Doctor’s Race Unrelated to Disparities in Cardiac Care
Black heart attack patients remain "far less likely" than whites to undergo cardiac catheterization, a "common and potentially life-saving procedure," regardless of the race of their doctors, a new study published in today's New England Journal of Medicine found (Stolberg, New York Times, 5/10). Researchers at Yale University examined data from the Cooperative Cardiovascular Project -- a study of Medicare beneficiaries hospitalized for acute myocardial infarction in 1994 and 1995 -- to determine whether black and white patients received cardiac catheterization within 60 days after acute myocardial infarction at different rates based on the race of their physicians. According to researchers, who analyzed the medical records of 35,676 white and 4,039 black patients treated by 17,550 white and 588 black doctors, the study found no "significant interaction between the race of the patients and the race of the physicians in the use of cardiac catheterization." The study revealed that white physicians offered cardiac catheterization to 45.7% of white and 38.4% of black patients, while black doctors offered the procedure to 49.6% of white and 38.2% of black patients. The study found that "racial discordance between the patient and the physician does not explain differences between black patients and white patients in the use of cardiac catheterization" (Chen et al., New England Journal of Medicine, 5/10). In addition, the study found no difference in survival rates for black and white patients three years after suffering an acute myocardial infarction.
Although other studies have found a "stark racial disparity in care," Yale researchers say their study, the first to examine the effect of a doctor's race on differences in care, "debunks the notion that discrimination by white doctors against black patients is the sole source of the disparity," the Times reports. In the study, doctors of both races referred white patients for cardiac catheterization 40% more often than black patients. Dr. Harlan Krumholz, an associate professor of cardiology at Yale and the study's lead author, said, "The traditional, easy framing of this problem as simply being discrimination by the majority group against the minority group does not seem to be supported by this study. We do find disturbing differences in patterns of care, but whatever accounts for this is likely to be pervasive throughout the system." Experts attributed the difference in care to a "combination of factors," including quality of care, patient preference and a "tendency by doctors to be more aggressive" in treating whites. "The disparities are probably very complicated social phenomena," Dr. Arnold Epstein, chair of the department of health policy at the Harvard School of Public Health, said, adding, "But it looks like whatever part the doctor is playing, black and white doctors play it the same."
Experts who study racial disparities in health maintain that "unconscious or subtle discrimination is almost certainly at work." Dr. H. Jack Geiger, professor of community medicine at City University of New York, said that "something about going through medical school" may "creat[e] or reinforc[e] stereotypes, like some people's not wanting certain kinds of care or being less able to comply with doctors' instructions." In addition, David Williams, a sociologist at the University of Michigan, said that doctors, "socialized within the same professional context," often "view certain patients as undesirable," issues related more to "class than race" (New York Times, 5/10). Dr. Elizabeth Ofili, president of the Association of Black Cardiologists and a professor at the Morehouse School of Medicine in Atlanta, added that black patients may have "less access" to doctors and medical information or may "listen to friends who said medical procedures might be dangerous." She said, "It is possible that the way information is presented to the patient might affect the response, especially if the patient is coming to the table with a deficit of information." Still, the Hartford Courant reports that the study may indicate "white patients may receive more treatment than is medically necessary" (Hathaway, Hartford Courant, 5/10). To view a summary of the study, titled "Racial Differences in the Use of Cardiac Catheterization after Acute Myocardial Infarction," go to