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Disclosure:
Cai reports non-financial medical aid from doctors for a national health plan while the study was being conducted, as well as personal fees from the US House of Representatives outside of the study. Woolhandler does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.
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Racial and ethnic minority groups were “significantly underrepresented” in outpatient practices in most medical specialties, and these differences persisted even when researchers considered social determinants of access to care.
“Two previous studies found that Black and Hispanic Americans had few visits to neurologists and that minority teens received much less psychiatric treatment than white teens.” Stephanie Johanna Wool handlis, MD, MPH, a lecturer in the medical division of the Cambridge Health Alliance, said Healio Primary Care. “However, this is the first study to examine all major medical specialties and document racially unequal care for most of them.”
Reference: Cai C, et al. JAMA Intern Med. 2021; doi: 10.1001 / jamainternmed.2021.3771.
The researchers collected information on doctor visits and outpatient visits from the 2015-2018 Medical Expenditure Panel survey. Their analysis included 132,423 adults (60% white, 17.7% Hispanic, 12.3% black, 6.1% Asian, 0, 8% Native Americans and continue to be identified as others). The survey does not include “detailed clinical metrics” that could be used to tabulate patient outcomes, and it relies on patients to indicate the type of specialist care they are receiving, the researchers said.
Stephanie Joan Woolhander
Woolhandler and colleagues reported that black patients had low attendance rates in 23 out of 29 medical specialties, compared to white patients who had low attendance rates in 17 of the 29 medical specialties. Black-and-white disparities were most pronounced in fields with many visits, including dermatology (adjusted rate ratio = 0.27; 95% CI 0.21-0.34), ENT medicine (aRR = 0.38; 95% – CI 0.32-0.46), plastic surgery (aRR = 0.41; 95% CI 0.23-0.75), general surgery (aRR = 0.55; 95% CI, 0.44-0.69 ), Orthopedics (aRR = 0.59; 95% CI, 0.51-0.69), urology (aRR = 0.62; 95% CI 0.5-0.78, and pulmonology (aRR = 0.63 ; 95% CI 0.48-0.81) In contrast, black patients had higher attendance rates for nephrologists (aRR = 2.78; 95% CI 1.37-5.62) and hematologists (aRR = 1 , 65; 95% CI, 1-2.7) The attendance rates for internists, geriatrists, and oncologists were similar in black and white patients.
Compared to white patients, Hispanic patients had significantly lower attendance rates in 20 of the 29 specialties, and Asian / Pacific Islanders had low attendance rates in 21 of 27 specialties. “Similar patterns were seen among Native Americans, even though the 95% KIs were broad,” the researchers wrote.
The results also showed that Hispanic patients had a “significantly lower” visit rate to specialist practices compared to white patients for dermatology (aRR = 0.39; 95% CI 0.33-0.46), ENT (aRR = (0, 47; 95% CI, 0.39.) -0.56) and pulmonology (aRR = 0.55; 95% CI, 0.4-0.77) The aRR for patients from Asia / Pacific Islands were im Compared to white patients “significantly low” for hematology (0.18; 95% CI, 0.08-0.39), pulmonology (0.26; 95% CI, 0.15-0.45) and ENT ( 0.39; 95% CI, 0.31-0.48).
Findings remained largely consistent when the researchers corrected for gender, self-reported health, health insurance, educational level, and income. The aRR for black vs. white patients in these models were 0.34 for dermatology (95% CI, 0.26-0.43), 0.35 for plastic surgery (95% CI, 0.21-0, 59), 0.43 for ENT (95% CI, 0.34-0.54.). ), 0.54 for general surgery (95% CI, 0.42-0.69), 0.63 for orthopedics (95% CI, 0.54-0.74), 0.63 for urology (95% CI) % CI, 0.51-0.78) and 0.56 for pulmonology (95% CI, 0.4-0.77).
“In other words, most medical specialists make disproportionately fewer visits to colored patients,” the study co-authored Christopher Cai, MD, a clinical associate in medicine at Brigham and Women’s Hospital, said Healio Primary Care.
Woolhandler suggested that many doctors wonder what they can do about systemic racism.
“Our job can start with getting our own house in order and making sure that all patients have equal access to our offices and clinics,” she said.
Christopher Cai
Cai agreed and described the results as a “call to action”.
“Our study underscores the need for doctors to do more to combat the effects of structural racism: differences in insurance, referral systems, practice locations and other factors that cause black patients to have poorer health outcomes,” he said.
Cai also encouraged physicians to increase educational opportunities and introduce policies that improve access to specialized care for underrepresented populations.
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