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Dr. Fauci's wake-up call to my med school class

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As a new medical student, I didn't fully grasp the significance of his statement at that moment. But as Covid-19 has spread rapidly, impacting communities across the country and exposing the disparities in our health care system, Dr. Fauci's words have taken on a whole new meaning.

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On March 20, 2020, better known to medical students as Match Day, I learned that I had been matched with my top choice residency program. I was going to be an internal medicine physician at Thomas Jefferson University Hospital in Philadelphia.

Jefferson was my first choice for several reasons. For starters, it's close to my family in Pennsylvania. It's also a hospital dedicated to medical education, health care innovation and top-quality patient care. Most important to me, though, is Jefferson's embrace of diversity and inclusion, as it serves many low-income and marginalized populations.

Part of the reason Jefferson serves such a diverse community is its location. Its flagship hospital is based in Center City, the major downtown neighborhood and cultural center of Philadelphia. This area is home to thriving African American, Asian, and Latinx communities, as well as a large LGBTQ community.

Several of these communities -- including the Black community -- remain some of the most underserved in the city. And nowhere is that reality more obvious than in health care outcomes. As noted in the 2019 city report "Health of the City," Black men and women in Philadelphia have the lowest life expectancy of any racial group in the city. Black men are also more often affected by heart and kidney disease, and Black children are hospitalized more for asthma attacks.
After I matched, though, I still had several months before I could dive into my new career and help address some of these health care outcomes at Jefferson. But there was a complicating factor -- Covid-19 cases were growing, surpassing 1,000,000 in the US, and just weeks before my graduation.

When I finally arrived at my virtual graduation day, I helped lead my class in reciting the Hippocratic Oath, a code binding medical graduates to the highest standard of medical ethics, and one which marks the official transition to becoming a physician. While graduation was certainly about the many accomplishments we had achieved over the last four years, it also gave me time to reflect on the new challenges -- and opportunities -- of becoming a resident physician in Philadelphia during this pandemic would bring.

I realized that the health care disparities that impact communities of color in Philadelphia were just as apparent -- if not more so -- during Covid-19. As of late June, out of 25,443 positive coronavirus cases in the city, Black residents accounted for just over 46% of the cases -- though they only comprise 40% of the population.
They were also more likely to be hospitalized and encounter severe complications due to Covid-19 than other racial groups. And Black patients account for over half of all coronavirus deaths in Philadelphia, according to the city health department.
In addition, Black and Hispanic patients are also more likely to have low-wage or essential jobs within the city, placing them at higher risk of contracting the virus -- and are more likely to live in neighborhoods or homes that make it difficult to practice social distancing.
The issues in Philadelphia, of course, are a reflection of what we are seeing on a national level, where minority patients feel the impact of the pandemic to a greater degree than their White counterparts and face disproportionately more policing around issues of social distancing.
But these numbers are particularly stark to me, since as an internal medicine intern, I will be entering an institution that has seen the highest number of Covid-19 cases in the city, according to state data.
An institution that has also taken on the responsibility of absorbing a large number of patients (a majority underserved) after last year's closing of Hahnemann University Hospital in Center City. And while I'm concerned for my own risk of exposure, what's far more concerning are these pronounced racial disparities in health care -- both in Philadelphia and across the country.
To be effective healthcare providers, my colleagues and I have to do more than treat the individual patient at his or her bedside. We have to delve into the disparities affecting the communities in which we serve. Social determinants of health -- the complex circumstances in which people are born and live -- play a significant role in health outcomes. And factors like access to health care, affordable housing, healthy food options, clean water and racial biases all impact overall well-being.
As new doctors taking root in new cities and towns, my fellow graduates and I must strive to form collaborative relationships with our future patients to understand both their individual needs as well as the needs of their communities. And as physician-advocates, we can and should push for greater accessibility to quality medical care, increased community engagement from fellow health care workers, and more education on available resources for patients -- all the while ensuring an emphasis on cultural respect and trust.

In addition to the larger systemic issues in healthcare, Dr. Fauci's words also speak to the community within the hospital walls, especially my fellow incoming residents. As we rotate through hospital floors, intensive care units and the emergency room, caring for Covid and non-Covid patients, we all have a new group of physicians to lean on for support and morale. In addition, we have the support of our fellow medical school graduates and mentors who taught us how to adapt to ever-changing situations and gave us the foundation to take on the challenges of residency during a pandemic -- especially as a second peak may be imminent.

While it may have taken until my graduation day, amid a global contagion, to fully grasp the responsibility of my role as a physician, I hope my fellow graduates and I can serve in the dual roles of caring for our patients as individuals and as part of a larger community.

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