White Physicians Research Articles

Variation in Scope and Area of Practice by Family Physician Race and Ethnicity.

Family physicians who are self-identified members of Black, Hispanic, and American Indian/Alaska Native racial groups are more likely to practice in disadvantaged areas but also tend to have narrower scopes of practice when compared with White family physicians, despite holding the same certification. Considering the established benefits of comprehensive primary care, these results suggest the need for policies incentivizing and supporting broader scopes of practice in disadvantaged areas.

Physician suicide demographics and the COVID-19 pandemic.

Objective:To identify suicide rates and how they relate to demographic factors (sex, race and ethnicity, age, location) among physicians compared to the general population when aggravated by the coronavirus disease 2019 (COVID-19) pandemic.Methods:We searched U.S. databases to report global suicide rates and proportionate mortality ratios (PMRs) among U.S. physicians (and non-physicians in health occupations) using National Occupational Mortality Surveillance (NOMS) data and using Wide-ranging Online Data for Epidemiologic Research (WONDER) in the general population. We also reviewed the effects of age, suicide methods and locations, COVID-19 considerations, and potential solutions to current challenges.Results:Between NOMS1 (1985-1998) and NOMS2 (1999-2013), the PMRs for suicide increased in White male physicians (1.77 to 2.03) and Black male physicians (2.50 to 4.24) but decreased in White female physicians (2.66 to 2.42).Conclusions:The interaction of non-modifiable risk factors, such as sex, race and ethnicity, age, education level/healthcare career, and location, require further investigation. Addressing systemic and organizational problems and personal resilience training are highly recommended, particularly during the additional strain from the COVID-19 pandemic.

Strategies to build trust with trainees who are underrepresented in medicine.

Strategies to build trust with trainees who are underrepresented in medicine.

Honoring Black Hopes: How to respond when the family is hoping for a miracle.

Background: Racial and ethnic disparities in end-of-life healthcare can be reduced by showing physicians how to best respond to a documented underlying cause: African American families' hopes for a miracle via divine intervention influence their end-of-life medical decisions, like, for example, making them not want to withdraw ventilatory support in cases of poor neurologic prognosis because they are still hoping for God to intervene. Methods: Autoethnographic research probing the author's Spiritual Care experience in this context yields a nuanced, 90-second point-of-care spiritual intervention physicians can use to address the religious aspect of African American families who base end-of-life medical decisions on their hopes for a miracle via divine intervention. Autoethnographic analysis is framed by physician-author, Dr. Jessica Zitter's documented journey of grappling with this context. The evolution of Dr. Zitter's responses to miracle-hoping African American families provides a framework for applying autoethnographic analysis to a critical appropriation of the Johns Hopkins "AMEN" communication protocol for families hoping for a miracle. Results: The common instinct of white physicians to remain neutral, holding miracle-hoping African American families at arm's length, rather than supportively engaging their hopes, is shown to be an intellectual ruse for emotional avoidance. A novel, counterintuitive spiritual intervention for the religious aspect of miracle-hoping African American families is integrated into an existing physician communication protocol for responding to families hoping for a miracle with recommendations for utilization of existing communication technology when necessary. Conclusion: Properly addressing the religious dimension of African American families hoping for a miracle may help physicians to increase their therapeutic connection with families, decrease their own stress/burnout levels, and eliminate racial and ethnic disparities in end-of-life healthcare. .

Slavery, Health, and Healing Now: The State of the Field.

The scholarship on slavery, health, and healing has dramatically transformed over the past two decades. This essay synthesizes several themes within the thriving subfield, highlighting its relevance to historians of medicine and science working in adjacent fields, and suggesting new directions forward. The recent scholarship builds on research begun in the 1970s, but where earlier scholarship relied on quantitative methods and retrospective diagnoses, the new scholarship takes a social constructivist approach. Scholars today are exploring how slavery shaped the natural and built environment to create new disease environments in the New World; how Black healing knowledge was either circulated or suppressed by White physicians; and how gender and race intersected in slave societies to influence diagnoses and the categorization of specific diseases. Most importantly, the new scholarship suggests that medical knowledge produced in slave societies was not marginal-but central-to the rise of early modern medicine. The lack of any synthesis of the recent literature, combined with the recent public attention given to racial health disparities, make this literature vitally important to all historians of medicine and allied sciences. It can provide useful insights for scholars working in other areas, and it can diversify and complicate the stories we tell about the origins of modern medicine.

Vaccine Hesitancy Narratives

Vaccine Hesitancy Narratives

31.6 Burnout and Depression Among Residents and Faculty in a Single Academic Medical Institution: A Pilot Study

Burnout is defined as a long-term, unresolvable job stress leading to feelings of exhaustion, overwhelm, cynicism, detachment from job, and a lack of sense of personal accomplishment. Medscape Physician Burnout surveys have shown that over 40% of physicians report burnout. There is a scarcity of studies that investigated the association between physician burnout and depression. Our study aimed to investigate this association and to compare this association's changes by groups of interest. The Maslach Burnout Inventory (MBI) and Quick Inventory of Depressive Symptomatology–Self Report (QIDS-SR) were used to assess burnout (N = 168) and depression (N = 167) among faculty and trainees (residents and fellows) in Psychiatry and Pediatrics at a large academic medical institution in the Southeast. The 3 subscale scores of MBI (emotional exhaustion [EE], depersonalization [DP], and personal accomplishment [PA]) and QIDS-SR scores were analyzed between trainees vs faculty, race, gender, and specialty. χ2 and Fischer’s exact tests were used to determine statistical significance of categorical association. Approximately 28% of faculty and trainees had high EE, and trainees reported nearly twice as much moderate EE than faculty (18.75% vs 39.29%). Trainees had high DP compared to faculty (41.07% vs 12.5%), and more psychiatrists reported high DP than pediatricians (35.81% vs 12.87). Notably, African American physicians reported a higher rate of depression than White physicians and physicians of other races (14.29% vs 11.11% and 11.9%, respectively) with no difference in depression rates between faculty and residents, by specialty, or by gender. Eleven percent of trainees and 14% of faculty reported clinically significant depression. There was significant correlation between burnout and depression (p < 0.0001). Physicians in training were twice as likely to experience burnout. High burnout is a predictor of clinically significant depression. Although this is a pilot study with only 2 specialties, the rate of depression is found to be higher (11%-14%) than the general population (7.1%). Creating a better understanding of the interrelationships among these measures can increase awareness among the physician community, which may help identify burnout early, seek help, and prevent serious downstream effects such as anxiety, depression, and suicide.

Examining Wage Disparities by Race and Ethnicity of Health Care Workers.

Prior studies demonstrated that wage disparities exist across race and ethnicity within selected health care occupations. Wage disparities may negatively affect the industry's ability to recruit and retain a diverse workforce throughout the career ladder. To determine whether wage disparities by race and ethnicity persist across health care occupations and whether disparities vary across the skill spectrum. Retrospective analysis of 2011-2018 data from the Current Population Survey using Blinder-Oaxaca decomposition regression methods to identify sources of variation in wage disparities. Separate models were run for 9 health care occupations. Employed individuals 18 and older working in health care occupations, categorized by race/ethnicity. Annual wages were predicted as a function of race/ethnicity, age, sex, marital status, having a child under 5 in the household, living in a metro area, highest education attained, and usual hours worked. Non-Hispanics consistently made more than Hispanic licensed practical/vocational nurses (LPNs/LVNs), aides/assistants, technicians, and community-based workers. Asian/Pacific Islanders consistently made more than Black, American Indian/Alaska Native, and Multiracial individuals across occupations except physicians, advanced practitioners, or therapists. Asian/Pacific Islanders only made significantly less when compared with White physicians, but more than White advanced practitioners, registered nurses, LPNs/LVNs, and aides/assistants. Based on observed attributes, Black registered nurses, LPNs/LVNs, and aides/assistants were predicted to make more than their White peers, but unexplained variation negated these gains. Many wage gaps remained unexplained based on measured factors warranting further study. Addressing wage disparities is critical to advance in careers and reduce job turnover.

Black Healers, Surgeons and 'Witches': Medicine, Mobility and Knowledge Exchange in Swedish St Barthélemy 1785-1815.

SummaryWhen Swedish civil servants took possession of the Caribbean island of St Barthélemy in 1785, they discovered a complex medical landscape in which Black healers played important roles. They competed with white physicians for patients and formed an itinerant community—both voluntary and forced in nature—which travelled throughout the archipelago exchanging remedies and practices. The healers’ work was not associated to revolt and rebellion as in many other Caribbean territories and the Swedish court of law treated them with less cruelty than in many other colonies. The healers’ activities cannot be simply reduced to acts of resistance to slavery; many of them gained the trust of large parts of both Black and white communities. Their interactions with people on the surrounding islands show how Caribbean colonial historiography gains from a wider geographical contextualisation, allowing a better understanding of the Black population’s role in healing and medicine.

Effect of Physician-Delivered COVID-19 Public Health Messages and Messages Acknowledging Racial Inequity on Black and White Adults’ Knowledge, Beliefs, and Practices Related to COVID-19

Social distancing is critical to the control of COVID-19, which has disproportionately affected the Black community. Physician-delivered messages may increase adherence to these behaviors. To determine whether messages delivered by physicians improve COVID-19 knowledge and preventive behaviors and to assess the differential effectiveness of messages tailored to the Black community. This randomized clinical trial of self-identified White and Black adults with less than a college education was conducted from August 7 to September 6, 2020. Of 44 743 volunteers screened, 30 174 were eligible, 5534 did not consent or failed attention checks, and 4163 left the survey before randomization. The final sample had 20 460 individuals (participation rate, 68%). Participants were randomly assigned to receive video messages on COVID-19 or other health topics. Participants saw video messages delivered either by a Black or a White study physician. In the control groups, participants saw 3 placebo videos with generic health topics. In the treatment group, they saw 3 videos on COVID-19, recorded by several physicians of varied age, gender, and race. Video 1 discussed common symptoms. Video 2 highlighted case numbers; in one group, the unequal burden of the disease by race was discussed. Video 3 described US Centers for Disease Control and Prevention social distancing guidelines. Participants in both the control and intervention groups were also randomly assigned to see 1 of 2 American Medical Association statements, one on structural racism and the other on drug price transparency. Knowledge, beliefs, and practices related to COVID-19, demand for information, willingness to pay for masks, and self-reported behavior. Overall, 18 223 participants (9168 Black; 9055 White) completed the survey (9980 [55.9%] women, mean [SD] age, 40.2 [17.8] years). Overall, 6303 Black participants (34.6%) and 7842 White participants (43.0%) were assigned to the intervention group, and 1576 Black participants (8.6%) and 1968 White participants (10.8%) were assigned to the control group. Compared with the control group, the intervention group had smaller gaps in COVID-19 knowledge (incidence rate ratio [IRR], 0.89 [95% CI, 0.87-0.91]) and greater demand for COVID-19 information (IRR, 1.05 [95% CI, 1.01-1.11]), willingness to pay for a mask (difference, $0.50 [95% CI, $0.15-$0.85]). Self-reported safety behavior improved, although the difference was not statistically significant (IRR, 0.96 [95% CI, 0.92-1.01]; P = .08). Effects did not differ by race (F = 0.0112; P > .99) or in different intervention groups (F = 0.324; P > .99). In this study, a physician messaging campaign was effective in increasing COVID-19 knowledge, information-seeking, and self-reported protective behaviors among diverse groups. Studies implemented at scale are needed to confirm clinical importance. ClinicalTrials.gov Identifier: NCT04502056.

Diabetes And Race

Diabetes And Race

62 Patient satisfaction in subspecialty gynecology clinics

To evaluate the impact of a gynecologic subspecialist’s practice location on patient satisfaction. Retrospective cohort study of patients who completed Press Ganey surveys following an encounter with a subspecialty gynecologist who sees patients at multiple practice sites. There were 28 subspecialty gynecologists identified who saw patients at different practice-type locations. Press Ganey survey responses from 11,628 gynecologic subspecialty patient encounters between January 2014 and January 2020 completed on these physicians were evaluated. While there was a difference between aggregate physicians at each location (P<.0001), there was no difference in patient satisfaction for individual physicians across location (P=.6975). When subspecialists were aggregated, there was no difference seen between those practicing at hospital-based clinics (P=.395) and rural locations (P=.112). Urogynecologists were associated with higher patient satisfaction as compared to gynecologic oncologists (P=.003), while no difference was found when compared to minimally invasive gynecologists or reproductive endocrinologists. Asian American physicians were correlated with lower patient satisfaction scores than their white colleagues (P=.046), and no difference was seen when comparing African American and white physicians (P=.558). Female physicians were associated with higher patient satisfaction scores than male colleagues (P=.006). Practice type and location of individual subspecialty gynecologists does not have an impact on patient satisfaction scores though patient bias towards providers may exist towards non-White gynecologic specialists.

Racial and Ethnic Diversity of Family Physicians Delivering Maternity Care

Maternal and birth outcomes represent some of the most profound racial and ethnic disparities in health in the USA, and are, in part, attributed to a lack of diversity in the maternity care workforce. Family physicians are an often-overlooked part of the maternity care workforce, yet frequently provide care to underserved populations. This study aims to characterize the family physician workforce providing obstetric care in terms of race/ethnicity. In this cross-sectional study, we used data collected via the American Board of Family Medicine Exam Registration Questionnaire from 2017 to 2019. Respondents included family physicians seeking to continue their certification in those years. We conducted bivariate tests and an adjusted analysis using logistic regression to examine associations with providing obstetric deliveries. Variables included race, ethnicity, age, gender, degree type, international medical graduate status, practice site, and rurality. Of 20,820 family physicians in our sample, those identifying as Black/African American (OR 0.55, CI 0.41 to 0.74) and Asian (OR 0.40, CI 0.31 to 0.51) had significantly lower odds of including obstetrics in their practice than those identifying as White. We found no significant difference in practicing obstetrics between Hispanic and non-Hispanic family physicians (OR 0.94, CI 0.73 to 1.20). Asian (OR 0.40, CI 0.31 to 0.51) and Black/African American (OR 0.55, CI 0.41 to 0.74) physicians still have significantly lower odds of providing obstetric care than White physicians after controlling for rurality. Family physicians who identified as Black/African American or Asian are less likely to include obstetrics in their practice. A diverse and racially/ethnically representative maternity care workforce, including family physicians, may help to ameliorate disparities in maternal and birth outcomes. Enhanced efforts to diversify the family physician maternity care workforce should be implemented.

Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: the role of gender, ethnicity and sexual orientation

ObjectiveTo determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation.Design, setting and participantsWe conducted a cross-sectional survey (August–October in 2020) of internal...

Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists

Workplace mistreatment can manifest as microaggressions that cause chronic, severe distress. As physician burnout becomes a global crisis, quantitative research to delineate the impact of microaggressions is imperative. To examine the prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic-minority surgeons and anesthesiologists and assess the association with physician burnout. This cross-sectional survey evaluated microaggressions and physician burnout within a diverse cohort of surgeons and anesthesiologists in a large health maintenance organization. A total of 1643 eligible participants were sent a recruitment email on January 8, 2020, 1609 received the email, and 652 replied, for a response rate of 41%. The study survey remained open until February 20, 2020. A total of 588 individuals (37%) were included in the study after exclusion criteria were applied. The Maslach Burnout Inventory, the Racial Microaggression Scale, and the Sexist Microaggression Experience and Stress Scale. The primary outcomes were prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic-minority surgeons and anesthesiologists using the Sexist Microaggression Experience and Stress Scale and Racial Microaggression Scale. Secondary outcomes were frequency and severity of microaggressions, prevalence of physician burnout, and associations between microaggressions and physician burnout. Data obtained from 588 respondents (249 [44%] female, 367 [62%] racial/ethnic minority, 224 [38.1%] 40-49 years of age) were analyzed. A total of 245 of 259 female respondents (94%) experienced sexist microaggressions, most commonly overhearing or seeing degrading female terms or images. Racial/ethnic microaggressions were experienced by 299 of 367 racial/ethnic-minority physicians (81%), most commonly reporting few leaders or coworkers of the same race/ethnicity. Criminality was rare (18 of 367 [5%]) but unique to and significantly higher for Hispanic and Black physicians. Individuals who identified as underrepresented minorities were more likely to experience environmental inequities (odds ratio [OR], 4.21; 95% CI, 1.6-10.75; P = .002) and criminality (OR, 14.93; 95% CI, 4.5-48.5; P < .001). The prevalence of physician burnout was 47% (280 of 588 physicians) and higher among female physicians (OR, 1.60; 95% CI, 1.03-2.47; P = .04) and racial/ethnic-minority physicians (OR, 2.08; 95% CI, 1.31-3.30; P = .002). Female physicians who experienced sexist microaggressions (racial/ethnic-minority female physicians: OR, 1.84; 95% CI, 1.04-3.25; P = .04; White female physicians: OR, 1.99; 95% CI, 1.07-3.69; P = .03) were more likely to experience burnout. Racial/ethnic-minority female physicians (OR, 1.86; 95% CI, 1.03-3.35; P = .04) who experienced racial microaggressions were more likely to report burnout. Racial/ethnic-minority female physicians who had the compound experience of sexist and racial/ethnic microaggressions (OR, 2.05; 95% CI, 1.14-3.69; P = .02) were more likely to experience burnout. The prevalence of sexist and racial/ethnic microaggressions against female and racial/ethnic-minority surgeons and anesthesiologists was high and associated with physician burnout. This study provides a valuable response to the increasing call for evidence-based data on surgical workplace mistreatment.

Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians

ObjectiveThe COVID-19 pandemic has transformed healthcare delivery in the USA, but there has been little empirical work describing the impact of these changes on clinicians. We conducted a study to...

Defeating Unconscious Bias: The Role of a Structured, Reflective, and Interactive Workshop.

Unconscious or implicit biases are universal and detrimental to health care and the learning environment but can be corrected. Historical interventions used the Implicit Association Test (IAT), which may have limitations. We determined the efficacy of an implicit bias training without using the IAT. From April 2019 to June 2020, a 90-minute educational workshop was attended by students, residents, and faculty. The curriculum included an interactive unconscious biases presentation, videoclips using vignettes to demonstrate workplace impact of unconscious biases with strategies to counter, and reflective group discussions. The evaluation included pre- and postintervention surveys. Participants were shown images of 5 individuals and recorded first impressions regarding trustworthiness and presumed profession to unmask implicit bias. Of approximately 273 participants, 181 were given the survey, of which 103 (57%) completed it with significant increases from pre- to postintervention assessments for perception scores (28.87 [SEM 0.585] vs 32.73 [0.576], P < .001) and knowledge scores (5.68 [0.191] vs 7.22 [0.157], P < .001). For a White male physician covered in tattoos, only 2% correctly identified him as a physician, and 60% felt he was untrustworthy. For a smiling Black female astronaut, only 13% correctly identified her as an astronaut. For a brooding White male serial killer, 50% found him trustworthy. An interactive unconscious bias workshop, performed without the use of an IAT, was associated with increases in perceptions and knowledge regarding implicit biases. The findings also confirmed inaccurate first impression stereotypical assumptions based on ethnicity, outward appearances, couture, and media influences.

Intentional self-harm associated mortality among U.S. White physicians, nurses, lawyers &amp; judges

The mortality associated factors can be quantified in terms of proportionate mortality ratios (PMR) per National Occupational Mortality Surveillance (NOMS) data. Therefore, we explored NOMS data for the United States (U.S.) occupational workers’ mortality during 1999, 2003-2004, 2007-2014 to compare physicians’ mortality associated factors to the mortality associated factors among nurses vs. the mortality associated factors among lawyers &amp; judges. Due to lack of adequate sample sizes of decedents being concurrently present among physicians, nurses, and lawyers &amp; judges of Black race, we were able to tabulate 25 causes of death with significant PMRs among physicians, nurses, and lawyers &amp; judges only of White race. Therein, intentional self harm associated mortality was found to be common among U.S. White physicians, nurses, lawyers &amp; judges.

Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings

The Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings. To evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance. A cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019. Patient-physician racial/ethnic and gender concordance. The primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance. In total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90). In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.

The Stereotype Content Model as an Explanation of Biased Perceptions in a Medical Interaction: Implications for Patient-Provider Relationship

ABSTRACT This experimental investigation uses the stereotype content model (SCM) to explain the biases associated with the perceptions of healthcare providers and the subsequent impact of such biased perceptions. Specifically, the 2 (gender: male, female) by 2 (race: Arab, Caucasian) between-subjects experiment examined the impact of physician race and gender on people’s perceptions regarding physician’s communication competence, trust, and intentions to visit. The findings indicate that female physicians are considered not only warmer but also more competent than male physicians. White physicians are considered less competent overall than their minority counterparts, though no differences in perceived patient-centered communication behaviors were observed. In addition, perceived competence and warmth mediated the effect of physician gender and race (only warmth) on the perceptions of trust, physician’s use of patient-centered communication, and intentions to visit. The theoretical and practical implications of the study are discussed.