Training, Resources for Doctors a Factor in Racial Disparities in Health Care, Study Finds
Doctors treating mostly African-American patients and practicing in largely African-American neighborhoods are more likely than their colleagues to say they have trouble providing high-quality care, according to a study in this week's issue of the New England Journal of Medicine, the Wall Street Journal reports. Researchers from Memorial Sloan-Kettering Cancer Center and the Center for Studying Health System Change analyzed data from 150,391 "routine" doctor visits by African-American and white Medicare beneficiaries to 4,355 primary care physicians who participated in a 2000-2001 telephone survey (Windham, Wall Street Journal, 8/5).
The study is based on information from HSC's Community Tracking Study Physician Survey, which collects information from 12,000 practicing physicians, and Medicare claims information from a representative sample of 5% of Medicare beneficiaries (HSC release, 8/5).
The study authors say that African-American and white patients are treated to a large extent by different groups of physicians, resulting from geographic segregation, the Boston Globe reports. According to the study, 22% of physicians accounted for 80% of visits by African-American patients but only 22% of visits by white patients (Dembner, Boston Globe, 8/5). Researchers found that almost 28% of visits by African-American patients were to doctors who said they "could not consistently provide high-quality care," compared with 19% for whites, USA Today reports (Szabo, USA Today, 8/5). In addition, 77% of doctors treating more African-American than white patients had board certification in their primary care specialty, compared with 86% of doctors with primarily white patients (Boston Globe, 8/5).
Noncertified doctors are less likely to screen patients for diseases and more apt to treat symptoms rather than diagnose underlying diseases, according to the study. Doctors who treat African Americans more often also said they had trouble referring patients to specialists, obtaining diagnostic imaging tests and admitting patients to hospitals for nonemergency treatment (USA Today, 8/5). Such differences remained even after researchers accounted for patients' insurance statuses (Boston Globe, 8/5). According to the study, "Disparities in health care could emerge if these two groups of physicians differed in their ability to provide high-quality care, either because of differences in their clinical training or because of differences in their access to resources."
The findings are part of a "growing body of evidence" outlining disparities in the medical system, the Boston Herald reports (Heldt Powell, Boston Herald, 8/5). The study shows that the "dual system for blacks and whites" is not a result of physician bias but of geographic segregation and could explain the higher rates of disease and death that persist among African Americans, the Boston Globe reports (Boston Globe, 8/5). Peter Bach, lead author and a pulmonologist and epidemiologist at Memorial-Sloan Kettering, said, "The findings paint a picture of two health systems, where physicians treating black patients appear to have less access to important clinical resources and be less well-trained." Arnold Epstein of the Harvard School of Public Health, who wrote an editorial accompanying the study, said "In health care, integration is not complete, and separate is not equal" (USA Today, 8/5).
John Fromson, Massachusetts Medical Society vice president, said, "This is a really important study because it really raises our awareness of this issue. The question is, will it help us make some important changes in terms of the type of care that members of our black community get?" (Boston Herald, 8/5). An abstract of the study is available online. NPR's "All Things Considered" on Wednesday reported on the study. The segment includes comments from Bach and Randall Maxey, president of the National Medical Association (Jones, "All Things Considered," NPR, 8/4). The complete segment is available online in RealPlayer.