Tracey Conti, MD, is executive vice chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine and program director of the UPMC McKeesport Family Medicine Residency, which features Latterman Family Health Center in McKeesport as its clinical site. She also is president of the Pennsylvania Academy of Family Physicians. Dr. Conti’s interests include health disparities and health care delivery to underserved communities, medical education, and women’s health issues.
What inspired you to become a doctor?
As far back as I can remember, I wanted to be a doctor. My mother worked in the West Penn Hospital laundry. She’d point to the hospital across the street and say, “Remember — that’s where you want to be.” She was raised by her grandparents on a working farm in South Carolina, and my dad was a Vietnam veteran. Both really valued learning, but neither had the opportunity to advance their education. They always encouraged me, saying, “You have the ability and all the love in the world to do what you want to do.”
Why did you decide to specialize in family medicine?
When I was in college, my parents adopted my brother. His mother had a substance use disorder, and he was prenatally exposed to the substance. That experience was formative: I realized that I wanted to take care of these mothers when they were pregnant — and then take care of their kids. I just didn’t know how I could combine those interests into a career.
As a medical student at Temple University in Philadelphia, I discovered family medicine through the school’s family medicine interest group. When I learned that family doctors care for patients from birth to death, I knew that’s what I wanted to do.
Health Disparities Q&A
As a third-year medical student, I did a rotation in family medicine at the University of Maryland School of Medicine in Baltimore. My first day there, the chair of the Family Medicine Department called me to say, “There’s a delivery — let’s go!” I went from a delivery in the morning to caring for pediatric patients in the afternoon. I realized nothing could be closer to my vision of being a doctor than family medicine. I went on to do my residency training in family medicine there.
When did you first see health disparities in medicine?
My medical studies had a huge impact on me because both institutions have a focus on inner city populations. That’s where I’ve always wanted to serve. My goal was to blend family medicine with the community aspects of being a family doctor.
One of my favorite things as a resident was seeing patients in their homes. You learn so much about people and the barriers they face when you get outside the four walls of your office. How can we as doctors possibly understand what our patients are going through if we never see the road they have to travel? I’ve always tried to remember that and really try to walk in my patients’ shoes.
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For example, if you’ve never had to rely on buses to get around, you may not think of public transit as a barrier to health. You don’t know the stress of having to take little children with you to an appointment because you don’t have access to childcare — or arriving late to the doctor’s through no fault of your own because the bus was late, only to be told you missed the appointment.
Access to medical care may be even harder today here in Pittsburgh because budget cuts mean there are fewer buses running in many communities. Here at Latterman Family Health Center in McKeesport, the bus stop in front of our building was suddenly eliminated. Patients had to walk to our offices from another stop several blocks away until we advocated for it to be reinstated. It was just another barrier our patients had to face to get to care.
What are some of the critical issues that need to be addressed?
You can’t talk about health disparities without also talking about racism in medicine. Until now, that’s been a subject no one really wanted to discuss, but it’s an underlying issue we must understand.
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This is a deep, multigenerational issue in the Black community. More than 100 years ago, the speculum was created by a gynecologist who did experimental surgeries on enslaved Black women. In my parents’ lifetime, the Tuskegee research study followed the lives of Black men with syphilis without ever giving them a diagnosis or treatment. The Black community’s mistrust of medicine has its roots in these and many other acts of racism.
That past can’t be ignored if we want to establish trust. And, unless we earn the trust of our diverse communities, the gap in health care will continue. Nowhere is that more evident than during COVID-19.
What’s been the impact of COVID-19 in the black community?
Black Americans are getting sicker and dying from the coronavirus at much higher rates than other populations. My own dad was infected this spring and is thankfully doing well, but it’s been a long and frustrating recovery. Now, as researchers work toward developing a vaccine, there’s talk on Facebook, Twitter, and even in churches that the COVID-19 vaccine will be just another experiment on Black people. In recent years, I’ve also seen a growing antivaccination sentiment among young Black mothers. It’s a trust issue. We have to constantly work on rebuilding the trust between doctors and patients to break down the barriers that affect health care.
Why is the doctor-patient relationship so important?
The bond between patient and doctor is central to the quality of care. That relationship takes time to develop and build rapport. I worry about the pressure that many doctors face today to complete a patient visit in just 15 minutes. The emphasis on productivity can erode that relationship.
One of the core tenets of family medicine is continuity of care. It’s so important for family doctors to be able to see their patients over time. When I first came to Pittsburgh I was still doing deliveries, so I specifically practice in a residency clinic today because I still want to see those pregnant moms! I love caring for patients who are with child, then caring for them and their children as the kids grow up. That relationship with the family is central to building trust.
How can medical education help address health disparities?
Our family medicine residency at Latterman Family Health Center emphasizes the importance of knowing and responding to the needs of our community. You can’t do that if you stay inside your office, so we work hard to have a relationship with the entire McKeesport community.
Our family medicine residents attend community provider meetings so they can get to know other service organizations and better understand community needs. They’ve created a community advisory committee to encourage conversations on a neighborhood level. That effort has led to a mentoring program at the local high school, funded with help from the Beckwith Institute of UPMC, that’s designed to introduce students to the many career paths available in health care. Food insecurity also is a major concern for many of our patients, so we partner with the Greater Pittsburgh Community Food Bank and 412 Food Rescue to offer thrive boxes at our office.
We have to be aware of the social determinants of health so we can break down those barriers to care. If we can’t help our patients with basic needs for living, how can we care for them in our offices? It’s very fulfilling to me to work in an environment where we’re teaching new family medicine doctors how to do this in a way that is community-oriented, then see them take this approach to medicine into other communities around the country.
I’m also very excited and encouraged by the partnerships that are developing between UPMC and local communities on health disparities. There’s a new openness among all parties to talking about disparities and how we got here.
How can partnerships bring about change?
I was installed as president of the Pennsylvania Academy of Family Physicians just as the pandemic hit. In that role, I quickly learned how much politics impacts what happens on a community level during a time like this. I don’t think the average person knows how influential it can be to talk with local leaders.
Health doesn’t just happen in a doctor’s office. If we’re going to address a health crisis like asthma, for example, we need to look at issues like poor housing and air quality. That means getting county and state support. It’s critical to know and interact with the key players politically because that is how decisions are made. Health equity must have a diversity inclusion component. We can do everything that we want on a microlevel in our offices, but unless we also influence policy, we really won’t see change.
I am seeing open and honest discussions happening in medicine like never before. In my own role as a family doctor at UPMC, I feel like it’s my duty to keep pushing the envelope and keep trying to make it better for the people who come after me.
Health disparities are preventable and disproportionate health conditions that exist among all ages in a certain population. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles.
For more information on health disparities, visit UPMC.com/healthdisparities.