Providing state-of-the art surgical care to the diverse population of the San Joaquin Valley has been a long-held mission of the UCSF Fresno Department of Surgery. This fall, it strengthened its purpose by forming an Intentional Recruitment Coalition (IRC) with a mission to increase diversity in the surgery program to better reflect underserved and underrepresented patients, and in so doing, improve the health of the community.
“We know that people of color, people of minority communities, have long had issues of trusting doctors. Survey studies show that if medical providers look like their patients, the patients are more trusting. In fact, patients get better care because of better relationships and more trust with the medical providers,” said James W. Davis, MD, FACS, chair of the UCSF Fresno Department of Surgery, chief of surgery at Community Regional Medical Center and the Steven N. Parks, MD, Endowed Chair.
Creating the IRC grew from a grand rounds lecture entitled, “Time for Change,” given by Kamell Eckroth-Bernard, MD, FACS, a UCSF Fresno residency alumnus and vascular surgeon, and UCSF Fresno associate professor of surgery. Dr. Eckroth-Bernard called on the department to enhance its diversity recruitment efforts and championed the establishment of the IRC in September. “I am very proud of my clinical work as a vascular surgeon, but if I can make some real, positive changes for our society and for our community, I think long-term this will be more important than any of the things I do from a clinical perspective.”
To be successful at increasing diversity, UCSF Fresno’s surgery program must be intentional in recruitment, said Dr. Eckroth-Bernard, who is Black. Despite nationwide goals in the 1970s to increase the percent of Black male physicians in the physician workforce, the efforts were not successful, he said. “There’s a difference between having good intentions and being intentional. The UCSF Fresno Department of Surgery is saying that we are actively embracing diversity, equity and inclusion to change the face of our program for the betterment not only of our community but for the betterment of the patients that we take care of.”
The IRC is a team effort. Surgery faculty, other department faculty, surgery staff, community physicians, surgery residents, community leaders and Fresno State leadership are members of the coalition.
“The best thing about this is we have the support of Dr. Davis,” said Dr. Eckroth-Bernard. “And we have support of General Surgery Residency Program Director Mary Wolfe, MD, FACS, as well as support of Associate Program Director Amy M. Kwok, MD, MPH, FACS.”
The IRC is committed to increasing matriculation and retention of underrepresented minority surgical residents and faculty; providing opportunities for education and teaching with respect to the underserved population in the San Joaquin Valley; providing ongoing conferences dedicated to diversity training and cultural awareness; and improving and fostering relationships between the UCSF Fresno Department of Surgery and the underserved community.
The coalition is divided into subcommittees for residency recruitment, pre-medical surgical internship, health disparity research and underrepresented minority (URM) medicine.
Drs. Wolfe and Kwok are on the subcommittee that reviews resident applications and conducts interviews. They have been leaders in residency recruitment for nearly a decade, and a review by the IRC of this year’s applicant selections concurred overall with the doctors’ recommendations. “We have always striven to make sure that we try to have a diverse department and a diverse panel that we interview,” Dr. Wolfe said. “But while we have always been very committed to diversity, we realize that it is important to state that we are devoted to diversity,” she said. “Even though it is obvious to me, it may not be obvious to other people. We need to make sure it is up front and visible that we are committed to this.”
Medical school outreach and pre-medical school mentoring is important for increasing the residency applicant pool. Yazen Qumsiyeh, MD, a third-year resident in the UCSF surgery program, is leading the ICR pre-medical surgical internship subcommittee. Dr. Qumsiyeh emigrated to the United States with his family as a young teenager. “I did not speak English when I came here and I didn’t have much guidance, except for a few mentors in college and medical school,” he said. “I had to figure it out mostly on my own.”
Dr. Qumsiyeh approached Dr Eckroth-Bernard about bringing pre-medical students from underserved backgrounds to UCSF Fresno to be mentored by a surgery team. “With this program, these students are going to work with medical students from UCSF and with our residents and our attending physicians,” Dr. Qumsiyeh said. “A lot of people who are very smart, very driven and who can contribute a lot to the field of medicine do not have the guidance, and do not know where to go for resources,” he said. “I want to create that opportunity for these students,”
John Moua, MD, interim chair of the UCSF Fresno Department of Pediatrics, is adding a diverse voice from outside of the surgery program as a member of the IRC pre-medical surgical internship subcommittee. He is one of only a few Hmong physicians practicing in the central San Joaquin Valley. There are about 30,000 members of the Hmong community in the Fresno area, but there is no Hmong surgeon to serve them, for example, Dr. Moua said. He gets phone calls, as do other Hmong physicians in town, from family members of patients who are in the hospital, asking for medical advice, he said. “That speaks to the level of trust. They are looking for from someone from their same background.”
Dr. Moua appreciates the invitation to be a member of the pre-medical surgical internship subcommittee. As a high school and college student, he participated in programs at Stanford University that steered students into pre-medical classes. “I was one of the first groups of students to go through that,” he said. I was the student that we are currently trying to attract and recruit into the health care field.”
The UCSF Fresno surgery program is collaborating with Fresno State to find applicants for the pre-medical surgical internship program. “We are a community-engaged university, so we need to be interacting with partners that are going to help our students to succeed,” said Jason Bush, PhD, chair of the Department of Biology at Fresno State. He is coordinating Fresno State’s partnership with UCSF Fresno. “We have to reduce boundaries and obstacles that underrepresented minority students encounter when getting in professional careers in medicine or other bio-medical fields,” Bush said. “We have to change the demographics that are in medicine, that are in science.”
Leah Lucero, MD, a UCSF Fresno third-year resident in the surgery program, is heading the IRC resident recruitment subcommittee to reach out to medical schools and medical student associations to connect with underrepresented medical students. Dr. Lucero is the first in her family to attend medical school and residency. She received help from mentors along the way. “Without that mentorship I don’t think I would be where I am right now,” she said. Through the IRC, UCSF Fresno’s surgery program can show medical students it is willing to invest in them and there are people willing to help them and mentor them, she said.
Dr. Lucero is gratified to be working with an underserved patient population. “Physicians who look like their patients and who are from similar backgrounds can break down some cultural barriers we face when treating patients,” she said.
Sammy Siada, MD, a UCSF Fresno vascular surgeon, grew up the son of immigrants in a bilingual household. Dr. Siada has an interest in research and accepted an invitation from Dr. Eckroth-Bernard to lead the IRC subcommittee on health disparity research. Health disparities affect health outcomes, and he appreciates belonging to an institution that is committed to increasing its diversity to better serve its diverse patient population, he said.
The IRC has attracted a diverse group of members since September, said Milena Ocon, administrative manager of the UCSF Fresno Department of Surgery. Ocon is the IRC coordinator, facilitating meetings and making sure tasks are completed. “As our IRC has rooted and grown legs (subcommittees) it’s become this amazing kaleidoscope of diversity and hence diverse solutions,” she said.
Ocon was instrumental in introducing the IRC to Armando Valdez, founder and director of the nonprofit Community Center for the Arts and Technology (CCAT) in Fresno. He has agreed to help create a logo for the coalition. CCAT is a grassroots community-based center that offers free classes for children, youths and adults in digital media and performing arts.
Too often, students who have shown an interest in health care careers are not given any direction after high school graduation, Valdez said. “I want to see them followed through. There are not enough people there to direct them and they lose hope,” he said. “You guys are allowing those dreams to come true for some of those kids who want to get into the medical field. If there is an opportunity for those avenues for those kids, I am always for it. And I hope I can help them out.” He will give the IRC has much time as he can, he said. He is distributing food and other help to farmworkers and their families who are among the most vulnerable to COVID-19.
Dr. Eckroth-Bernard has been happily surprised by the warm reception to the IRC – but recruitment is just getting started. “My goal is to get everybody on the coalition. I want the whole surgical department to be part of the coalition,” he said.
The IRC has his support, Dr. Davis said. The UCSF Fresno Department of Surgery must resemble the community it serves because it is essential to providing outstanding medical care, he said. “We must be successful with this — this must happen.”
