Black, Hispanic and Asian physicians care for a disproportionate number of disadvantaged patients in the United States, according to a new study published in JAMA Internal Medicine.
Led by researchers at Harvard Medical School and Cambridge Health Alliance, the study found that patients who have low incomes, are from racial and ethnic minority backgrounds, have Medicaid insurance or do not speak English—groups that historically have had difficulty in accessing medical care—are much more likely to receive care from minority physicians.
At the same time, African-Americans and Hispanics are underrepresented in the physician workforce. Despite comprising more than 25 percent of the U.S. population, they account for less than 15 percent of physicians.
“Patients from disadvantaged groups have substantial problems accessing care,” said lead author Lyndonna Marrast, an HMS fellow in general internal medicine and a physician at Cambridge Health Alliance. “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.”
The research team analyzed data from a 2010 federal survey of 7,070 patients across the U.S. and found that:
- Minority physicians care for 54 percent of minority patients and 70 percent of non-English-speaking patients
- Asian, Hispanic and Black patients were 19 to 26 times more likely to be cared for by a minority physician of their same race
- Low-income patients were 1.5 to 2 times more likely to be cared for by Black, Hispanic and Asian physicians
- Medicaid patients were 2 to nearly 4 times more likely to be cared for by Black, Hispanic and Asian physicians
The study also showed that minority physicians were substantially more likely to care for patients with worse self-reported health status. For other measures of health, the picture was mixed. For example, black physicians were more likely, while Hispanic and Asian physicians were less likely, to care for obese patients.
The Patient Protection and Affordable Care Act is expected to expand insurance coverage for low-income, uninsured patients, many of whom will also be minorities.
However, said senior author Danny McCormick, associate professor of medicine at HMS and a physician at Cambridge Health Alliance, “There is a lot of concern that there will not be enough physicians willing and able to care for them. 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.”
“Our findings do not argue for strengthening the existing de facto segregation of medical care,” said Steffie Woolhandler, professor of public health at City University of New York, study co-author and HMS visiting professor of medicine. “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.”
Adapted from a Cambridge Health Alliance news release.
