How UC San Diego Health became more inclusive and diverse

Luis Castellanos, MD, joined the University of California San Diego's department of medicine in 2010. At that time, he was the only Latino faculty member on the division of cardiology's 20-person team.

Dr. Castellanos was surprised by the lack of diversity, given that the U.S. Census Bureau estimates 30.2 percent of San Diego residents are Hispanic or Latino.

"You would think the faculty in the medical center would be more reflective of the patient population we treat," he said.

Dr. Castellanos set out to improve diversity and inclusiveness at UC San Diego Health System, and he is now the first director of diversity in medicine and faculty outreach in UC San Diego's department of medicine.

He started by finding likeminded colleagues to help develop think groups and strategies to promote diversity efforts. Fortunately, the chancellor and vice chancellor of the university were receptive and agreed the school needed to improve diversity in terms of race, ethnicity and gender, he said.

Dr. Castellanos and his colleagues looked at internal numbers and found that in 2016, about 10 percent of residents in UC San Diego's department of medicine were from racial and ethnic minority groups. Their goal is to double that within six years, and they identified multiple ways to achieve that.

The idea has been to try to make the internal medicine residency program more reflective of the community it serves. That will ultimately mean UC San Diego Health has a more diverse and larger pool of physicians to recruit from, and a more diverse group of physicians who eventually become faculty.

"We can recruit and retain young physicians … by doing a better job of promoting the university and the many diversity attributes we have here," said Dr. Castellanos. "[This involves] reaching [out] to our own medical students as well as in other communities and also bringing [in] guest speakers from diverse backgrounds [to talk] to students, getting them excited about academic medicine and the fact they could succeed as physicians [and] provide care for vulnerable populations in an academic setting."

The UC San Diego Hispanic Center of Excellence has also played a role in diversity efforts. Through the center, Dr. Castellanos said junior faculty are hired from diverse backgrounds and given time to do scholarly activities and receive mentorship. They learn about the academic medical center working environment and are more likely to be promoted and advance to other levels, according to Dr. Castellanos.

He said improving diversity at UC San Diego Health could ultimately improve the overall health of patients.

"Part of our motivation is because we believe if we have a clinical workforce that's more reflective of the patient population that we treat, we're more likely to make a positive impact on our patients and provide better care so the patients are more receptive to the advice that's given to [them]."

The diversity efforts have specifically been successful within the department of medicine's division of cardiology. In 2010, Dr. Castellanos became one of the 20 clinical faculty members within the division of cardiology. He was the only Latino faculty member and three on the team were women.  As of May 2018, the division has 31 clinical faculty with three Latinos and seven women.

Outside the department of medicine, diversity efforts have also ramped up within the UC San Diego School of Medicine.

Improving diversity among medical school faculties is a need seen at various organizations. That's because minorities are underrepresented on these faculties, according to data from the Association of American Medical Colleges. The data showed American Indians and Alaskan Natives made up 1 percent of the 174,570 full-time faculty at U.S. medical schools as of Dec. 31, 2017. Asians made up 17.6 percent, blacks or African-Americans made up 3.3 percent, and those who reported themselves as Hispanic, Latino or of Spanish origin made up 2.3 percent. Whites made up the majority, at 63.4 percent. 

According to Alexander Norbash MD, professor and chair of radiology at the UC San Diego medical school and associate vice chancellor for diversity at the university, the UC San Diego diversity strategic plan has three areas of focus: climate, which focuses on how welcoming the environment is to diversity and such details as how employees engage in civil dialogue when there are disagreements; access, referring to pipeline programs that increase the incoming volume of eligible underrepresented minorities and women; and accountability, using data and analytics to understand and create approaches that reinforce positive motion regarding recruitment and retention.

Dr. Norbash is specifically responsible for faculty climate as well as professional development where diversity is concerned. As one example of the climate dimension, Dr. Norbash described a mediator initiative where 30 faculty members across the university have been trained as certified mediators to help address perceived bullying or "strident" disagreements through a remediation process where faculty are concerned.

"That's a big deal for us … [to] establish behavioral standards and have a way of resolving differences and moving forward that are structural and process based, in order to change the natural entrenched response to disagreements," he said.

With respect to the professional development piece, Dr. Norbash has been approached on a number of occasions by university faculty seeking to discuss and help resolve instances where they perceive potential discrimination. In such instances, Dr. Norbash sees his job as listening to employees, helping them identify solutions and connecting them with leaders who could facilitate the necessary resolutions.

"What I've found is faculty are looking for someone to work with them and [to] help solve their issues, and that deans and faculty chairs so far and without exception have been exceptionally helpful and solution-oriented," he said.


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