Differentiated health care: The new St. Paul clinic stresses culturally competent providers

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By Sheila Mulroney Eldred | Sahan Journal

Even before the outbreak, Dr. Julia Joseph-DiCaprio had a keen sense of how challenging life was for many Minnesotans. She confirmed the information she saw as senior vice president and chief medical officer at health plan nonprofit UCare. Children are left behind in things like regular vaccinations and well visits. Covid-19 has presented additional challenges.

Even more troubling for Joseph-DiCaprio, who lives in St. Paul’s Merriam Park neighborhood, was that much of it happened in her own backyard. “So I thought, well, what can I do in my area?” She said.

Like many doctors, Joseph DiCaprio has long dreamed of opening his own clinic. But for most, this is a non-starter. Almost. 75 percent of doctors work for a hospital, health system or corporate entity In the year By 2021, this is 20 percent higher than before the pandemic. Also, Joseph-DiCaprio recently celebrated her 60th birthday.

But what would be an insurmountable obstacle for many seemed like an opportunity for Joseph-DiCaprio. She felt her background in patient care and management positioned her perfectly for the challenge.

“I said that I have the knowledge and experience to do this. Also, I’d better do it now because I’m not old enough to start it, but I will be in a few years!” she said via email. “I understand the complex administrative elements of health care and most importantly, I know that health care needs to try new things.”

Why not combine everything I’ve talked about over the years to not only find a new way to serve people with disabilities, but also to be a model that others can use?”

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This month, Dr. Joseph-DiCaprio will begin seeing patients Skip child and adolescent careA non-profit clinic she founded to provide “high-quality health care for people with significant barriers to health and wellness.” The Community Action Partnership of Ramsey and Washington County found a home for the clinic in the Syndicate St. North building.

She has big ambitions. At one point she wanted to revive proven elements of care, even toying with the idea of ​​including home visits. She plans to incorporate new technologies including telehealth. She plans to accept all patients, whether they have insurance or not. She definitely does not want to leave patients waiting in the waiting room. And she wants to solve the social issues that determine the health of patients, providing connections with social services.

She will start as the clinic’s sole MD, but plans to build a small staff of culturally competent providers to serve the Hmong, Somali, black and Spanish-speaking populations of the Midway neighborhood. She hired a receptionist who she had known for years, a medical assistant and psychology student at the University of Minnesota.

Born in Canada but raised in America, Joseph-DiCaprio always knew she wanted to be a doctor. “It’s the perfect job for me—combining service to others with science and continuing education,” she says. When she began practicing 30 years ago, after completing her pediatric residency and adolescent medicine fellowship at the University of Minnesota School of Medicine, little interest was paid to the social determinants of health and diversity, equity, and inclusion. But Joseph-DiCaprio, who is black, was paying attention.

“I think different presenters can listen differently,” she explains over coffee in a cafe on Selby Street. “I walk into the room after a patient walks into the room, and I see the change when they see who I am. I’m not saying there’s anything magical about me, but the way they share is completely different. It’s like they’re waiting to bring out their full selves.”

She recalled an example when she worked at Hennepin Healthcare, then HCMC, where she spent 22 years, first as a pediatric and adolescent medicine specialist and later as chief of pediatrics. She was called to the ward where the patient was suspected of abusing substances. After listening to the patient for a few minutes, Joseph-DiCaprio realized that the woman had suffered a brain injury.

“It’s not that people haven’t been good or aren’t trying,” she said. “A person who shares your experience is more likely to listen to what you have to say.”

Only 2.6 percent of the state’s doctors are Black 2018 study. Just under 2 percent identified as Hispanic and 13.7 percent identified as Asian. More than three-quarters are white. It’s important to Joseph-DiCaprio that she inspires some of her young patients to follow her path and ultimately serve their own communities.

Her experiences have led her to focus on social issues in health, including racism. In her most recent position at UCare, she hired a health equity officer, initiated anti-bias training and created a new position for associate vice president for equity and inclusion.

But while she loves her job as an executive and is known for getting results, the thought of returning to patient care has always bothered her, she said. So she approached friend and CEO of North Point Health and Wellness Center Stella Whitney-West about seeing patients there part-time.

“She’s a great family medicine physician, and her niche is adolescent/pediatrics — that’s what she’s been missing,” Whitney-West said. “B [many doctors] And for Dr. Julia, he will burn them. Seeing patients is their first purpose as a physician.

Whitney-West grew up in the Rhodo neighborhood near the new Lip Clinic and met with Joseph-DiCaprio to consult on the project. It’s a community with deep roots, Whitney-West said, where generations of families choose to stay and send their children to local schools.

“Even those who are separated are connected to the community,” Whitney-West said. “They come to barbershops, they support businesses and churches. Racial care — when a patient and a doctor are of the same race — often have a positive effect on people of color,” Whitney-West said.

“And being Dr. Julia makes a particularly big difference because she’s a highly respected medical doctor and she’s a woman and a woman of color.”

Dr. Julia Joseph-DiCaprio poses outside her new clinic on September 8, 2022.

One of Joseph-DiCaprio’s first patients will be the 3-year-old son of Chowdhury Tasnova Tahsin. A University of Minnesota doctoral student from Bangladesh is looking for a pediatrician she has trusted since her son was born.

Tahsin said her son was born in the low birth weight range, and her first pediatrician scolded her even though he was getting the right weight.

“I come from a diverse background, and I felt like I couldn’t get along—or that they wouldn’t answer my concerns,” she said. When the child was diagnosed with an ear infection, she thought the antibiotics they were given were unnecessary.

And when she runs into Joseph-DiCaprio at a farmer’s market where the doctor is promoting his new clinic, she immediately signs up.

“I felt I could trust her,” Tahsin said. She is very approachable and trustworthy.

Whitney-West also had a thing or two for Joseph-DiCaprio. “I told her you’re a brave woman,” Whitney-West said, adding that the business and financial side of running a small practice can be extremely challenging.

Epidemiologist and public health expert Jonathan James, chief financial officer of Axis Medical Center, a federally qualified health care center in Minneapolis, said self-employed doctors work twice as hard for less pay. During the pandemic, things became more difficult for doctors in private practice due to staff shortages and supply chain disruptions.

“What they often don’t realize is all that goes on and is done behind the scenes,” says James. “Endless compliance issues, legal conflicts, vendor and clinic credentials… Plus, how do you have time to fix a copier? Install phones? Will technology improve?”

But he hopes she catches him. “You’re setting the stage for health in the first five years of life,” he said. “You’re setting healthy habits for everything from second-hand smoke and lead hazards. [in homes] For vaccination.

It will be one more big challenge for Joseph-DiCaprio, and an opportunity to serve up a career filled with both. After earning her MD from the University of Illinois at Urbana-Champaign, she earned a Master of Public Health from the University of Minnesota. While at Hennepin Healthcare, she served as medical director for Minneapolis Public Schools school-based clinics and various correctional facilities. She served as medical director for Medica and senior medical director for HealthEast when it merged with MHealthFairview.

At UKER, she started a department dedicated to mental health and substance abuse disorders. During the outbreak, she helped treat homeless shelters in North Minneapolis. She has organized the Covid-19 vaccination expansion efforts through UCare to ensure that UCare members are vaccinated at the same rate as everyone else across the state. She and her son volunteered at Catholic Charities on Sunday nights, distributing hygiene supplies to those in need at the beginning of the pandemic.

On the verge of opening the clinic to patients, Joseph-DiCaprio is excited to be confident that Leap will serve the Midway neighborhood in a unique and much-needed way. But the most important thing is the impact on the young patients who come through the door.

“I want my children To know that there are black doctors and Hmong doctors and this is possible for me, she said.

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