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Minority Physicians Face More Difficulties Obtaining Needed Care for Patients than White Counterparts
Medscape Study Shows Racial/Ethnic Disparities in Specialty Referrals and Hospital Admissions
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ASHINGTON, D.C. - African-American and Hispanic physicians are much more likely than white physicians to report being unable to obtain needed hospital admissions and specialty referrals for patients, according to a study by the Center for Studying Health System Change (HSC) published today in Medscape General Medicine, Medscapes - www.medscape.com - peer-reviewed, on-line general medical journal.
Among African-American and Hispanic physicians, one in three reported they could not obtain hospital admissions for patients compared with one in four white physicians, according to the study by J. Lee Hargraves, Ph.D., Jeffrey Stoddard, M.D., and Sally Trude, Ph.D. The authors are researchers at HSC, a nonpartisan policy research organization funded solely by The Robert Wood Johnson Foundation.
Similarly, according to the study, about 12 percent of African-American physicians and almost 15 percent of Hispanic physicians reported difficulty obtaining specialty referrals for patients, compared to less than 8 percent of white physicians. The study is based on a 1998-99 survey of more than 12,000 physicians and is the first national survey to examine minority physicians ability to obtain needed care for patients. The Medscape General Medicine article, "Minority Physicians Experiences Obtaining Referrals to Specialists and Hospital Admissions," is available at www.medscape.com/medgenmed/minorityphysicians.
"African-American and Hispanic physicians compared to their white colleagues have more difficulty getting needed services for their patients," Hargraves said. "The inability of minority physicians to obtain needed specialty and hospital care for patients likely contributes to the well-documented health disparities among African Americans, Hispanics and whites."
For example, deaths from heart disease are greater for African Americans than whites; Hispanics and African Americans are less likely than whites to receive surgical procedures for heart disease; African Americans and Hispanics are diagnosed with cancer at more advanced stages than whites; and African Americans with diabetes receive less preventive care than whites.
Even after the researchers took into account physician and community differences, they found disparities persisted, suggesting there are health-system barriers hindering minority physicians from obtaining needed care for their patients. After adjusting for these differences, the researchers found African-American physicians were still more likely to report problems obtaining hospital admissions and Hispanic physicians were more likely to report problems obtaining specialty referrals, compared to white physicians. Health-system barriers may include the proximity of specialists and hospitals to physicians and their patients; discrimination against minority physicians, their patients or both; the clout of individual physicians; and other difficult-to-measure factors, according to the study.
"The findings suggest that there are real barriers in the health care system that keep minority physicians from being able to access needed care for their patients," Hargraves said.
Physician differences the researchers accounted for in the study include such factors as experience, training, practice size, charity care provision, and participation in managed care, Medicare and Medicaid, while community differences include such factors as the per-capita supply of hospital beds and specialists.
Current policies to close the access-to-care gap between whites and minorities such as increasing the supply of minority physicians or expanding health insurance coverage will not alone eliminate racial/ethnic health disparities because of these health-system barriers, according to the study authors.
In an editorial accompanying the Medscape General Medicine article, Cheryl R. Whitaker, M.D., and Eric E. Whitaker, M.D., M.P.H., from Northwestern Universitys Institute for Health Services Research and Policy Studies, state the study "sheds light on an important yet understudied area." The editorial is available at www.medscape.com/medgenmed/minorityphysicianseditorial.
The two physicians continue that "As African-American physicians who have lived and practiced in underserved communities for many years, we do not find the results from this surprising. They support anecdotal experiences of colleagues who practice in both well-served and underserved communities throughout this country. .The federal government and the medical establishment must be vigilant in ensuring that patients and their doctors have access to appropriate admissions and referrals, whatever their race."
For reaction to the HSC study, contact:
Elena Rios, M.D., President, National Hispanic Medical Association at (202) 628-5895
Rodney G. Hood, M.D., President, National Medical Association at (202) 347-1895
B. Waine Kong, Ph.D., J.D., CEO of the Association of Black Cardiologists at (800) 753-9222
Contact numbers for editorial authors:Cheryl R. Whitaker, M.D., Northwestern Universitys Insitute for Health Services Research and Policy Studies, (312) 503-0427
Eric E. Whitaker, M.D., M.P.H., Northwestern Universitys Institue for Health Services Research and Policy Studies, (312) 740-4742