Fellowship Prepares Physicians To Address Minority Health Needs

A postresidency fellowship program at Harvard University is preparing physicians and other health care professionals to lead efforts to reduce disparities in health care for ethnic minorities and underserved populations.

Psychiatrists can apply for one of two fellowships under the Harvard University Fellowship Program in Minority Health Policy, both of which lead to a master's degree in public health at the university's School of Public Health or a master's degree in public administration at the university's John F. Kennedy School of Government.

The fellowship pays for tuition and fees, and fellows receive a $50,000 stipend for the year.

In addition to taking courses at Harvard's schools of medicine, government, and public health, fellows take specialized courses in minority health policy.

The program began in 1995 with the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy, which selects five fellows a year and seeks to prepare physicians for leadership roles in health policy, public health, and academia.

According to a program brochure, courses offered through the fellowship seek to help physicians “improve the effectiveness of the health care system to address the health needs of minority and disadvantaged populations.”

In 2001 Harvard added the California Endowment Scholars in Health Policy Fellowship, open to physicians, doctoral-level psychologists, and dentists interested in reducing disparities in the health status and access to care of underserved populations in California.

`Hands-On' Experience Encouraged

According to Joan Reede, M.D., M.P.H., M.S., director of both fellowships, it is the “hands-on” aspect of the fellowships that makes much of the learning possible.

For instance, each of the fellows makes site visits to federal, state, and local health agencies to understand how those agencies work and make connections with agency leaders. This way, Reede noted, the fellows can better understand the agencies' missions “in regard to health disparities, minority health, and the health of poor populations.”

In addition, fellows spend three to four days shadowing nationally recognized leaders in their area of expertise. Fellows can thus attend senior staff meetings and participate in policymaking, said Reede, who is also dean for diversity and community partnership at Harvard.

Psychiatrists' Input Vital

As a pediatrician with training in child psychiatry, Reed encouraged psychiatrists' participation in the fellowships.

“We need to have psychiatrists at the table when we are figuring out how best to allocate resources” to address the mental health needs of minority and poor populations, she remarked.

Francis Lu, M.D., is chair of APA's Council on Minority Mental Health and Health Disparities and sits on the advisory committee for the California Endowment Scholars in Health Policy. He also recommended the fellowship.

“I see this fellowship program as a way people can learn essential leadership and management skills that will affect mental health policy,” Lu told Psychiatric News.

Richard Nunes, M.D., M.P.H., who completed the California Endowment Scholars fellowship in June, views the fellowship as a vehicle to improve the delivery of services to minority patients with mental illness. “I've seen a lot of inefficiency in terms of how services are delivered,” he noted.

Nunes is now chief of child psychiatry for Santa Clara County, Calif.

“As psychiatrists, many of the patients we treat are underserved.. .not just [because of] race and ethnicity, but the fact that due to mental illness, they are stigmatized” by the health care system, he noted.

During the fellowship, Nunes shadowed Stephen Mayberg, Ph.D., director of the California Department of Mental Health, and participated in a conference about Proposition 63, also known as the Mental Health Services Act.

Californians passed Proposition 63 in November 2004. It authorizes a 1 percent tax on annual adjusted gross incomes over $1 million to support county-operated mental health systems.

In his current role, Nunes is helping to decide how money generated by Proposition 63 is allocated within Santa Clara County.

He said that the fellowship gave him insight into “the challenges facing health care delivery” to marginalized populations and noted that the “opportunities, education, and exposure offered by the fellowship are probably unmatched anywhere else.”

Octavio Martinez Jr., M.D., M.B.A., M.P.H., the first psychiatrist to complete the Commonwealth Fund fellowship program, agreed. “This fellowship was the only one I found that put it all together” by combining education on policymaking and management with education about disparities in health care among racial and ethnic minorities.

Martinez completed the fellowship in 2002. He is an assistant professor of psychiatry, faculty associate in the Center for Medical Humanities and Ethics, and director of the consultation-liaison service in the Department of Psychiatry at the University of Texas Health Science Center at San Antonio.

Martinez helps devise the curriculum for medical students at the university and has relied on his fellowship experiences to introduce information about health disparities in underserved populations to the medical students, he noted.

In addition, he has forged a relationship between the university's psychiatry department and Barrio Comprehensive Family Health Care in San Antonio, which serves the medical needs of many Latino patients. Martinez provides mental health services there and has developed a mental health clinic at the center.

In addition, he has applied for a grant that will enable psychiatry residents and medical students to rotate through Barrio Comprehensive as part of their training.

He cites the fellowship's networking opportunities as chief among its benefits—he has maintained contact with many of the people he met during his shadowing experience with Bernard Arons, M.D., who was then director of the Center for Mental Health Services of the federal Substance Abuse and Mental Health Services Administration.

He also pointed out that networking continues long past the year spent at Harvard. Each year there are annual meetings held in Boston for members and alumni of both fellowships.

“The fellowship has built a cadre of people who are committed to making a difference in health care for the underserved,” he said.

The deadline for application to both fellowships is January 3, 2006.

More information about the California Endowment Scholars in Health Policy at Harvard University is posted at<www.mfdp.med.harvard.edu/fellows_faculty/California_endowment/program/details.htm>. Information about the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy is posted at<www.mfdp.med.harvard.edu/fellows_faculty/cfhuf>.▪