First MUP Request Letter

Andy Jordan, MSPH, Director
Office of Shortage Designation
Health Resources and Services Administration
Parklawn Building , Room 8C-26
5600 Fishers Lane
Rockville, MD 20857

December 2, 2008

Dear Director:

The American Academy of Developmental Medicine and Dentistry (AADMD) is a 501c3 not-for-profit organization whose mission is to improve the quality of healthcare for people with Neurodevelopmental Disorders and/or Intellectual Disabilities (ND/ID).

In 2002, Surgeon General Satcher published a report entitled “Closing the Gap”.  This report found that people with ND/ID (also known as “Mental Retardation” or “Developmental Disabilities”) continue to experience significant disparities in accessing quality medical and dental care in nearly every community across the United States.

As the Surgeon General concluded in his report, one of the primary reasons for this glaring access disparity is the lack of focus of our medical and dental educational systems on the care of people with ND/ID.  The AADMD, through a grant from Special Olympics International and the CDC, recently completed a survey of every medical and dental school in the country, along with every pertinent residency program as well.  Our findings suggest that most schools do not consider this population to be a high priority to focus on, and, as such, most medical and dental students will graduate from school without ever seeing or touching a patient with ND/ID.

From a public health perspective, this perpetuates the tragedy of disparate healthcare for this population.  The cycle starts with lack of training of our students.  This, in turn, creates graduates who do not feel competent or confident in treating this population.  This discomfort eventually leads to professional avoidance and misunderstanding which, in turn, serves to preserve the disparate state of healthcare for people with ND/ID.

The population of people with ND/ID comprises over 7% of the United States’ population, 10 times more than the number of people with HIV.  Though it is difficult to imagine any medical or dental student graduating from school without learning about, discussing, seeing and touching at least one person with HIV, over 80% of medical students will graduate without ever having any clinical experience with patients with ND/ID.

In order to begin to move in a direction that reduces the health disparities experienced by this population, the federal government, namely HRSA, must first acknowledge that a problem exists.  The purpose of this letter is to ask that you formally designate the ND/ID population as a Medically Underserved Population.  Moreover, that this designation be made without regard for geography given that people with ND/ID are not “concentrated” in any one geographical locale.

Our initial application of the MUP formula to the ND/ID population shows that this population should qualify (with a score of roughly 52) for designation as a Medically Underserved Population.

Enclosed you will find a copy of our application of the MUP formula to the ND/ID population.  There are scores of publications which state and confirm that this population is experiencing great health disparities.  We have included a compendium of information containing the report of the Surgeon General, the Yale Report, Special Olympics Health Data, the CAN Project report, and other reports for your perusal.  Should you require any further assistance, please do not hesitate to contact our Executive Director via email at mattholder@aadmd.org.

Sincerely,

Matthew Holder, MD, MBA                      Henry Hood, DMD
Executive Director, AADMD                     President, AADMD