Hispanic Physicians Research Articles

Correlates of tobacco cessation counseling among Hispanic physicians in the US: a cross-sectional survey study.

BackgroundPhysician advice is an important motivator for attempting to stop smoking. However, physicians' lack of intervention with smokers has only modestly improved in the last decade. Although the literature includes extensive research in the area of the smoking intervention practices of clinicians, few studies have focused on Hispanic physicians. The purpose of this study was to explore the correlates of tobacco cessation counseling practices among Hispanic physicians in the US.MethodsData were collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians practicing in New Mexico, and who were members of the New Mexico Hispanic Medical Society in the year 2001. Domains of interest included counseling practices, self-efficacy, attitudes/responsibility, and knowledge/skills. Returned surveys were analyzed to obtain frequencies and descriptive statistics for each survey item. Other analyses included: bivariate Pearson's correlation, factorial ANOVAs, and multiple linear regressions.ResultsRespondents (n = 45) reported a low level of compliance with tobacco control guidelines and recommendations. Results indicate that physicians' familiarity with standard cessation protocols has a significant effect on their tobacco-related practices (r = .35, variance shared = 12%). Self-efficacy and gender were both significantly correlated to tobacco related practices (r = .42, variance shared = 17%). A significant correlation was also found between self-efficacy and knowledge/skills (r = .60, variance shared = 36%). Attitudes/responsibility was not significantly correlated with any of the other measures.ConclusionMore resources should be dedicated to training Hispanic physicians in tobacco intervention. Training may facilitate practice by increasing knowledge, developing skills and, ultimately, enhancing feelings of self-efficacy.

Does the market value racial and ethnic concordance in physician-patient relationships?

To determine if the market-determined earnings per hour of physicians is sensitive to the degree of area-level racial/ethnic concordance (ALREC) in the local physician labor market. 1998-1999 and 2000-2001 Community Tracking Study Physician Surveys and Household Surveys, 2000 U.S. Census, and the Area Resource File. Population-averaged regression models with area-level fixed effects were used to estimate the determinants of log earnings per hour for physicians in a two-period panel (N=12,886). ALREC for a given racial/ethnic group is measured as the percentage of physicians who are of a given race/ethnicity less the percentage of the population who are of the corresponding race/ethnicity. Relevant control variables were included. Average earnings per hour for Hispanic and Asian physicians varies with the degree of ALREC that corresponds to a physician's race/ethnicity. Both Hispanic and Asian physicians earn more per hour in areas where corresponding ALREC is negative, other things equal. ALREC varies from negative to positive for all groups. ALREC for Hispanics is negative, on average, due to the small percentage of the physician workforce that is Hispanic. This results in an average 5.6 percent earnings-per-hour premium for Hispanic physicians. However, ALREC for Asians is positive, on average, due to the large percentage of the physician workforce that is Asian. This results in an average 4.0 percent earnings-per-hour discount for Asian physicians. No similar statistically significant results were found for black physicians. The market-determined earnings per hour of Hispanic and Asian physicians are sensitive to the degree of ALREC in the local labor market. Larger sample sizes may be needed to find statistically significant results for black physicians.

The Effect of Race/Ethnicity, Sex, and Social Circumstances on Coronary Revascularization Preferences

Disparities in cardiac care cannot be explained by clinical factors alone. We previously found that physicians' perceived nonclinical factors such as patient preferences influenced decisions for coronary revascularization. For this study, we mailed a questionnaire to a random sample of family medicine physicians, internists, cardiologists, and cardiothoracic surgeons to examine whether the patient's sex, race/ethnicity, and social circumstances impacted treatment preferences for different physician subgroups. All physicians were randomized to receive 1 of 4 questionnaires that contained a vignette describing certain hypothetical situations (desire for an active lifestyle, heavy career or family demands) for a 50-year patient who was a candidate for coronary revascularization who was 1) female, 2) male, 3) black male, or 4) white male. The response rate was 70% (544 of 777). The patient's race/ethnicity and sex did not significantly affect the physicians' treatment preferences. However, significant differences were found according to the social circumstance. More male physicians (78%) than female physicians (66%) recommended revascularization for patients with heavy family demands (P < 0.05). In logistic regression analyses, if the patient desired an active lifestyle, black and Hispanic physicians and fee-for-service physicians preferred revascularization less often than white and salaried physicians, respectively (odds ratio [OR] = 0.45 [0.21-0.94] for black/Hispanic; OR = 0.40 [0.18-0.86] for fee-for-service). Based on these results, certain social circumstances might influence treatment preferences among physician subgroups more than sex- or race-based patient factors. Research examining for causes of disparities in cardiac care should consider the effects of sociocultural issues on management decisions.

Hispanic Physician Group Aims to Develop Leaders

Hispanic Physician Group Aims to Develop Leaders

Training and retaining of underrepresented minority physician scientists – a hispanic perspective: NICHD-AAP workshop on research in neonatology

In a workshop organized by NICHD and the AAP in January 2004, we addressed and discussed issues related to a Hispanic perspective in Training and Retaining of underrepresented minority physician scientists in the United States. A review of the literature related to training of underrepresented minority physicians in the United States (US) was performed, giving emphasis to those related to the Hispanic population. Success and failure in training and retention of Hispanic physician scientists and trainees was examined. An underrepresentation of Hispanic minorities in medical research workforce was found. This fact has recently resulted in efforts to increase their recruitment and there is a mandate by the National Institute of Health (NIH) for their inclusion. The Hispanic population in the US has increased rapidly, with diversity among the Hispanics in their personal and professional behavior. Significant disparities in health, health risk factors and access to health care manifested by an increased burden of illness and death have been documented. There in an undersupply of academic Hispanic neonatologist. Factors such as availability of academic employment, limited research funding in pediatrics, managed care and large debt burden of the US medical graduates interfere with recruitment of Hispanic trainees and academic physician scientist. Possible solutions, including recognition research awards, revision of NIH policies in awarding funds for neonatology, establishing strategies to improve minorities' acceptance, participation in research and increase accrual of Hispanic population in clinical trials should be given priority.

NHMA Aims to Develop More Hispanic Physicians, Leaders

NHMA Aims to Develop More Hispanic Physicians, Leaders

Hispanic Physician Group Aims to Develop Leaders

Hispanic Physician Group Aims to Develop Leaders

Hispanic physicians' tobacco intervention practices: a cross-sectional survey study

BackgroundU.S. Hispanic physicians constitute a considerable professional collective, and they may be most suited to attend to the health education needs of the growing U.S. Hispanic population. These educational needs include tobacco use prevention and smoking cessation. However, there is a lack of information on Hispanic physicians' tobacco intervention practices, their level of awareness and use of cessation protocols, and the type of programs that would best address their tobacco training needs. The purpose of this study was to assess the tobacco intervention practices and training needs of Hispanic physicians.MethodsData was collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians. Data analyses included frequencies, descriptive statistics, and factorial analyses of variance.ResultsThe response rate was 55.5%. The majority of respondents (73.3%) were middle-age males. Less than half of respondents routinely performed the most basic intervention: asking patients about smoking status (44.4%) and advising smoking patients to quit (42.2%). Twenty-five percent assisted smoking patients by talking to them about the health risks of smoking, providing education materials or referring them to cessation programs. Only 4.4% routinely arranged follow-up visits or phone calls for smoking patients. The majority of respondents (64.4%) indicated that they prescribe cessation treatments to less than 20% of smoking patients. A few (4.4%) routinely used behavioral change techniques or programs. A minority (15.6%) indicated that they routinely ask their patients about exposure to tobacco smoke, and 6.7% assisted patients exposed to secondhand smoke in understanding the health risks associated with environmental tobacco smoke (ETS). The most frequently encountered barriers preventing respondents from intervening with patients who smoke included: time, lack of training, lack of receptivity by patients, and lack of reimbursement by third party payers. There was no significant main effect of type of physician, nor was there an interaction effect (gender by type of physician), on tobacco-related practices.ConclusionThe results indicate that Hispanic physicians, similarly to U.S. physicians in general, do not meet the level of intervention recommended by health care agencies. The results presented will assist in the development of tobacco training initiatives for Hispanic physicians.

Physicians' perceptions of the effect of nonclinical factors on coronary revascularization.

The main objective of this study was to determine if physicians perceive that extracardiac or nonclinical factors such as patients' financial status, lifestyle, or trust in the physician impact coronary revascularization decisions. A self-administered questionnaire was developed and mailed to a random sample of 1200 family physicians, internists, cardiologists, and cardiothoracic surgeons who were active members of well-respected medical organizations in the United States. Survey questions were rated on a 4- and 5-point Likert scale to determine whether physicians perceive that nonclinical factors impede or facilitate coronary revascularization, respectively. The survey response rate was 70%. Family physicians were most likely to perceive that unhealthy lifestyle (51%), financial barriers (48%), and lack of social support (31%) probably or definitely precluded revascularization. White physicians (52%) were more likely to perceive that distrust in the physician affected revascularization, compared with black (33%), Hispanic (38%) and Asian (40%) physicians. Mean responses regarding how often (1 = rarely to 5 = most of the time) nonclinical factors facilitate revascularization revealed that women and Hispanic physicians were more likely to perceive male patients had easier access to the procedure (mean response, 2.8 for women versus 2.1 for men; 2.8 for Hispanics versus 2.4 for blacks and 2.1 for whites). Physicians perceived that nonclinical factors influence decision making for coronary revascularization. What needs to be further explored is whether such factors affect actual patient outcomes or contribute to disparities in the utilization of cardiac interventions.

Racial Matching among African-American and Hispanic Physicians and Patients

It is widely known that minority doctors have more patients of their own race and ethnicity than would be predicted by random distribution, but most measures of racial matching do not control for physician specialty, practice setting, or location. When we control for these variables, differences by doctor's race are much smaller and, in many cases, not statistically significant, suggesting that simply increasing the number of minority physicians may not be the best way to increase access for under-served populations. However, we do find some evidence of culture-specific human capital (in the form of language ability) for Hispanics.

Discriminating positively: preferential acceptance of minorities may be good for society.

Affirmative action is a reality in US medical schools. A recent report by the Center for Equal Opportunity, a private nonprofit think tank based in Washington, DC, found that black and Hispanic students are being admitted to American medical schools with substantially lower college grades and test scores than white or Asian students.1 It is not surprising that medical schools deny this. The US Supreme Court has ruled that quotas based on race or ethnicity are illegal. There is no doubt that affirmative action constitutes reverse discrimination in the admissions process. But in recruiting minority students, medical schools are showing a commitment to justice and to serving the community.2 Many minority groups distrust the medical profession,3 and providing minority physicians can increase their trust. A recent study showed that quality of care was improved significantly when black and Hispanic physicians cared for black and Hispanic patients.4 Patients were more likely to access preventive health care and to feel satisfied with the care they received. Other studies have shown that minority physicians are more likely to care for the underserved and for sicker patients than their white counterparts.5 Therefore, the provision of minority physicians also promotes equality of access to health care providers. Of course, the admissions process must ensure that the physicians who qualify can provide the highest quality of care for the country. The Center for Equal Opportunity's study showed that about a quarter of black students admitted to 6 American medical schools failed the first 2 steps of the medical licensing examination at first attempt. This compared with only a few failing in other ethnic groups. But other studies put these data into perspective. Although the dropout rate is slightly higher, most minority students get through the course without difficulty.2,6 And most importantly, no differences have been found in the time taken to complete residency training after graduation, the evaluations of performance, or the number choosing primary care disciplines. So giving special consideration to minority students with lower examination scores does not appear to affect the quality of new physicians. Diversifying the medical workforce has other advantages. It can help to ensure a comprehensive research agenda targeted to the problems of all areas of the population. Drawing from the diverse pool of talent in the United States may also lead to better management of the country's health care system.7 The use of race or ethnicity as a criterion for medical school admission is controversial. But it is wrong to assume that all minority students are academically inferior. What admissions policies are really battling to eliminate is the effect of poverty. Minority students are disadvantaged in college admission systems by poorer grades, by coming from poorer schools, and from having had fewer opportunities to succeed. Progress in this battle will require both short- and long-term solutions. Long term, medical schools must stimulate and sustain minority groups' interest in medicine as a profession.8 Mentorship programs can try to reach students early, provide role models, and show that the health care profession functions across cultural and racial barriers. Prospective students also need to feel that the field of medicine is not beyond their reach. In the short term, however, more immediate solutions are needed. To date, no one has been able to elicit the factors that determine a good physician. There is little evidence that academic selection criteria correlate with professional acumen after graduation. Therefore, for institutions to consider the needs of the community seems reasonable. The legal issues surrounding this subject are becoming increasingly complex. However, society functions better with physicians who represent all sectors, and affirmative action is the only short-term solution to serving society's needs.

Effect of Training Program on Physicians’ Attitude towards Knowledge and Practice Related to Assessment and Screening of Clients with HIV/AIDS

This is a study which examines the effects of an educational program on Hispanic physicians' attitudes towards and knowledge of HIV/AIDS. The study also examines physicians' practice patterns related to the screening and testing of Hispanic patients at risk for the disease. A oneon- one educational program was taken to the physician's office at a time convenient to the physician. A pre- and post-test design is used with questionnaires developed for the study that assess self-reported data related to physicians' attitudes, knowledge and practice patterns. A convenient sample of physicians participated. This limited the generalizability of the results to other groups. However, it does point out that a training program can alter physicians' screening and testing practices as well as their attitudes towards clients with HIV/AIDS. This has implications for providers in remote rural areas or in medically underserved communities where access to formalized continuing education may be limited or offered at times not compatible with a busy practice. The study may suggest that one kind of training and education need to beplanned and developed to facilitate provider participation. Perhaps, online courses or programs might be most effective of providing this one on one approach. Keywords : HIV/AIDS, Hispanic physicians, practice patterns, physician education http://dx.doi.org/10.14574/ojrnhc.v1i3.485

Patient-physician racial concordance and the perceived quality and use of health care.

Patients from racial and ethnic minority groups use fewer health care services and are less satisfied with their care than patients from the majority white population. These disparities may be attributable in part to racial or cultural differences between patients and their physicians. To determine whether racial concordance between patients and physicians affects patients' satisfaction with and use of health care. We analyzed data from the 1994 Commonwealth Fund's Minority Health Survey, a nationwide, telephone survey of noninstitutionalized adults. For the 2201 white, black, and Hispanic respondents who reported having a regular physician, we examined the association between patient-physician racial concordance and patients' ratings of their physicians, satisfaction with health care, reported receipt of preventive care, and reported receipt of needed medical care. Black respondents with black physicians were more likely than those with nonblack physicians to rate their physicians as excellent (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.55-3.72) and to report receiving preventive care (adjusted OR, 1.74; 95% CI, 1.01-2.98) and all needed medical care (adjusted OR, 2.94; 95% CI, 1.10-7.87) during the previous year. Hispanics with Hispanic physicians were more likely than those with non-Hispanic physicians to be very satisfied with their health care overall (adjusted OR, 1.74; 95% CI, 1.01-2.99). Our findings confirm the importance of racial and cultural factors in the patient-physician relationship and reaffirm the role of black and Hispanic physicians in caring for black and Hispanic patients. Improving cultural competence among physicians may enhance the quality of health care for minority populations. In the meantime, by reducing the number of underrepresented minorities entering the US physician workforce, the reversal of affirmative action policies may adversely affect the delivery of health care to black and Hispanic Americans.

Patient-physician pairing: does racial and ethnic congruity influence selection of a regular physician?

Many public and private sector efforts are devoted toward increasing the training of physicians from under-represented minority groups, yet little has been documented regarding the association between physicians' racial backgrounds and the patient populations they serve. To address this question, we use 1987 National Medical Expenditure Survey to examine the impact of race/ethnicity on the matching between physician and patients. Our results show that minority patients are significantly more likely to report having a minority physician as their regular doctor. We estimate that minority patients are five times as likely as non-minorities to report that their regular physician is a member of a racial/ethnic minority. This effect is especially pronounced among Hispanics who identify a Hispanic physician as their regular provider 19 times more often than non-minorities. After controlling for other socioeconomic factors, both these figures remain significant, but drop by approximately one-half. These results support the notion that minority patients tend to see minority physicians at a disproportional rate independent of other socio-economic factors.

The role of black and Hispanic physicians in providing health care for underserved populations.

Patients who are members of minority groups may be more likely than others to consult physicians of the same race or ethnic group, but little is known about the relation between patients' race or ethnic group and the supply of physicians or the likelihood that minority-group physicians will care for poor or black and Hispanic patients. We analyzed data on physicians' practice locations and the racial and ethnic makeup and socioeconomic status of communities in California in 1990. We also surveyed 718 primary care physicians from 51 California communities in 1993 to examine the relation between the physicians' race or ethnic group and the characteristics of the patients they served. Communities with high proportions of black and Hispanic residents were four times as likely as others to have a shortage of physicians, regardless of community income. Black physicians practiced in areas where the percentage of black residents was nearly five times as high, on average, as in areas where other physicians practiced. Hispanic physicians practiced in areas where the percentage of Hispanic residents was twice as high as in areas where other physicians practiced. After we controlled for the racial and ethnic makeup of the community, black physicians cared for significantly more black patients (absolute difference, 25 percentage points; P < 0.001) and Hispanic physicians for significantly more Hispanic patients (absolute difference, 21 percentage points; P < 0.001) than did other physicians. Black physicians cared for more patients covered by Medicaid (P = 0.001) and Hispanic physicians for more uninsured patients (P = 0.03) than did other physicians. Black and Hispanic physicians have a unique and important role in caring for poor, black, and Hispanic patients in California. Dismantling affirmative-action programs as is currently proposed, may threaten health care for both poor people and members of minority groups.

The Health Care of Hispanics-Reply

In Reply. — We compliment Dr Manson on his work stressing between Spanish-speaking patients and their physicians, and we agree that is a need for greater language concordance among American health care providers. However, we would like to point out that in our editorial we wrote there are many hypotheses but little consensus regarding health care utilization by Hispanics, not, as Dr Manson says, 'there are many hypotheses but little consensus' as to whether increasing the number of Hispanic physicians will improve health care utilization for Spanish-speaking patients. The two sentences have different meanings. Dr Manson notes that increasing the number of Hispanic physicians would improve the provision of health care for Hispanics. We have no doubt that if were substantial increases in Hispanic physicians in the United States, assuming that the large majority of them could speak Spanish and they practiced in areas where the

The Health Care of Hispanics

To the Editor. — In one of the editorials of the January 9, 1991, issue, Drs Furino and Munoz 1 state that there are many hypotheses but little consensus as to whether increasing the number of Hispanic physicians will improve health care access and utilization for Spanish-speaking patients. We studied the effect of a language barrier on health care utilization by Hispanic patients. 2 We found that, compared with monolingual Spanish-speaking patients with bilingual physicians (language concordant patients), monolingual Spanish-speaking patients with monolingual English-speaking physicians (language discordant patients) were three times more likely to omit medications, three times more likely to miss office appointments, and twice as likely to make emergency department visits. All but one of the bilingual physicians were Hispanic. Moreover, we surveyed 43 university hospitals in the United States and found that over half had no bilingual physicians on staff. The dimensions of this problem are suggested

A Sociodemographic Profile of Hispanic Physicians in Three United States Metropolitan Areas

A Sociodemographic Profile of Hispanic Physicians in Three United States Metropolitan Areas