THE GIFT OF DIVERSITY IN HEALTHCARE. Commencement Address Downstate Medical Center Carnegie Hall New York City May 27, 2010

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1 THE GIFT OF DIVERSITY IN HEALTHCARE Commencement Address Downstate Medical Center Carnegie Hall New York City Steven A. Wartman, MD, PhD, MACP President/CEO Association of Academic Health Centers Washington, DC

2 Today we celebrate one of the most meaningful days in the lives of those gathered here: graduation. We also celebrate another remarkable achievement: the 150 th anniversary of the inaugural class of what is now called Downstate. Now, 150 years is quite a short time in world history, but an extraordinary time in the history of health care. Indeed, a lot has happened since two physicians established a dispensary in downtown Brooklyn in 1856 to provide care to poor immigrants, and the State of New York granted a charter for a new medical school in This dramatic and famous Hall, for example, was built by Andrew Carnegie in Carnegie was an immigrant whose first job at age 13 was changing spools of thread in a cotton mill 12 hours a day, 6 days a week - for which he was paid $1.20 per week. He, of course, rose to make an immense fortune in steel, but was determined to give away most of his money - said to be over 4 billion in today s dollars. He especially liked to donate to the field of education. Interestingly, Carnegie Hall is said to have been the first major concert venue in the U.S. to hold a biracial music performance in

3 How fitting that we are in his great Hall to commemorate this capstone of graduation! And note how closely the theme of the immigrant is tied to Downstate, Carnegie Hall, and to all of us today. My father was the first generation son of Eastern European immigrants, and wanted very much to be a doctor. He attended West Philadelphia High School, where he was a straight A student and a star athlete in football and baseball. When it became time to go to college and to study premedical education, the choice was simple when nearby LaSalle College (now called LaSalle University) offered him a scholarship. My father excelled in academics and athletics, starring as a running back and second baseman. During his senior year, he started on the path to fulfill his dream by applying to medical school. On March 30, years and 58 days ago -- the instruction of Downstate s first class of 57 students began. Importantly, a key precedent in American medical education was established by combining a hospital with a 3

4 medical school. And today Downstate consists of the colleges of health related professions, medicine, and nursing, and the schools of graduate studies and public health. My father waited anxiously for the news regarding his applications to medical school. The year was One by one they came in, and in each case his application was rejected. How could an honor student and star athlete be denied his dream? The answer can be found in the work of the well known medical historian Kenneth Ludmerer, based at Washington University in St. Louis. In his book, A Time to Heal, Ludmerer notes that in the period prior to World War II, there were prejudices in medical schools against the admission of Catholics, Italians, Jews, and other ethnic and religious minorities. African Americans faced very severe obstacles, with the exception of Meharry and Howard Universities. Women did not fare particularly well either, except for the Women s Medical College of Pennsylvania. 4

5 So my father was unable to realize his dream. When I was growing up, he never once asked me to consider applying to medical school. But I suspect that I applied to medical school in part because of him. And now today I have the real pleasure of speaking before perhaps the most diverse graduate class in America! It is overwhelming to stand before you and reflect on the changes from 1860 to 1936 to 1970 to This privilege you have offered me became especially poignant two months ago, when I visited Downstate to meet with its leadership and with 10 students representing its schools and colleges. As any visitor to Downstate will attest, the diversity of individuals is astounding. My medical school class of 1970, for example, was 96% White; Downstate s in 2009 was 48%. My class was 10% female; Downstate s 48%. In fact, including all schools, Downstate was 58% non-white and 65% female. And, of course, this crude breakdown does not even come close to capturing the real richness of the ethnic diversity that lies within the classes. In my meeting with the students, I learned how Downstate has 5

6 unleashed the power of diversity, and has done so in ways that I believe will profoundly improve health care delivery. There are so many important things that I learned from the students that day. This is an institution that encourages self-sufficiency and autonomy. As one student put it, there is no hand holding. To succeed at Downstate you need to be highly self motivated and to find your own way. And by doing so, one develops a great sense of accomplishment. You grow up fast; you become independent quickly in an environment that breeds motivation and ambition. An education at Downstate has been described as a voyage of self discovery. Your training and diversity give you the tools and confidence to work with patients of all backgrounds, to get the most out of your colleagues, and, importantly, to gain a deep understanding of the human perspective, and not brush off people because you can t relate to them. All these qualities, I believe, will make each of you a better, more empathetic and, ultimately, a more satisfied practitioner. You are indeed the changing face of the health professions. 6

7 The excitement in this room is palpable. But there is also another emotion, not so far under the surface: some degree of apprehension. This is certainly understandable. You have many questions and concerns, both personal and professional, such as: Did I make the right choice? Am I up to the demands of my chosen profession? Will I enjoy it? And, more broadly, concerns about: What is happening to health care in this country? How will it be organized and paid for? Where will science be taking us and what does that mean for my work? And what crises and challenges loom ahead? I can assure you that these feelings are quite normal. You re jumping headlong into a career, one which is driven as much by idealism as it is by practicality. When we take a leap into the relatively unknown, we all 7

8 become pioneers, not in the sense of taking a journey that no one has taken before, but in the sense that the journey is unique to us. Who isn t a bit nervous before such a trip? In fact, graduates, your choice of a career in the health professions and biomedical research is most timely. Health care has become the largest US industry, employing 13.5 million workers or 10% of the total workforce. With about 1 in every 10 jobs in the health field, a recent jobs report pointed out that, despite the recession, health care was one of very few employment categories to have shown job growth. The Bureau of Labor Statistics says the nation will need approximately 3.5 million health workers to meet increasing demands, in addition to the two million workers who will be needed to replace those individuals who leave their positions. And these statistics were gathered prior to the passage of health care reform, which I believe will create an even greater need for health workers. At the same time, science is poised for great leaps ahead. So please be reassured that you have made a wise choice! 8

9 Of course, at this point in time, we re all concerned about health reform and what it may mean for us and our patients. All the implications of the historic Patient Protection and Affordable Care Act are as yet unclear. However, my support for health reform is based on the principles of social justice. While the Act is an imperfect one, I believe that a just society cannot continue to have large segments of its population forced to make decisions between their health and their financial well-being. And, I believe, that health professionals like all of you can and must play an important role in healthcare reform by maintaining a high professional standard, a standard that demonstrates that the path to successful health care reform begins with caring about the patient. This brings me to the more personal aspects of your chosen profession. Your choice of a health career is not a trivial one. It is a profound one which will change your life forever. And with this choice comes a degree of responsibility that I want you to think about, not just on this special day, but every day. 9

10 Health care, as we all know, is both an art and a science. It weds expert knowledge and service in the care of others. While mastery of knowledge is important, it is not the single characteristic that will serve your patients best. What will serve your patients best are your compassion, your work ethic, and your integrity in short, your commitment to what I refer to as your professionalism. As a health professional, you: Must always maintain your commitment to scholarship; Be aware of your social responsibility, so as to always apply your knowledge and skills in the service of the greater good; and, Learn to understand your own values while respecting the values of others. But true professionalism is even more than this: it is a special combination of compassion and integrity. Here is one description of professionalism that I admire: 10

11 Professionalism means acting rightly, when the right path is clear before you, but other pressing needs and desires are trying or tempting you to pull away. Or, to put it another way: Professionalism is taking the time and making the effort to do the right thing, when the path of least resistance would be to take an easier way out. I m sure you all understand the deeper meaning here: putting your patient s interest first sometimes requires putting yourself second. Many of you are about to take on new responsibilities in a variety of roles a period in your life that is tough, as we all know, where there is a lot to learn and a lot to do at a fast pace. And the subsequent years are not easy either. They are full of professional and family responsibilities sick patients who need your time, attention and skill; keeping up with, and contributing to, the knowledge in your field; and, we mustn t forget, the 11

12 pressure of earning a living all against a background of changing political and societal priorities. But you must not allow these pressures to overwhelm you to the point of losing your perspective. You must always conduct yourself by keeping the best interests of the patient in mind. Families and friends: your help and support is also needed. Taking care of patients is always personal, so we must help the graduates remember the care in health care. Keep them grounded by reminding them that they were - and still are - a regular person before becoming a health professional or scientist! My wife Gina has certainly done this for me and has been essential to any success that I have had. I have no doubt that you will achieve much success and gain considerable fulfillment in your chosen career. And I believe this to be the case not just because of the excellent education you have received, but because of the person you have become as a result of it. 12

13 At the end of the day, the diversity of this class is, perhaps, its single most important attribute. Because, above all, it has taught you tolerance: tolerance of others beliefs and values, and understanding of others world views and priorities. Being empathetic, understanding, and nonjudgmental in the delivery of health care is essential. And this indeed is the gift that Downstate has brought to you -- and that you have brought to Downstate. So the past 150 years have been remarkable indeed - and not just for the medical and scientific progress, but also for the progress we are making as a society, and to which you will contribute enormously. The founders of Downstate would be astounded, as would Andrew Carnegie. And I wish my father were here to see it. Occasionally, colleagues will ask me what I miss most about my old job as a medical school dean. My answer is easy: I miss graduation, which was for me the best day of the year. So, I want to thank you for allowing me the privilege of being part of your special day. 13

14 But I want to wish you more than congratulations and good luck: I want to wish you a fulfilling, successful career in the service of others. And please remember, only by caring about each other can we learn how best to care for each other. 14