Abstract
ImportancePatient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients.ObjectiveTo examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians.Design, Setting, and ParticipantsThis population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018.ExposuresPhysician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken.Main Outcomes and MeasuresThe highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey.ResultsOf the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity.Conclusions and RelevanceThis study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.
Highlights
Measures of patient satisfaction have become increasingly important during the last decade
The odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians
Asian physicians served a greater proportion of Asian patients, who were more likely to give lower satisfaction scores than non-Asian patients
Summary
Measures of patient satisfaction have become increasingly important during the last decade. By affecting hospital reimbursements and physician compensation in the form of performance bonuses, measures of patient satisfaction are associated with financial incentives to monitor and improve the quality of health care services and delivery.[1,2,3]. A growing body of literature has demonstrated that immutable, patient-level characteristics, such as age, overall health status, educational level, and race/ethnicity, serve as important determinants of patient-reported satisfaction.[4,5,6,7,8,9,10] To avoid possible measurement bias, health organizations adjust patient satisfaction scores for various characteristics, including age, sex, and health status.[11,12] For example, health organizations that use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to assess patient-reported satisfaction commonly adjust for a patient’s general and mental health status and educational level.[5] the association between race/ethnicity and patient satisfaction scores—and the consequent need to make statistical adjustments for patient race/ethnicity—remains uncertain. Many previous studies have examined differences in the patient satisfaction scores of black or African American and Hispanic patients relative to non-Hispanic white patients (hereafter referred to as white patients).[13,14,15,16] Fewer studies have investigated the association between Asian race/ethnicity of patients and patient satisfaction scores, and those that have were conducted outside of the United States, limited by small samples, and/or constrained by the use of patient satisfaction survey instruments with limited generalizability.[17,18,19,20,21,22,23] The research that is currently available suggests that Asian patients assign lower patient satisfaction scores relative to other racial/ethnic groups.[17,18,19,20,21,22,23]
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