New St. Paul clinic will stress culturally competent providers

Even before the pandemic, Dr. Julia Joseph-Di Caprio intuitively knew 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, she longed to open her own clinic. But for most, that's a non-starter. Almost 75% of doctors work for a hospital, health system or corporate entity as of 2021. That's almost 20% more than before the pandemic.

But what would be an insurmountable barrier for many looked like an opportunity to Joseph-Di Caprio, 60. She believed that her background in patient care and administration positioned her well 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 healthcare and, more importantly, I know that healthcare needs to try new things."

This month, Joseph-Di Caprio will start seeing patients at Leap Pediatric and Adolescent Care, the nonprofit clinic she founded to provide "high quality healthcare 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 N. in St. Paul.

She has big ambitions.

She wants to revive proven elements of old-fashioned care, even possibly adding 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 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 MD 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. "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% of the state's doctors identified as Black in a 2018 survey. Just under 2% identified as Hispanic, and 13.7% 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.

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.

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."

This story comes to you from Sahan Journal, a nonprofit newsroom dedicated to covering Minnesota's immigrants and communities of color. Sign up for its free newsletter to receive stories in your inbox.