A different kind of health care: The new St. Paul clinic will emphasize culturally competent providers

By Sheila Mulroney Eldred | Sahan Journal

Even before the pandemic, Dr. Julia Joseph-DiCaprio felt intuitively how challenging life was for many Minnesotans. The data she saw as senior vice president and chief medical officer at the nonprofit health care organization UCare confirmed it. Children fell behind on things like routine immunizations and well visits. Covid-19 has posed additional challenges.

What was more troubling for Joseph-DiCaprio, who lives in St. Paul’s Merriam Park neighborhood, was that much of it was happening 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, it’s a non-starter. Almost 75 percent of doctors work for a hospital, health system or corporate entity by 2021. That’s almost 20 percent more than before the pandemic. Also, Joseph-DiCaprio recently celebrated his 60th birthday.

But what would be an insurmountable barrier for many seemed like an opportunity for Joseph-DiCaprio. She felt that her background in patient care and administration placed her in a perfect position for the challenge.

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

“Why not combine everything I’ve thought about over the years and not only find a new way to serve people who have barriers, but also be a model that others can use?”

Did you know that MPR News is member-supported? Contributions from individuals enhance the titles, clarity, and context found here. Give during the Fall Member Drive to become a member today.

This month, Dr. Joseph-DiCaprio will begin seeing patients at Leap Pediatric and Adolescent Care, the nonprofit clinic she founded to provide “high-quality health care for those who face the greatest barriers to health and wellness’. She found a home for the clinic in the Community Action Partnership of Ramsey & Washington Counties building on Syndicate St. North.

She has big ambitions. She wants to revive proven elements of old-fashioned care, even toying with the idea of ​​incorporating home visits at some point. It plans to incorporate the latest technologies, including telehealth. She plans to see all patients regardless of what insurance they have – or not. She definitely doesn’t want me to leave patients waiting in the waiting room. And she wants to address the social determinants of patients’ health, providing links with social services.

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

Joseph-DiCaprio, who was born in Canada but grew up in the US, always knew she wanted to be a doctor. “This is the perfect career for me – combining service to others with science and continuous learning,” she said. When she began practicing more than 30 years ago, after completing her pediatric residency and fellowship in adolescent medicine at the University of Minnesota Medical School, there was little interest in things like social determinants of health and diversity, equity, and inclusion. But Joseph-DiCaprio, who is black, was paying attention.

“I think different providers can listen differently,” she explained over coffee at a Selby Avenue cafe. “I’ll walk into a room after the patient has been settled, 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 come out.”

She recalled an example from 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 a room where the patient was suspected of substance abuse. After a few minutes of listening to the patient, Joseph-DiCaprio realized that the woman had a brain injury.

“It’s not that people weren’t nice or didn’t try,” she said. “It’s that someone who shares your experiences is better able to listen to what you’re expressing.”

Just 2.6 percent of the state’s physicians identified as black in a 2018 survey. Just under 2 percent identified as Hispanic and 13.7 percent identified as Asian. More than three-quarters are white. For Joseph-DiCaprio, it’s important that she inspires some of her young patients to follow her path, ultimately serving their own communities.

Her experience led her to focus on the social determinants of 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 of equity and inclusion.

But while she loved her job as executive director and was known for getting results, the idea of ​​returning to patient care always percolated, she said. So much so that she reached out to friend and NorthPoint Health and Wellness Center CEO Stella Whitney-West about seeing patients there part-time.

“She’s an outstanding family medicine physician and her real area is adolescent/pediatric care — that’s what she was missing,” Whitney-West said. “For [many doctors] and for Dr. Julia, it fuels them. Seeing patients is their purpose first and foremost as a doctor.”

Whitney-West grew up in the Rondo neighborhood near the new Leap clinic and met with Joseph-DiCaprio to advise her on the project. It’s a community with deep roots, Whitney-West said, a place where generations of families choose to stay and send their children to local schools.

“Even the ones that have moved away, they’re connected to the community,” Whitney-West said. “They come to the barbershops, support businesses and churches. Racially congruent care — when the patient and the doctor are of the same race — tends to have a positive effect on the experience of a person of color,” Whitney-West said.

“And because it’s Dr. Julia in particular, it makes a big difference because she’s a well-respected doctor and she’s a woman, and she’s 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 Chowdhury Tasnova’s 3-year-old son Tahsin. The University of Minnesota doctoral student from Bangladesh has been looking for a pediatrician she can trust since her son was born.

Tahsin said her son was born with a birth weight in the lower range and that her first pediatrician scolded her even though she was gaining the required weight.

“I’m from a different background and I felt like I couldn’t communicate — or they wouldn’t address my concerns,” she said. When the boy was diagnosed with an ear infection, she thought the antibiotics he was given were unnecessary.

So when she ran into Joseph-DiCaprio at a farmer’s market where the doctor was promoting the new clinic, she immediately signed up.

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

Whitney-West also had a word or two of warning for Joseph-DiCaprio. “I told her, ‘You’re a brave woman,'” Whitney-West said, because the business and financial side of running a small practice can be extremely challenging.

Doctors who branch out on their own often end up working twice as much for less pay, said Jonathan James, an epidemiologist and public health expert who is chief financial officer at Axis Medical Center, a federally qualified health center in Minneapolis. Things have become even more difficult for doctors in private practice during the pandemic due to staff shortages and supply chain disruptions.

“What they often don’t realize is behind the scenes of all the things that are being done and done for them,” James said. “There are endless compliance issues, legal battles, provider and clinic credentials… Besides, how do you have time to fix a copier? Installing phones? Upgrading the technology?”

But he hopes she can handle it. “You set the trajectory of health in the first five years of life,” he said. “You establish healthy behaviors for everything from the dangers of secondhand smoke and lead [in homes] to vaccines.”

It will be another big challenge for Joseph-DiCaprio and a chance to serve up a career full of both. After earning her doctorate from the University of Illinois at Urbana-Champaign, she earned a master’s degree in public health from the University of Minnesota. While at Hennepin Healthcare, she also served as medical director for school-based clinics for Minneapolis Public Schools and for various correctional facilities. She also served as medical director for Medica and senior medical director for HealthEast when it merged with MHealthFairview.

At UCare, she started a department dedicated to mental health and substance abuse disorders. During the pandemic, she helped homeless shelters in North Minneapolis with medical care. She is organizing a COVID-19 vaccination effort through UCare to ensure that UCare members are vaccinated at the same rates as the rest of the state. She and her son volunteered at Catholic Charities on Sunday evenings, handing out hygiene supplies to people in need at the start of the pandemic.

On the cusp of opening the clinic to patients, Joseph-DiCaprio is excited and confident that Leap will serve the Midway neighborhood in a different and much-needed way. But most important is the effect it can have on the young patients who walk through the doors.

“I want my children to know that there are black doctors and Hmong doctors,” she said, “and that this is an opportunity for me.

Leave a Comment

Your email address will not be published. Required fields are marked *