine explained that 46 states have adopted this option and that 3 states are in the process of adopting this option. He asked Dr. Lawson why the extension of postpartum Medicaid coverage is so crucial. Dr. Lawson answered that postpartum Medicaid coverage allows both mom and baby to get access to healthcare services and that promoting infant health has strong implications for a person later in life. She added that two of the leading five causes of death for infants are death from complications during birth and low birth weight. • Senator Mike Braun (R-IN) touted his legislation with Chairman Sanders that would increase price transparency for health plans and hospitals, which he claimed are becoming increasingly consolidated and leading to skyrocketing prices for patients. He criticized private equity firms and other corporate entities for purchasing healthcare organizations, arguing that these companies have no intention of improving the health and well-being of patients. He emphasized the importance of preventive care and how a cultural shift is needed to address the root cause of chronic disease, which is one of the main drivers of excessive healthcare spending. Last, Senator Braun lamented the high rates of maternal deaths in his state of Indiana—the third worst state in the entire country for maternal mortality rates.
Senator John Hickenlooper (D-CO) believes apprenticeships can be helpful in connecting racial and ethnic minority groups to unfilled healthcare professional jobs. His state, Colorado, is already piloting a program to do this. He asked Dr. Galvez and Dr. Andrades if registered apprenticeships were a good idea to expand the minority healthcare workforce pipeline. Mr. Galvez agreed that apprenticeships have the great potential to increase the number of minority health professionals. He cited “shadowing” as an example of how apprentices can learn about the critical work healthcare providers do and get a more in-depth experience of what the day-to-day operations of working as a healthcare professional is like. Dr. Andrades followed-up, arguing that apprenticeships give students access to multiple different perspectives and opportunities they would not otherwise have access to.