EVMS surgeon L.D. Britt has received a $2.5 million NIH grant to study disparities in surgery. The research could be a model for other specialties.

In his inaugural address as President of the American College of Surgeons, L.D. Britt, MD, MPH, cited healthcare disparities as a crucial concern for surgeons nationwide.

Beginning Sept. 1, Dr. Britt, the Edward J. Brickhouse Chair in Surgery, the Henry Ford Professor of Surgery, and Chair and Professor of Surgery at EVMS, will lead an historic effort by the American College of Surgeons (ACS) to confront the problem head on.

Dr. Britt is principal investigator on a $2.5 million R01 grant from the National Institutes of Health that will fund the first national effort to quantify surgical disparities. Through the grant, the ACS, Dr. Britt and his colleagues will develop a series of “disparities-sensitive” metrics to measure surgical quality in five key areas: access to care, clinic admission, anesthesia, surgery and recovery.

“The greatest challenge facing this nation is health care disparities,” Dr. Britt says. “There are widening disparities as far as who has access and what sort of therapeutic options patients have. It’s probably the biggest embarrassment for the nation, and it’s unacceptable.”

David Hoyt, MD, is Executive Director of the American College of Surgeons, the largest surgical organization in the world with more than 70,000 members. He was in the audience in 2010 when Dr. Britt gave his presidential address and spoke about disparities.

“Dr. Britt made the comment that you cannot have quality without access,” Dr. Hoyt recalls. “We were starting a campaign on quality, and when he made that comment, it just resonated with many of this, that this was a fundamental problem that we needed to address.”

Dr. Britt knows firsthand the hardships of healthcare disparities. As a child, he saw family struggle when one of them became sick and had to visit the doctor.

“They would have to pack a lunch and a dinner because they would have to wait six or more hours just to see a doctor for a few minutes,” he recalls today. “I knew something was wrong. There just weren’t enough doctors.”

Richard Homan, MD, President and Provost and Dean of the School of Medicine, says the grant closely aligns with the school’s community-focused mission.

“This is an important first step in an effort that could eventually help countless patients around the country,” Dr. Homan says. “Dr. Britt is the ideal individual to lead this project, given his legacy of community service, his stature among his colleagues nationally and his passion for confronting difficult yet critical issues.”

Disparities are the result of a complicated mix of issues, Dr. Britt says.

“A lot of people think it’s based on race, but one of the greatest drivers is poverty,” Dr. Britt says. “If you’re poor, you’re not going to have the same health care options as somebody who is not poor. If you’re in a rural area, you don’t have the same access as somebody in a more urban setting. So, it’s based on income, it’s based on where you live, it’s based on ethnic background – all of that.”

Surgeon Ron Maier, MD, the Jane and Donald D. Trunkey Endowed Chair in Trauma Surgery at the University of Washington, has seen the problem play out in eastern Washington State, where five rural towns have lost their community surgeons.

“The problem is enormous,” he says of disparities. “Before you can deal with the answers you have to deal with the scope of the problem. This grant is important because it will provide real, valid data to truly assess the impact.”

NIH R01 grants are among the most competitive awards in scientific research. Dr. Britt’s research team comprises experts in the field who work in respected medical organizations and academic institutions, such as the ACS, Harvard Medical School and the University of California, Los Angeles.

Once Dr. Britt and his team have been able to define the disparities and understand the scope of the problem, they will look for additional funding to develop ways to intervene. It’s a systematic approach that Dr. Britt believes could be adopted by other medical disciplines.

“Every discipline has health care disparities,” Dr. Britt says. “I’m hoping that this is a template for other disciplines to do the same. I want this to be a movement.”