A different kind of health care: New St. Paul clinic will stress culturally competent providers

By Sheila Mulrooney Eldred | Sahan Journal

Even before the pandemic, Dr. Julia Joseph-Di Caprio felt intuitively how challenging life was for many Minnesotans. The data she saw as senior vice president and chief medical officer at health plan nonprofit UCare confirmed it. Kids were getting further behind on things like routine immunizations and well visits. COVID-19 presented additional challenges. 

What was more troubling for Joseph-Di Caprio, 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-Di Caprio had long dreamed of opening her own clinic. But for most, that’s a non-starter. Almost 75 percent of doctors work for a hospital, health system or corporate entity as of 2021. That’s almost 20 percent more than before the pandemic. Plus, Joseph-Di Caprio recently celebrated her 60th birthday. 

But what would be an insurmountable barrier to many looked like an opportunity to Joseph-Di Caprio. She felt that her background in patient care and administration put her in perfect position for the challenge.  

“I have said that 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 don’t I combine all that I’ve been ruminating on over the years and not only find a new way to serve folks who have barriers, but also be a model that others can use?”

This month, Dr. Joseph-Di Caprio will start 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 Street.

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. She plans to incorporate the latest technology, including telehealth. She plans to accept all patients, regardless of what type of insurance they have — or don’t have. She definitely does not want to leave patients waiting in the waiting room. And she wants to address the social determinants of health for patients, providing  connections to social services. 

She’ll start as the clinic’s sole medical doctor but plans to slowly build a small staff of culturally competent providers to serve the Midway neighborhood’s Hmong, Somali, Black and Spanish-speaking populations. She has hired a medical assistant she’s known for years and a receptionist who is a University of Minnesota psychology student.

Joseph-Di Caprio, who was born in Canada but grew up in the U.S., always knew she wanted to be a doctor. “It is the perfect career for me — combining service to others with science and continuous learning,” she said. When she started practicing more than 30 years ago, after completing her pediatric residency and adolescent medicine fellowship at the University of Minnesota Medical School, scant interest was paid to things like social determinants of health and diversity, equity and inclusion. But Joseph-Di Caprio, who is Black, was paying attention.

“I think diverse providers are able to listen differently,” she explained over coffee at a cafe on Selby Avenue. “I’ll go into a room after a patient has been roomed, 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 bring their full self.”

She recalled one example from when she was working 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 in which the patient was suspected of abusing substances. After a few minutes of listening to the patient, Joseph-Di Caprio realized the woman had a brain injury.

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

Just 2.6 percent of the state’s doctors identified as Black in a 2018 survey. Just under 2 percent identified as Hispanic, and 13.7 percent as Asian. More than three-quarters are white. It’s important to Joseph-Di Caprio that she might inspire some of her young patients to follow her path, eventually serving their own communities. 

Her experiences led her to focus on 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 an associate vice president of equity and inclusion. 

But while she loved her job as an executive and was known for getting results, the idea of getting back to patient care was always percolating, she said. So much so that she approached friend and CEO of NorthPoint Health and Wellness Center Stella Whitney-West about seeing patients there on a part-time basis.

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

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

“Even those who have moved out, they’re connected to the community,” Whitney-West said. “They come to the barber shops, support the businesses and churches. Racially concordant care – when a patient and doctor are of the same race – usually has a positive effect on a person of color’s experience,” Whitney-West said. 

“And since it’s Dr. Julia, particularly, it makes a big difference because she is a well-respected medical doctor and she is a woman and a woman of color.”

Dr. Julia Joseph-Di Caprio posing outside her new clinic on September 8, 2022.

One of Joseph-Di Caprio’s first patients will be the 3-year-old son of Chowdhury Tasnova Tahsin. The University of Minnesota doctorate student from Bangladesh has been looking for a pediatrician she can trust ever 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 he was gaining the appropriate amount of weight. 

“I am from a diverse background, and I felt like I couldn’t communicate – or they wouldn’t answer 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-Di Caprio at a farmer’s market where the doctor was promoting the new clinic, she immediately signed up. 

“I felt that I could trust her,” Tahsin said. “She’s very approachable and trustworthy.” 

Whitney-West also had a word or two of caution for Joseph-Di Caprio. “I told her, ‘You are a brave woman,’” Whitney-West said, since the business and financial side of running small practices can be extremely challenging.

Doctors who branch out on their own often end up working twice as hard 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 care center in Minneapolis. Things became even more difficult for doctors in private practice during the pandemic due to staffing shortages and supply chain disruptions. 

“What they often don’t realize is behind the scenes all the things that are done and done for them,” James said. “There’s endless compliance issues, legal battles, credentialing for providers and the clinic… Plus, how do you have any time to fix a copy machine? Install phones? Upgrade technology?”

But he hopes she sticks it out.  “You’re setting the trajectory of health in the first five years of life,” he said. “You’re setting healthy behaviors, for everything from the dangers of second-hand smoke and lead [in homes] to vaccines.”

It will be one more big challenge for Joseph-Di Caprio, and a chance to serve, in a career full of both. After earning her MD from the University of Illinois at Urbana-Champaign, she obtained a master of public health from the University of Minnesota. While at Hennepin Healthcare, she also served as medical director for Minneapolis Public Schools school-based clinics and for different correctional facilities. She has also served as medical director for Medica and a senior medical director for HealthEast when it merged with MHealthFairview.

At UCare, she launched a department dedicated to mental health and substance abuse disorders. During the pandemic, she helped homeless shelters in North Minneapolis with medical care. She organized COVID-19 vaccination outreach efforts through UCare with a goal of ensuring that UCare members were getting vaccinated at the same rates as others across the state. She and her son volunteered at Catholic Charities on Sunday nights, handing out hygiene supplies to people in need early in the pandemic. 

On the verge of opening the clinic to patients, Joseph-Di Caprio 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 could have on the young patients who come through the doors. 

“I want my children to know that there are Black doctors and Hmong doctors,” she said, “and that that’s a possibility for me.” 

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