Empowered PCP: A Conversation with Dr. Michelle Gourdine about health and wellness in the Black community

As part of a new blog series called the Empowered PCP, we are sitting down with powerful voices in the primary care physician (PCP) community to learn how they are creating healthier communities through value-based care and share their perspectives to empower other PCPs.

We sat down with agilon health Board of Director member, population health leader and author Dr. Michelle Gourdine for our inaugural Empowered PCP interview. In addition to sharing her perspectives on health and wellness in the Black community, both historically and present day, Dr. Gourdine provides thoughts on the key role Black physicians have in improving health in Black patients, the important role of value-based care today and in the future, and her advice for female physicians.

Q: Dr. Gourdine, how did you get involved with population health initiatives and encouraging health and wellness in the Black community?

It’s been a long journey that stretches back to when I was young. I was raised in Mississippi in the 1960s by my father who was a civil rights attorney and my mother who was a 4^th grade teacher in an underserved community. Looking back, one of my life threads has been that of social justice, which was shaped by the work of my parents. At an early age, I learned about the value of all people and understood that different communities were resourced differently – today, we refer to them as “social determinants of health.” As I pursued my medical career, I began to understand how these factors impact how healthy a person is – or is not. These learnings contributed to my decision to become a PCP – and later evolved into a career in public health. The growth of my expertise in public health and population health intersected with a shift in focus at hospitals and health systems, spurred by the Affordable Care Act, to prevention and well-being, and resulted in an opportunity to lead population health at the University of Maryland Medical System, a 12-hospital system, in 2017.

Q: How has the COVID-19 pandemic impacted the health and wellness of the Black community?

The pandemic shed light on disparities in health that have been long-standing for decades – if not centuries. Since the inception of this country, there has been a difference in the health of Black populations versus that of white populations, and what the COVID-19 pandemic did was to highlight the real factors that drive health in communities.

We all know that access to healthcare is important. But 80% of health outcomes are driven by social factors. When you see the disproportionate impact of COVID-19 in communities of color, you realize that these communities might not have had equal access to resources to protect themselves. They may not have had access to face masks. They may have lived in multi-generational houses, had jobs that couldn’t be done from home, or had to take public transportation, all of which didn’t allow for social distancing. COVID-19 became a real demonstration of the differential access to resources that people need to be healthy (beyond having a doctor), which has led – historically over time – to disparities in healthcare.

Q: How does Black culture shape health and wellness choices?

African American households – where I grew up and in which I currently live – value health as much as any other culture. Our approach to health is directly related to not only the social factors I referenced, but also our level of knowledge about health and well-being, and our health literacy. It’s important to note that health literacy has less to do with how intelligent you are or how much education you’ve received; it’s your ability to receive and process health information and apply it to improve your own health.

Q: What is the role of Black PCPs in educating the Black community about health and wellness, and helping close the health gap among people of color?

Black doctors play a significant role. When you think about the relationship between a doctor and a patient, trust is at its core. People tend to trust their doctor; they trust what their doctor says to them. Research reveals that Black doctors are better at communicating with Black patients in a way that helps the patient to better understand health conditions and what the patient and doctor can do together to improve their health. The foundational component of better communication is that trust factor.

It’s important to mention that only 5% of physicians in this country are African Americans even though African Americans make up 13% of the population. And only 2% of African American physicians are women. So we have some work to do in this area.

Q: How will the move to value-based care within primary care practices help to support health and wellness of Black patients?

Shifting from volume-based (fee-for-service) to value-based care will give physicians more time to establish strong, trusting relationships with Black patients. This will allow Black patients – who may be reticent – to share non-medical-related concerns (e.g., housing, food) with their physician. Value-based care incents the care team to support the patient – in partnership – to address those non-medical factors that bubble to the top, which are really driving their health outcomes.

Value-based care provides the opportunity to make a difference, particularly in Black communities and other underserved populations. The work being done by agilon health and its PCP partners should be the model for the rest of the country in how to do this the right way.

Q: agilon health recently announced the launch of a Female Physician Leadership Council, which recognizes, supports and engages female PCPs in furthering their careers. What else should be done to help raise up the leadership of female PCPs, particularly Black female PCPs?

As I reflect back on what helped me and what would have been helpful to me as my career was rising, I would have benefitted greatly from a forum for female doctors to share their voices and day-to-day concerns. I’ve heard this from African American women and women of other races. We really need a safe space to talk. The ability to be heard, seen and supported are all so important. In addition, for those of us who are further along in our careers, I think it’s helpful to share our personal experiences and how we’ve overcome barriers to younger women physician leaders; we have the ability to mentor as well as sponsor these women – and use the influence of our careers to help open doors. These are all vital tools.

Michelle is senior vice president, Population Health and Primary Care at the University of Maryland Medical System. She’s also clinical assistant professor, Pediatrics and Epidemiology/Preventive Medicine at the University of Maryland School of Medicine, and senior associate, Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. Plus she’s an author of a widely acclaimed book, Reclaiming Our Health: A Guide to African American Wellness.