Starting the Conversation: An Interview with Denise Powell, M.D.

The future of health equity in America lies with our future healthcare professionals. Dr. Denise Powell, a pediatric resident physician at University of California, San Francisco is one of those professionals. She had a strong role model in her mother growing up in Mississippi, and Dr. Powell has made it her goal to spread awareness about the health disparities that exist in American rural and urban communities. She believes an equitable healthcare system is possible in America, but not without first addressing the root of the inequity: access to resources.??

On health disparities in Black communities…?

In Mississippi, and throughout the country and world, access to resources dictates much of health outcomes. That’s one of the reasons working with a Historically Black College and University by hosting a health literacy program for youth there, one where I spent a lot of time growing up (Jackson State University) was so important to me - because they offer so much support, education, and inspiration to the community. Tapping into these already existing structures, like educational institutions, is important because they can be another conduit of counteracting health disparities, in which access to general healthcare also plays into this.

In my home state of Mississippi, there is a lack of healthcare providers across the state. If you look at the Office of Mississippi Physician Workforce, we have “65.9 per 100,000 population active primary care physicians,” and we rank 50th in “physician to population ratio” regarding physicians, among the lowest physicians per capita in the country.

I joined the Mississippi Rural Physicians Scholarship Program after I graduated residency and do plan on going back because I truly believe we have the capability to build a healthier Mississippi through a collaborative approach but by especially spending our efforts on dismantling long-standing racial health disparities. For some patients, they must drive all the way to the state’s capital, Jackson, or even a different state like Louisiana, depending on where they live in the state, to receive primary care or specialty services. Not every city in Mississippi or rural parts of California will have specialists and primary care doctors embedded in the community. Right now, working at a major research and medical center in San Francisco and having trained at a large academic center in Mississippi, I’ve realized the importance of having access to colleagues, specialists, referral systems, and basic care needs to streamline care for patients. If we were to compare disparities in rural areas to large cities throughout this nation, access is a large discrepancy.?

On the importance of diversity in healthcare…?

A lot of who I am has stemmed from the values my mom taught me as a child. She instilled in me a need to be vocal, even if I felt uncomfortable, and taught me to always be inclusive of those around me, have the strength to persevere, and do right by my community.

I’d say my upbringing also had a great deal to do with the amount of thought that I put into choosing a residency program. I knew I wanted to go somewhere that would be supportive of me being a person of color. This active reflection and searching began in medical school when I realized there was a great push at the time to diversify the class and increase representation. I’d say, out of at least around 140+ students, about 15 of us were African American. There’s still a great deal of work to do there. On a positive note, I had a community within my class, and it made a huge difference for me personally. I would say even though the road ahead is a long one, just having the conversation, as well as the monetary and moral support for students of color is a good start. It’s not where it should be, but it’s growing. We’re taking the steps and organizations, like National Medical Fellowships and the Student National Medical Association/National Medical Association, now exist to fill these gaps and do the necessary additional work to make the percentage of black healthcare professionals more proportionate to the communities where we live and work.?

On current challenges in healthcare…?

Within our healthcare system structuring, the thing that has been on my mind during residency the most recently has been the limited amount of time and number of slots in-clinic visits. Each time we see a patient, I think, ‘Is this going to fit into the visit? Do we have the capacity to do this?’ This is why I’m so thankful for the other systems built into our primary care system, like social work, mental health teams, telehealth and the other levels of support that can be helpful when time is limited. Even with these established partnerships, it’s hard to address everything by time-limited visits.

The different challenges in healthcare can be provider, specialty, and situation-dependent. The way in which hospitals and clinics get funding, as well as different insurance models, has been a fluctuating component of healthcare that impacts access to healthcare in many ways that you see both in and outside direct patient care.

Throughout the pandemic, having adequate follow-up while balancing in-person versus telehealth visits allowed for the intricacies of medical technology to be brought to the forefront. Whether extra visits or phone calls to check-in really depends on the situation, but ensuring patients have the ability to check-in through the phone or computer is part of the follow-through of this process.

Finally, while checking in with patients, we must also remember to check in with ourselves. Mental health and self wellness are crucial to patients and the providers who serve communities. As physicians, we want to be able to provide that extra support and go the extra mile for patient care without draining ourselves because burnout is real. Triaging care for our patients and ourselves goes into the journey of delivering adequate care to patient care populations. ?

On how we can deliver change…?

If I were to boil it down to three real challenges we need to overcome to achieve justice in healthcare in the United States, I’d say it begins with cultural competency – delivering equitable care to diverse populations regardless of background, like socioeconomic status, ethnic background, or language spoken. We still have a long way to go. I’ve seen this play out in the medical system in a lot of different ways. It’s important to ensure we are delivering quality care even when clinic and hospital days are busy.

An example of this would be to utilize language services when needed, resulting in competent care and trust between patients, their families, and those in the medical system. As a physician, if I am working with a family that speaks a language different from the one I speak, I should ensure I am being diligent in using certified interpreter services appropriately. I’ve learned so much from the interpreter services staff at our hospital system in how to speak in shorter, easier to translate sentences, ensuring I am including families in patient-centered rounds in creative ways, and allowing families the opportunity to give their opinion or ask questions throughout interpreter-guided conversations.

A second aspect that would help bring us towards a more equitable future is being intentional about how we allocate our resources. In residency, we have specialized teams that have helped us recognize and act on social determinants that impact care; I’m truly grateful for the work they put forth towards bettering patient care outside of clinic visits. During the beginning of the pandemic, different residency programs throughout our institution began different google docs and templates to collaborate by jotting down community resources that could be useful to families who had additional stressors, like unstable housing, job instability, food insecurity – to name a few. Even tiny acts, like being able to give books to pediatric patients at the beginning of each visit, is a way to provide resources and act on health outcomes, like literacy and development, in some way. ?

Finally, I believe policy is a focal point for delivering change and can be utilized as a platform and mobilizer for ensuring health equity.?

To learn from other healthcare providers featured in the Starting the Conversation series,?click here.