Race May Affect Doctor Choice

More than one-in-five African-Americans and one in three Hispanic Americans prefer a doctor of the same race or ethnicity, a new study shows.

For African-Americans, this preference is strongly linked to believing that racism is inherent in the U.S. health care system. And African-Americans who prefer black doctors are more likely to rate their doctor as excellent than those who want a black doctor but don't have one.

This may lead doctors to think that all minority patients want same-minority doctors, says University of Washington researcher Frederick M. Chen, MD, MPH. Yet Chen and colleagues find that for two-thirds of black Americans and about half of Hispanic Americans, the race/ethnicity of the doctor doesn't matter. Their study appears in the March/April issue of Annals of Family Medicine.

"The fact is that the majority of minority patients don't have a strong preference about the race of their doctors," Chen tells WebMD. "We have programs to provide large numbers of minority doctors to minority patients, when this isn't an issue for the majority of these patients. Yet there is a group of patients who have a strong preference. Maybe we should be working harder to understand that and to make sure those patients are able to act on their preferences and have a choice."

Racial Disparities In U.S. Health Care: No Simple Cause, No Single Solution

Recent studies show that racial and ethnic minorities in the U.S. continue to get worse health care than white patients. The problem, these studies show, isn't as simple as laying the blame at the feet of a few racist doctors.

A complex web of factors throughout the health care system creates racial and ethnic disparities. Various researchers have looked at doctor issues, at cultural differences, at socioeconomic factors, at geographic distributions, and at institutional failures.

Now Chen and colleagues suggest that patients' beliefs must be taken into account.

"I think it is important for patients to know we are trying to understand better the problem of health care disparities," Chen tells WebMD. "We are looking for ways to fix it. That is going to require a more nuanced response than what we traditionally think of."

Racial disparity expert Michelle van Ryn, PhD, MPH, of the University of Minnesota Minneapolis, says the problem of unequal health care must be put into perspective. She argues that overcoming racial disparities is an integral component of improving health care for all patients.

"One of the things that is very important for African-American citizens to know is that despite disparities, most health care is equitable," she says. "If 70 percent of blacks and 80 percent of whites get proper care, true, blacks tend to get worse care — but most still get good care. The fact there is disparity doesn't mean every single minority patient will get bad care. It's just that these disparities mean their odds of getting good care are worse."

Who Wants A Same-Race/Ethnicity Doctor?

Chen's team analyzed data gathered from a 1999 survey by the Kaiser Family Foundation. The survey was based on telephone interviews with a nationally representative sample of about 1,500 white Americans, about 1,200 black Americans, and about 1,000 Hispanic Americans.

They found that 22 percent of blacks, 34 percent of Hispanics, and 13 percent of whites preferred a same race/ethnicity primary care provider. But 65 percent of blacks, 47 percent of Hispanics, and 76 percent of whites didn't care.

And even though only 27 percent of blacks and 35 percent of Hispanics had a doctor of the same race or ethnicity, about half of each group and half of white patients rated their doctors as excellent.

Even so, black patients who preferred a black doctor and who actually had one were three times more likely to rate their doctor as excellent than those who wanted a black doctor but didn't have one.

Why? Using a scale created from poll questions about racial attitudes, Chen and colleagues rated study participants on the degree to which they perceived racial discrimination in the U.S. health care system. Blacks and Hispanics who saw this most strongly were more likely to prefer a same-race/ethnicity doctor.

Such patients probably are, indeed, probably getting better health care — although that's far from proven, van Ryn says.

"If you have a lot of personal experience with day-to-day discrimination — racism or sexism — you are looking for it and alert to it," van Ryn tells WebMD. "If such patients have a same-race doctor they will probably enjoy the encounter more — and that is important because it affects adherence and proper history taking and overall quality of care. But there are a few problems with this."

One of the problems with matching the race of patients and doctors is obvious. Resegregating health care is a bad idea.

"Say a white person comes in and says, 'I only want to see a white doctor.' How comfortable are we with this?" van Ryn says. "And another problem is right now, blacks are a minority of doctors. And for black patients always seeing one, even if we had an equivalent ratio of black doctors to the black population, it is not going to work out. And what about Native Americans, and those who want women doctors? So while I think it is extremely important to have the health care work force represent the population being served, I am not sure [matching patients to doctors by race] is viable."

Combating Racial Disparity In Health Care

Training more minority-race/ethnicity doctors is widely considered one way to reduce racial disparities in health care. Aside from offering same-race/ethnicity doctors to minority patients, van Ryn says, it provides peers to counter white doctors' unconscious racial stereotypes.

Cultural sensitivity training gets a lot of attention, and van Ryn points to several promising techniques in this area. But most important, she says, is improving the quality of care for all patients. It's already clear that in areas of health care where clear quality-care guidelines exist, racial disparities diminish.

"For a long time there was this feeling that racial disparities were entrenched in health care and you could change nothing. But that seems not to be the case," van Ryn says. "The trick here is there are a few conditions that need to occur. And some of them mean system change. Providers have to have time to get individual information from and to patients, and they have to have energy freed up for their own self-awareness. Neither of these is extremely common in medical care."

Sources: Chen, F.M. Annals of Family Medicine, March/April 2005; vol 3: pp 138-143. Frederick M. Chen, MD, MPH, acting assistant professor of family medicine, University of Washington, Seattle. Michelle van Ryn, PhD, MPH, associate professor of family medicine and community health; director, colorectal cancer quality enhancement research initiative, University of Minnesota, Minneapolis and Minneapolis Veterans Affairs Medical Center.

By Daniel J. DeNoon
Reviewed by Brunilda Nazario, MD
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