• A
  • |
  • A
  • Text size

Quality Health Care for Minorities: Understanding Physicians' Experiences

Physicians are becoming engaged in addressing disparities

Preliminary survey brief
April 2005

According to a recent study conducted by the Institute for Ethics at the American Medical Association on behalf of the Commission to End Health Care Disparities, many of the nation's physicians are becoming involved in addressing health care disparities. The study consisted of a nationally representative sample of primary care physicians with an emphasis on those practicing in communities with a high proportion of racial and ethnic minorities. Early results indicate that many physicians now perceive health care disparities to be a problem and have become actively engaged in attempting to address them. These findings are in contrast to those of a 2001 physician survey that found lower levels of physician awareness of health care disparities. Despite the encouraging findings of the current study, several barriers to decreasing disparities remain, highlighting the importance of collaboration between individual physicians, their professional organizations, and the communities in which they practice.

Background

There are widespread and persistent racial and ethnic disparities in health care. Growing evidence of the extent and seriousness of these disparities culminated in a report by the Institute of Medicine, Unequal treatment: confronting racial and ethnic disparities in health care, highlighting the urgent need for action. In addition, a national survey conducted in 2001 by the Kaiser Family Foundation suggested that "the majority of physicians believe disparities in how people are treated within the healthcare system ‘rarely' or ‘never' happen based on factors such as income, fluency in English, educational status, or racial or ethnic background." Motivated by the Institute of Medicine Report and this 2001 survey, the American Medical Association, National Hispanic Medical Association, and National Medical Association, with funding from the Robert Wood Johnson Foundation, created a commission to raise awareness and leverage the strength of physicians and physician organizations to address health care disparities. The Commission to End Health Care Disparities includes leaders from the nation's largest physicians' organizations and more than 30 health-related groups. It works to educate physicians and health professionals about health care disparities while identifying and developing strategies to eliminate gaps in care based on race and culture. One of the aims of the commission is to promote understanding of the issue of health care disparities among physicians. To start addressing this aim, a survey of physicians was conducted to examine how many physicians are ready, willing and able to address health care disparities by focusing on these issues in their own practices and communities.

Health care disparities a problem

Overall, more than half (55 percent) of physicians agreed that "minority patients generally receive lower quality care than white patients", while 21 percent were unsure of this claim and about the same number (24 percent) disagreed with it.  Moreover, nearly two-thirds of the nation's physicians (62 percent) report they have witnessed a patient receive poor quality health care because of the patient's race or ethnicity.

Training, experience, and skills caring for minorities

Physicians report having the training and skills to care for minorities. Over four-fifths of physicians (88 percent) report that during their training they cared for minorities "often" or "very often," and 41 percent indicate their curriculum included some classes specifically devoted to minority health issues. During their medical training, 50 percent of responding physicians worked with someone who had a special interest in improving the health of minority patients. More than two-thirds (70 percent) report being well informed about possible cultural differences between themselves and patients they may care for. Two-fifths (41 percent) report fluency in a language other than English, one-fifth (21 percent) speak a foreign language with patients "often" or "very often," and 87 percent report having cared for a patient within the past month who did not speak English fluently.

Active engagement

Many physicians express an interest or are actively participating in educational or community activities to help address health care disparities. For example, within the past month, 32 percent percent have spoken with colleagues about ways to address specific health care needs of their minority patients and 44 percent have spoken with a community health worker about the health needs of patients in their practice community. Within the last six months, many have attended an educational event (19 percent) or read a journal article (54 percent) on improving the health of minority patients.

Nearly nine out of ten physicians (89 percent) believe that it is possible to provide high quality of care to all of their patients, and three out of four (75 percent) report they are in a position to make a difference in the quality of care that minority patients receive.

Barriers to quality of care

Several barriers were identified that hinder physicians from participating more actively in efforts to improve the health and health care of minorities. These barriers included difficulty accessing hospitals for non-emergency care (13 percent), poverty in the communities in which their minority patients live (20 percent), financial problems (21 percent), and time constraints (41 percent).

Implications

As the Institute of Medicine's Report, Unequal Treatment documented, there are many causes contributing to widespread racial and ethnic disparities in health care. Individual physicians are in a key position to address some of these. The findings from this survey suggest that physicians are increasingly aware of racial or ethnic health care disparities and many are actively engaged in efforts to address these quality differentials. Recognizing and building on this momentum is important because our findings suggest there is a receptive physician audience for educators and policymakers to approach with tools and resources. The findings also suggest that many physicians may be able to work in collaboration with community health workers or other community groups. These efforts are important as they may promote system changes at levels that commonly cannot be reached by physicians working alone. This study also documents the persistance of barriers that may retard physicians' efforts to deliver a uniformly high standard of care for all.

Links

Commission to End Health Care Disparities

Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care; 2003

Kaiser Family Foundation. National Survey of Physicians; March 2002

Data source and methods

The findings reported in this Survey Brief are based on a nationally representative survey of physicians conducted from December 2004 through March 2005 by the Institute for Ethics at the American Medical Association on behalf of the Commission to End Health Care Disparities. The survey was developed based on a previous survey examining physicians' views about health care disparities (Kaiser Survey), a review of the literature, and the experience of commission members. Items were constructed, piloted, and pre-tested to maximize saliency and minimize the likelihood of "yeah-saying" or socially desirable response bias. The survey sample included 1800 participants, with oversampling of physicians practicing in areas with high proportions of minorities as identified by U.S. Census Data and the National Minority Health Month Foundation. To account for the sampling strategy, survey weights were created following a common approach. First, a basic weight was calculated, equal to the inverse of the probability of selection. Next, a non-response adjustment was applied to the basic weights which were then post-stratified to key characteristics of the primary care physician population. Finally, overly influential weights were trimmed and a final post-stratification adjustment was applied. The resulting weights should allow for estimates that are representative of all primary care physicians in the United States.

The survey was developed based on a previous survey examining physicians' views about health care disparities (), a review of the literature, and the experience of commission members. Items were constructed, piloted, and pre-tested to maximize saliency and minimize the likelihood of "yeah-saying" or socially desirable response bias. The survey sample included 1800 participants, with oversampling of physicians practicing in areas with high proportions of minorities as identified by U.S. Census Data and the National Minority Health Month Foundation. To account for the sampling strategy, survey weights were created following a common approach. First, a basic weight was calculated, equal to the inverse of the probability of selection. Next, a non-response adjustment was applied to the basic weights which were then post-stratified to key characteristics of the primary care physician population. Finally, overly influential weights were trimmed and a final post-stratification adjustment was applied. The resulting weights should allow for estimates that are representative of all primary care physicians in the United States.The survey was developed based on a previous survey examining physicians' views about health care disparities (), a review of the literature, and the experience of commission members. Items were constructed, piloted, and pre-tested to maximize saliency and minimize the likelihood of "yeah-saying" or socially desirable response bias. The survey sample included 1800 participants, with oversampling of physicians practicing in areas with high proportions of minorities as identified by U.S. Census Data and the National Minority Health Month Foundation. To account for the sampling strategy, survey weights were created following a common approach. First, a basic weight was calculated, equal to the inverse of the probability of selection. Next, a non-response adjustment was applied to the basic weights which were then post-stratified to key characteristics of the primary care physician population. Finally, overly influential weights were trimmed and a final post-stratification adjustment was applied. The resulting weights should allow for estimates that are representative of all primary care physicians in the United States.

Commission to End Health Care Disparities

The Commission to End Health Care Disparities includes leaders from the nation's largest physicians' organizations and more than 30 health-related groups. It works to educate physicians and health professionals about health care disparities while identifying and developing strategies to eliminate gaps in care based on race and culture.

Secretariat

American Medical Association, National Hispanic Medical Association, National Medical Association

Funding

The survey and the Commission to End Health Care Disparities are funded in part by a planning grant from The Robert Wood Johnson Foundation.