Abstract
BackgroundLack of racial concordance between physicians and patients has been linked to health disparities and inequities. Studies show that patients prefer physicians who look like them; however, there are too few underrepresented minority physicians in the workforce. Hospitalists are Internal Medicine physicians who specialize in inpatient medicine. At our hospital, hospitalists care for 60% of hospitalized medical patients. We utilized the validated Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) to assess the effect of patient-provider race and gender concordance on patients’ assessment of their physician’s performance.MethodsFour hundred thirty-seven inpatients admitted to the non-teaching hospitalist service, cared for by a unique hospitalist physician for two or more consecutive days, were surveyed using the validated TAISCH instrument. The influence of gender and racial concordance on TAISCH scores for patient - hospitalist pairs were assessed by comparing the specific dyads with the overall mean scores. T-tests were used to compare the means. Generalized estimating equations were used to account for clustering.ResultsOf the 34 hospitalist physicians in the analysis, 20% were African American (AA-non-Hispanic), 15% were Caucasians (non-Hispanic) and 65% were in the “other” category. The “other” category consisted of predominantly physicians of South East Asian decent (i.e. Indian subcontinent) and Hispanic. Of the 437 patients, 66% were Caucasians, and 32% were AA. The overall mean TAISCH score, as these 437 patients assessed their hospitalist provider was 3.8 (se = 0.60). The highest mean TAISCH score was for the Caucasian provider-AA patient dyads at 4.2 (se = 0.21, p = 0.05 compared to overall mean). The lowest mean TAISCH score was 3.5 (se = 0.14) seen in the AA provider/AA patient dyads, significantly lower than the overall mean (p = 0.013). There were no statistically significant differences noted between mean TAISCH scores of gender and racially concordant versus discordant doctor-patient dyads (all p’s > 0.05).ConclusionsIn the inpatient setting, it appears as if neither race nor gender concordance with the provider affects a patient’s assessment of a hospitalist’s performance.
Highlights
Lack of racial concordance between physicians and patients has been linked to health disparities and inequities
In the United States, there are differences in clinically significant health outcomes based on race and gender [1]
We explored associations between both gender and racial concordance of the physician-patient dyads by comparing TAISCH scores for specific dyads with the overall mean TAISCH score using t-tests, for this normally distributed data
Summary
Lack of racial concordance between physicians and patients has been linked to health disparities and inequities. Studies show that patients prefer physicians who look like them; there are too few underrepresented minority physicians in the workforce. We utilized the validated Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) to assess the effect of patientprovider race and gender concordance on patients’ assessment of their physician’s performance. It is not surprising that in some studies minority patients expressed preferences to be cared for by providers of their same race/ethnicity and rate their visits with race-concordant providers more positively [5]. Caucasian patients were 33% more likely to report medical errors when the provider was non-white compared to when there was racial concordance [4]. There is evidence that women report more adherence to mammography screening with a racially concordant physician [7, 8]
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