Abstract
Background: Patient satisfaction surveys as a metric for quality-based financial incentives carry a risk of bias toward women and underrepresented physicians. Previous assessments in our department of medicine found that most women faculty were rated in the bottom quartile of patient satisfaction scores, whereas analysis of scores for underrepresented physicians had not been performed. To investigate, we compared patient satisfaction scores and relevant demographics of faculty physicians during 1 year when quality-related financial incentives were offered based on this metric.Methods: Patient satisfaction and communication scores collected during academic year 2015–2016 were obtained for 369 physicians (119 women and 250 men) at Indiana University Health system. Independent variables included physician gender, race, ethnicity, and subspecialty or division; 190 physicians constituted the study cohort for whom data were available for comparison. Statistical analyses were performed to determine if there were differences between gender and race in patient satisfaction scores (mean, median, t-tests, and Chi-square tests). A factorial analysis of variance model was performed to incorporate both main effects and to determine if there was a significant interaction between them.Results: Median and mean of scores were lower for women physicians and underrepresented physicians. Analysis demonstrated nonsignificant effect between gender-segregated cohorts. Racially underrepresented physicians had significantly lower mean scores than their white colleagues [F(4, 185)=2.46, p=0.046].Conclusion and Relevance: Our results indicate a significant difference in patient satisfaction scores between underrepresented and white physicians. These data may suggest a potential bias, among patients and institutional practices, ultimately leading to pay inequities through differences in financial incentives toward underrepresented physicians.
Highlights
The Agency for Healthcare Research and Quality (AHRQ) first released the Consumer Assessment of Healthcare Physicians and Systems Clinician & Group Survey (CGCAHPS) for adults and children in 2007.1 This survey was designed to assess patients’ experiences with physicians and health care staff, as a tool for improving the care provided by individual physicians, sites of care, medical groups, or provider networks.[1]
Through the lens of implicit bias and institutional bias we questioned the data for underrepresented physician groups, subsequently considering their financial incentive implications
We found that underrepresented faculty physicians score significantly lower in patient satisfaction and that women of color score significantly lower than their white female colleagues
Summary
The Agency for Healthcare Research and Quality (AHRQ) first released the Consumer Assessment of Healthcare Physicians and Systems Clinician & Group Survey (CGCAHPS) for adults and children in 2007.1 This survey was designed to assess patients’ experiences with physicians and health care staff, as a tool for improving the care provided by individual physicians, sites of care, medical groups, or provider networks.[1]. Designed to measure inpatient hospital-level performance, some health systems disaggregate their CAHPS data to compare, assess, and incentivize improvements in patient satisfaction and quality measures for individual physicians, nurses, and other staff. Conclusion and Relevance: Our results indicate a significant difference in patient satisfaction scores between underrepresented and white physicians. These data may suggest a potential bias, among patients and institutional practices, leading to pay inequities through differences in financial incentives toward underrepresented physicians
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