Shivani Parmar, MPH

In low-income areas where educational and career opportunities are limited, the AMA’s Doctors Back to School Program works to give students a vision of something bigger.   

Katie* is 16. She wants to be a neurosurgeon some day. She also lives in inner-city Detroit, MI and is the second oldest of 12 children in a single-parent family. 

“You can imagine the challenges she is going to face,” says Art Fleming, MD, Vice-Chair, Disparities in the Workforce Committee, Area Coordinator for the Doctors Back to School (DBTS) Program. Katie, however, is unique. Despite a difficult living situation, she has not let it stop her from dreaming big. In the minds of many students in a similar situation, becoming a doctor is simply not a realistic career option. The level of expectation of the average student living in a heavily unemployed, low-income, and drug-infested area is simply not that high. 

The Doctors Back to School Program was created precisely with these students in mind. 

“One of the things that remains a real challenge is the lack of diversity in the physician workforce… We have to be honest when we look at the statistics. We have to know that despite our best effort, there are still terrible healthcare disparities that occur in this country,” says AMA president Nancy Nielsen, MD, PhD. 

“African Americans, Latinos, and Native Americans make up one out of every four people in the United States, but only 7% in the physician workforce,” explains Fleming. Recognizing this discrepancy between the number of minorities in the US population, and the number of minorities represented in the physician workforce, the AMA’s 

 (DBTS) program in March 2002. The concept was simple: the program arranged for physicians, particularly minority physicians, to visit inner-city schools to share their experiences with students and talk about their journey to becoming a doctor. The visits would expose young people to the possibilities offered by the healthcare professions, and give them the opportunity to speak with a physician other than their own family doctor. The program was especially created to reach out to African American, Hispanic American, and American Indian students. 

Commission to End Health Care Disparities

 joined forces with the Minority Affairs Consortium. Because the Commission held meetings twice per year in different cities around the country to convene its 70 member organizations, the Commission was an ideal partner to help the MAC increase the reach of the Doctors Back To School program. Soon, the two groups began jointly arranging visits to schools right before, during, or just after the meetings. A typical visit consisted of physicians attending school for half-day meetings with students of varying age groups. Occasionally, the visits were set up as a general assembly where visiting physicians presented to 200-300 students at a time. 

“The overarching message is that somebody who looks like you, who is a minority like you, can become a doctor, and so you can become a doctor too,” says Sonja Boone, MD, Director of Physician Health and Health Care Disparities. This is an important and challenging message to convey to students living in low-income areas, for many of whom attending college simply is not a realistic or tangible goal. 

Physician Characteristics and Distribution in the US, 2008 Edition

“I grew up poor in West Virginia. My dad was a plumber. The horizon for a kid like me was really pretty narrow,” says Nielsen. “That’s true for many of our kids, whether they’re impoverished or from minority groups. Going to college has never happened in their family before, let alone going way beyond that for another four years to go to medical school. The important thing is to let kids know that they can have that kind of vision.” 

Boone, who comes from a single-parent family, says she has received many surprised reactions from students. “You were still able to pay for medical college?” they often ask her. “It’s amazing how their eyes just light up when they see somebody who looks like them standing before them in a white coat and talking about the challenges they may have had,” says Boone. “It can be hard for kids to relate to adults in general, but when these adults say, ‘You know, I came from a single-parent family and we were not wealthy or well-to-do, and I didn’t think I could go to medical school. But I did go to medical school. I was smart enough, and yes I had to get financial aid, but that’s okay. I still got the education, and I was able to pay those loans back,’ it opens the possibilities in the minds of these students that you can overcome any obstacle. You can do anything you want.” 

“Hopefully, speaking with a physician has at least given them a glimpse of what they can aspire to, and what a wonderful career medicine and other health careers offer. The problem though is that it’s only a one time thing,” says Nielsen. 

Ambition and dreams will not be enough to allow Katie to become a neurosurgeon. She is already struggling with her high school-level science classes. “She does not have a possible chance unless she is able to find someone who will help guide her, talk to her about the needs for a science background, and what she can do to get help in regards to her science courses,” says Fleming. 

“The first visit I did was to a school in southern California that had 309 graduates that year. Of those 309 graduates, only two had one or both parents who had started or finished college, meaning 307 had nobody in their family who started or finished college. Not only is this a handicap, but when you consider that the school is surrounded by four housing projects where there’s subsidized housing and large unemployment, you realize that it is not easy to impact these communities. That is where mentoring programs are going to be vital,” adds Fleming. 

Today, the DBTS program is working to create a mentoring component to build a support structure to keep students who are exhibiting an interest in the health sciences excited. The workforce committee of the commission is encouraging local medical societies and their doctors to regularly participate in DBTS visits and become involved in a mentoring program. Beyond commission physicians coming as a one-time visit, physicians locally will be able to stay in touch with interested students, meeting with them on occasion, providing them with support as they go through the process of studying for exams in high school, helping them to apply to colleges that have strong pre-med programs, and eventually giving them advice about getting into medical school. This kind of support is particularly important now with the increasing shortage of healthcare workers, especially in minority and inner-city areas. 

“It has been demonstrated time and time again that minority physicians are more likely to work in minority areas, or take care of underserved populations,” says Fleming. Since MAC and the Commission partnered together in 2007, the program’s physicians have spoken with more than 17,000 students. The DBTS program, however, has even more ambitious aims, hoping to reach 100,000 students in the next couple years. 

“Have the results been what we want? I think every group that gets together to talk about health disparities will tell you ‘Absolutely not,'" says Nielsen. “The real goal is to put ourselves out of business because there wouldn’t be anymore healthcare disparities. I’m being a little facetious here, but the point is we aren’t there yet. There is much, much more we need to do.” 

Get involved in the DBTS program by visiting 

 to download a tool kit or contact Dr. Arthur Fleming directly at 

Articles

In low-income areas where educational and career opportunities are limited, the AMA's Doctors Back to School Program works to give students a vision of something bigger.

Doctors, Go Back to School

 that Internet surfing can significantly relieve chronic pain in seniors. 

Three Illinois researchers conducted the Self-care Pain Management Project during which they “assessed the feasibility and efficacy of delivering online mind-body self-care techniques to 78 adults aged 55 and older with chronic pain.” The intervention group accessed a website with “six modules for support with pain coping techniques such as abdominal breathing, relaxation, writing about positive experiences, writing about difficult experiences, creative visual expression and positive thinking.” The site offered instructional materials such as videos, illustrations, and worksheets meant to encourage participants to reflect on their reactions to pain and the strategies they used to cope with their pain. Participants were instructed to use this online intervention at least once a week for six weeks.   

Researchers evaluated “changes in pain intensity, limitations due to pain, pain self-efficacy, depression, anxiety, and awareness of responses to pain from baseline to follow-up at 6 weeks.” The collected data showed that there was a “statistically significant difference in pain response awareness in the intervention group and meaningful improvements in pain intensity and levels of interference in daily activity attributed to pain.” The site helped to improve the level of patients’ confidence in nonmedical self-care techniques to manage pain.  

The authors suggest that online interventions may “empower older adults with chronic pain to engage in self care, focus on managing pain in a positive way, and integrate what they learn into their daily routines.”  

A new study published has found that Internet surfing can significantly relieve chronic pain in seniors.

Internet Eases Pain in Elderly

 (AAPM) has issued a new set of clinical guidelines aimed at aiding clinicians with prescribing opioids for patients with chronic non-cancer related pain. Panel co-chair Gilbert J. Fanciullo, MD, stated in a 

 that the experts concluded “that opioid pain medications are safe and effective for carefully selected, well-monitored patients with chronic non-cancer pain.”  

, the guidelines were established by reviewing more than 8,000 published abstracts and non-published studies. The review was conducted particularly because opioid prescribing has “increased significantly due to growing professional acceptance that the drugs can relieve chronic non-cancer pain, and the guideline acknowledges there are widespread concerns about increases in prescription opioid abuse, addiction and diversion.” The panel made 25 recommendations with unanimous support for almost all. The recommendations covered patient selection and risk stratification, high-risk patients, methadone, informed consent and opioid management plans, patient monitoring, and other topics.    

Panel co-chair Perry Fine, MD, emphasized that “Decisions about chronic opioid therapy must weigh the benefits of these medications against the risks, which include side effects and adverse outcomes associated with abuse.”  

The key recommendation advocates that clinicians “continuously assess patients on chronic opioid therapy by monitoring pain intensity, level of functioning and adherence to prescribed treatments. Periodic drug screens should be ordered for patients at risk for aberrant drug behavior.”   

“Regular monitoring of chronic opioid therapy patients is warranted because the therapeutic benefits of these medications are not static and can be affected by changes in the underlying pain condition, coexisting disease, or in psychological or social circumstances,” explained Fanciullo. “For patients at low risk for adverse outcomes and on stable doses of opioids, monitoring at least once every three to six months is sufficient, but weekly monitoring is justifiable for those at high risk for abuse and other adverse events.”  

Additionally, Fine pointed out that self reports provided by patients can often be unreliable and should be cross-checked with urine drug screenings, pill counts, and caregiver interviews to ensure there is no possibility for drug abuse.   

For the full text of the APS/AAPM clinical guidelines, please 

A panel of experts from the APS and AAPM has issued a new set of clinical guidelines aimed at aiding clinicians with prescribing opioids for patients with chronic non-cancer related pain.

New Opioid Prescribing Guidelines

Researchers from the Université de Montréal have determined that the ancient practice of Zen meditation may have pain reducing qualities. Published in the January issue of 

 shows that “Zen meditators have lower pain sensitivity both in and out of a meditative state compared to non-meditators.”  

Joshua A. Grant, co-author of the study, stated that while “previous studies have shown that teaching chronic pain patients to meditate is beneficial, very few studies have looked at pain processing in healthy, highly trained meditators. This study was a first step in determining how or why meditation might influence pain perception.” 

The study examined the reactions during a pain test of 13 Zen meditators who had at least 1,000 hours of practice against the reactions of 13 non-meditators. Participants were between the ages of 22 and 56. For the pain test, a “thermal heat source, a computer-controlled heating plate, was pressed against the calves of subjects intermittently at varying temperatures. Heat levels began at 43 degrees Celsius and went to a maximum of 53 degrees Celsius depending on each participant’s sensitivity.” Several of the meditators were able to cope with the maximum temperature. All of the non-meditators however bowed out below the maximum temperature.   

There was a major difference between the reactions of the two groups during the pain testing. The sensitivity of Zen meditators was considerably lower, even when they were not meditating. Through slower breathing meant to simulate meditation conditions, meditators further reduced their pain sensitivity. Zen meditators ultimately reduced their pain intensity by 18%.   

Grant noted that “Slower breathing certainly coincided with reduced pain and may influence pain by keeping the body in a relaxed state…While previous studies have found that the emotional aspects of pain are influenced by meditation, we found that the sensation itself, as well as the emotional response, is different in meditators.”  

More on Zen training, meditation, and related healthcare benefit:

Zen Training Speeds the Mind's Return After Distraction, Brain Scans Reveal

Patients Do Better with Psychotherapist Who Practice Zen Meditation, Study Suggests

Researchers have determined that the ancient practice of Zen meditation may have pain reducing qualities. 

Author | Shivani Parmar, MPH

Articles

Doctors, Go Back to School

Internet Eases Pain in Elderly

New Opioid Prescribing Guidelines

Zen Meditation Eases Pain