Nonwhite Physicians Research Articles

Physician Race and Care of Minority and Medically Indigent Patients

To examine the relationship between physician race and care of racial minority and ethnic minority patients and medically indigent patients. Secondary analysis of data from the 1987 National Medical Expenditure Survey, a cross-sectional survey of Americans designed to provide national estimates of health care utilization and expenditures. A sample representative of the total civilian noninstitutionalized US population with oversampling of minorities and the medically indigent. Survey respondents aged 18 years or older who identified a specific physician as their usual source of care (n = 15,081, corresponding to a national population estimate of 116 million Americans). Identification of a nonwhite physician as usual source of care. Of adult Americans who identified a usual-source-of-care physician, 14.4% identified a nonwhite physician as that source of care. Minority patients were more than four times more likely to receive care from nonwhite physicians than were non-Hispanic white patients. Low-income, Medicaid, and uninsured patients were also more likely to receive care from nonwhite physicians. Individuals who receive care from nonwhite physicians were more likely to report worse health, visit an emergency department, and be hospitalized. Individuals who receive care from nonwhite physicians reported more acute complaints, chronic conditions, functional limitations, and psychological symptoms as well as longer visits. Nonwhite physicians are more likely to care for minority, medically indigent, and sicker patients. Caring for less affluent and sicker patients may financially penalize nonwhite physicians and make them particularly vulnerable to capitation arrangements.

Dissemination of information about the US Preventive Service Task Force guidelines.

We assessed the familiarity of family physicians with the US Preventive Service Task Force guidelines and targeted groups for interventions to increase the practice of recommended preventive services. A national random sample of 480 family physicians were mailed a survey consisting of demographic items and a question regarding their level of exposure to the guidelines. The association of demographic factors with the level of exposure was assessed. Of the 263 responding physicians, 37% reported that they had not read any of the recommendations. Physicians who had read at least some of the recommendations were younger, more recently graduated from medical school, less likely to be in solo practice, more likely to be residency trained, and more likely to be white. Only year of graduation and race remained significantly associated with exposure to the guidelines in a logistic regression model. Additional dissemination efforts should focus on solo practitioners, less recent graduates, and nonwhite physicians.

Ethnicity and Estimates of Pain by Physicians-Reply

In Reply. —Dr Howell makes a good point regarding our study, namely, that physician ethnicity or cultural background may play an important role in the physician/patient encounter. We were unable to detect an effect of physician ethnicity in either of our studies examining ethnicity and pain management, but given the numbers of nonwhite physicians in our practice setting, we have limited power to examine this issue. 1 We suspect that the assimilation process involved in medical training produces physicians that are more alike than not, and we encourage others to examine this question. Dr Young takes us to task for using the term race in a table heading and the term bias in our discussion. He also states that we categorized Hispanics as a separate racial group. That was not our intention. We examined ethnic and cultural differences, not genetics. We hope that no one else was confused on