First Person with Dr. Debora Matossian: Hispanic Heritage Month Reflections
In honor of Hispanic Heritage Month, learn from Argentinian Nephrology Physician Dr. Debora Matossian about her passion for Hispanic representation in medicine. As the program director of the pediatric nephrology fellowship, Dr. Matossian is committed to making sure Hispanic patients see themselves in the providers who care for them and takes a special research interest in the barriers the Hispanic population faces when it comes to medical care access. In this Q&A, she discusses the importance of this work.
Q: Can you tell us about an experience that influenced your career path?
A: When I was a fellow, I was the only Hispanic physician in our nephrology division. The division head brought me a stack of paperwork for a young Hispanic patient who was going to cross the country, from Texas to Chicago, to obtain care at Lurie Children’s. His care coordination was overly complex, including risk of cancer, risk of end stage kidney disease, dialysis, and transplantation for this 9-month-old son of a single-mother Hispanic immigrant. His aunt travelled from Mexico, donated her kidney, and returned to her country. I felt empowered by the tremendous responsibility that this entailed. The trust that the division head had in me gave me the confidence to prepare and serve this complex medical situation, in a vulnerable patient, with flawless outcomes.
Gratefully, he is now a healthy adolescent with a working kidney transplant, playing soccer and excelling at school, supported by his strong mother and extended family.
Q: What motivates you in your career today?
A: Supporting families who struggle with chronic disease to the best of my ability. Particularly, vulnerable families who might be undeserved due to poor understanding of the system or due to other barriers related to language, culture, or education.
Q: Can you talk about the importance of Hispanic representation in your work and research?
A: Just recently, a parent asked if her son could be seen by a provider who spoke Spanish. She was frustrated and wanted to be heard and understood beyond a language barrier itself. Being Hispanic is much more than speaking Spanish. It is a way of conceptualizing family and parenting, it is how you love, communicate and live. It is bonding through food and culture. The comfort that can be transmitted by a Hispanic physician to a Hispanic patient is difficult to replicate.
My research* focus also attracts interest and discussion, and is a testimony to who I am and what I care about. I am interested in barriers to access medical care in Hispanic patients. I have found that pragmatic factors (such as taking time off work and transportation) and skills negotiating the health system are the most identified barriers amongst Hispanic patients.
*Dr. Matossian is currently working on a manuscript for this research. For context, the project was set up with the below design.
Patients who self-identified in EPIC as Hispanic were given a validated survey tool “Barriers to Care Questionnaire (BCQ)” at check-in for their routine pediatric nephrology appointments. Forms were completed by parents/legal guardians unless the patients were older than 18 years. Surveys could be filled out in English or Spanish. The survey had 40 questions divided into 5 categories: Pragmatic (logistical issues that might delay/prevent utilization), Skills (acquired/learnt strategies necessary to navigate the health care system), Marginalization (internalization of negative experiences within the HCS), Expectations, Knowledge and Belief (lay or popular ideas about the nature of illness which may differ from mainstream allopathic medicine). Sociodemographic data was also collected from the medical records and Area Deprivation Index (ADI) of the patients surveyed. A higher ADI score correlated with higher total barriers and exacerbated by language.
Q: Tell us about your role as the nephrology fellowship director and commitment to recruit more Hispanic providers in your field at Lurie Children’s.
A: Being the program director of the pediatric nephrology fellowship is a great responsibility. I get to select young physicians who will take care of our pediatric nephrology population. It is also a gift learning the paths that led to these hard-working physicians to love nephrology. Nephrology is not a popular subspecialty. There are about 30 applicants across the country every year. About 60% of programs do not fill all their positions. Forty-seven percent of the patient population at Lurie Children’s is Hispanic, and 40% of our current fellow team is Hispanic. Representation in medicine is key for adequate communication, trust, and better patient outcomes. Matching our patient population distribution has happened naturally and effortlessly.
The same way that I connect to my Hispanic patients in a distinct way, the same happens naturally when I interview URIM (Underrepresented in Medicine) candidates. I see strengths in the adversities and biases that they have had to work against.
Q: Is there a particular accomplishment you are proud of in your work?
A: In the last three years I have recruited one Hispanic fellow per year, out of two positions per year. With this accomplishment, the percentage of pediatric nephrology fellows at Lurie Children’s mimics the percentage of Hispanic patients we care for. This representation is key for patient satisfaction, adherence to medical treatments and outcomes. Trust is enhanced and better therapeutic relationships occur.
Q: Do you have any words of advice for young people interested in medicine?
A: Hispanics tend to be submissive, so my advice is to believe in yourself, overcome imposter syndrome, learn to speak up and stand up for your patients, and promote their rights and preferences.
Q: What is a tradition or piece of Hispanic culture that is meaningful to you?
A: Drinking mate* when gathered with friends.
*Mate is Argentina’s national drink. Learn more about the culture's herbal tea here.
Q: Do you have a favorite Hispanic-owned business in Chicago readers should try?
A: I am fond of 5411 Empanadas, owned by a group of close Argentinians friends (54 is the area code to Argentina, 11 to Buenos Aires). My favorite is the spinach empanada.
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