Racial and Ethnic Disparities in Care: The Perspectives of Cardiovascular Surgeons

Abstract

Although racial/ethnic disparities in care are well documented, particularly for cardiac care, we know little about what cardiac surgeons think about them. For educational efforts to be effective in helping physicians address disparities, they must consider providers' knowledge and beliefs about the underlying causes of the disparities. We conducted a survey in 2004 to assess cardiologists' and cardiac surgeons' knowledge of racial/ethnic disparities in cardiovascular care and their perceptions about the underlying causes. Respondents were recruited from the membership of four cardiovascular professional associations. This paper focuses on cardiovascular surgeons' responses (n = 208). Forty-four percent of cardiovascular surgeons thought that, among patients with cardiac risk factors, black patients were not as likely as white patients to receive cardiac diagnostic tests and procedures. Additionally, 30% thought that black patients were not as likely as white patients to receive therapeutic tests and procedures. However, only 13% agreed that cardiac care disparities occur "often" or "somewhat often" based on patients' race/ethnicity, independent of their insurance and education. Only 3% thought disparities were likely to occur in their clinical setting. Respondents appeared more likely to endorse patient factors (eg, health behaviors or treatment adherence) than system or provider (eg, miscommunication or continuity of care) factors as reasons for disparities. Although some surgeons acknowledge that racial/ethnic disparities in cardiac care occur, very few agree that they occur often, independent of patients' characteristics. Educational efforts tailored to local care settings, such as reviewing quality of care data on patients of different races/ethnicities within a clinic/hospital, may effectively inform all physicians of these disparities.