FOR IMMEDIATE RELEASE: July 19, 2021
Contact: Christopher Cai, M.D., ccai4@partners.org
Samuel Dickman, M.D., samuel.dickman@austin.utexas.
Clare Fauke, Physicians for a National Health Program communications specialist, clare@pnhp.org
People of color are underrepresented in the outpatient practices of most specialist physicians, according to a study appearing today in JAMA Internal Medicine. Black, Hispanic, Asian/Pacific Islander and Native Americans received much less care (measured by outpatient visit rates) from surgical specialists such as orthopedists or medical subspecialists such as pulmonary (lung) specialists. Disparities persisted even after accounting for patients’ insurance, income, education and health status. In contrast, primary care physicians saw patients of color and white patients at roughly equal rates.
The study, carried out by a team of researchers at Harvard Medical School, The City University of New York at Hunter College, Planned Parenthood South Texas, and Tufts University, analyzed data from 132,423 respondents to the Medical Expenditure Panel Survey, a national survey of healthcare use. Compared to white patients, Black patients were underrepresented in the practices 23 out of 29 physician specialties. For example, Black patients’ visit rates to orthopedic surgeons, urologists, pulmonologists and cardiologists were 59%, 62%, 63%, and 81% those of white individuals, respectively. Native American patients were also markedly underrepresented in most specialties’ practices, as were Hispanic- and Asian/Pacific Islander-Americans. Notably, nephrologists — who care for patients with end-stage kidney disease, almost all of whom are covered by Medicare, and many of whom are people of color — provided significantly more care to minority groups than to whites.
“Black Americans die nearly 5 years younger than white Americans and are more likely to have chronic illnesses, due to discrimination and poverty. Yet physicians who could close these gaps are far less likely to see Black patients,” said Dr. Christopher Cai, the study’s lead author and a resident physician at Brigham and Women’s Hospital and Harvard Medical School. “Inequities in health insurance are probably the main culprit for the racial disparities we found. White people are far more likely to have private insurance, which pays doctors higher fees. In addition, white patients are more often able to afford copayments and deductibles for visits. Our insurance system tells doctors that people of color are worth less than white people, a pernicious form of structural racism.”
Dr. Samuel Dickman, the study’s senior author and Director of Primary Care at Planned Parenthood South Texas, noted, “Black patients’ experiences of mistreatment by the health care system in the past may lead them to avoid seeking care. People of color may feel more comfortable seeing physicians from their own communities, but medical schools are not training nearly enough Black-, Latino- and Native-American physicians. Location is an important factor too, since relatively few specialists have offices in communities of color.”
Study co-author Dr. Steffie Woolhandler, a Distinguished Professor at CUNY’s Hunter College and Lecturer in Medicine at Harvard Medical School added, “One hopeful finding was that kidney specialists saw patients of color at rates commensurate with their high rates of severe kidney disease. Almost all patients who need dialysis or a kidney transplant qualify for Medicare, even if they are under 65, and hence bring doctors the same fees. Universal and equal insurance could go a long way toward equalizing care.”
“Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties,” Christopher Cai, M.D.; Adam Gaffney, M.D., M.P.H.; Alecia McGregor, Ph.D.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; and Danny McCormick, M.D., M.P.H.; Samuel Dickman, M.D. JAMA Internal Medicine.
Published online first, July 19, 2021 at 11:00 AM EST.
The full text of the article is available to media professionals upon request. Please contact mediarelations@jamanetwork.org.
Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 24,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.