Are We Ready? A Case for Making Hematology Fellows Competent in Treating the Booming Culturally Diverse Minority Populations.

United States is at an important phase of its growth since the dawn of the new century. US population has grown by 13% from 248 million to 281 million between 1990–2000. Projected increase in population by mid century will be 460 million. According to 2000 census, 11% of US population is foreign born and 17.9% speaks a language other than English at home. Population demographics indicate very significant trend changes. The projected race and ethnic changes are occurring sooner because of higher than expected increase in immigration rates. By 2050 the minorities will make about 50% of US population. Ethnically and culturally diverse minorities are projected to grow exponentially. Asians are expected to grow by 213% to 60 million, while Hispanics will increase in their ranks by 188% to 102.6 million i.e. roughly one quarter of the population. The black population will see a 71% increase to 61 million while Whites will grow by 7% to 210 million. These trends indicate that Asian and Hispanic populations will triple in number by mid century. This poses special challenges to the health care industry and physicians in particular. The Hematologists will be diagnosing and treating a much larger number of the diseases common in these ethnic groups e.g. Sickle cell disease, hemoglobinopathies including Thalassemias and thrombotic and hypercoaguable disorders etc. interaction with these ethnically and culturally diverse clients will be challenging for the Hematology fellows since no formal training in cultural competency training is incorporated in fellowship program structure. Review of the curricula of the training programs has revealed most of these are deficient in this regards. Some awareness of the issue is found in nursing training literature. There is awareness regarding the cultural competency issue at a national level where Health and Human Services have issued national standards for culturally and linguistically appropriate services in health care (CLAS). This initiative can be used as a road map for providing cultural competency training to Hematology fellows. This will enable them to appreciate, think and act in ways that acknowledge, respect and build upon ethnic, socio cultural and linguistic diversity. Fellows can be trained and evaluated during their training in core competencies such as self-awareness, effective communication, cultural knowledge, humility and proper use of interpreters. In conclusion I emphasize that I order to deliver quality health care to ethnically diverse populations and to decrease disparities in health care, cultural competency should be an integral part of Hematology training programs.