Like swirls of ice cream, America’s people come together as the world’s most diverse country — chocolate, vanilla, and coffee-flavored immigrants, among all kinds. Yet most Americans continue to practice a form of social segregation observed to varying degrees in medicine. Today, a new Harvard study shows that 54 percent of people of color receive care from a physician hailing from a minority background.
In a national survey, minority doctors were more likely than white counterparts to see the nation’s poor, huddled masses, including 70 percent of immigrants not speaking English. Overall, physicians with minority backgrounds handle a disproportionately large share of the nation’s Medicaid patients, among other groups with historically poor access to the medical system. Although composing a quarter of the U.S. population, African-Americans and Hispanics comprise only 15 percent of the country’s cadre of doctors, according to Lyndonna Marrast, a physician at Cambridge Health Alliance, who led the study.
"Patients from disadvantaged groups have substantial problems accessing care," Marrast, said in a statement. "The fact that minority physicians are much more likely to care for disadvantaged patients suggests that expanding the racial diversity of the physician workforce in the U.S. could be key to improving access to care."
In the study, investigators analyzed data from more than 7,000 patients collected in 2010 by the federal government. Among findings, minority doctors were “substantially” more likely to see sicker patients, as measured by self-rating of health status. In total, patients with minority backgrounds were 19 to 26 times more likely to receive care by a doctor of the same race, while poor patients were 1.5 to 2 times more likely to receive care from a black, Hispanic, or Asian doctor.
However, the picture becomes a bit more colorful with regard to obesity care. As expected, African-American physicians were more likely than others to care for obese patients, though Hispanic and Asian physicians were less likely to do so.
Investigator Steffie Woolhandler, a public health expert at City University of New York, says the study findings “do not argue for strengthening the existing de facto segregation of medical care,” though few might suggest such an idea. "But it is clear that doctors' decisions on where to practice and patients' decisions on where to go for care combine to create an outsized role for minority physicians in caring for the underserved."
As the Medicaid rolls continue to expand under the Affordable Care Act, millions of people of color newly insured on the private market — with some help from government subsidies — will soon flood doctor’s offices around the nation, worrying some about the availability of physicians in minority communities.
Danny McCormick, an investigator from Harvard Medical School, says the nation must work diligently to develop more physicians of color for underserved populations — offering pragmatism in the face of an intransigent system of social segregation. "There is a lot of concern that there will not be enough physicians willing and able to care for them," McCormick said in the statement. "In order to increase the number of black and Hispanic physicians, medical schools will need to more fully consider the physician workforce needs of the health care system as a whole in admissions decisions."
Source: Marrast L, Zallman L, Woolhandler S, Bor D, McCormick D. Minority Physicians' Role In The Care Of Underserved Patients: Diversifying the Physician Workforce May Be Key In Addressing Health Disparities. JAMA Internal Medicine. 2013.