Facing U.S. Health Care's Doctor Segregation

Is the U.S. health-care system segregated? Not in the sense that it was 50 years ago, when many hospitals had separate wards for blacks and whites. Such overt discrimination by doctors and hospitals ended with the civil rights movement, with a nudge from Medicare.

Yet “de facto segregation” remains in practice, according to research published Monday in the journal JAMA Internal Medicine. When minority patients get medical care, they are more likely to see doctors who are themselves people of color. And minority doctors disproportionately care for the poor, Medicaid patients, and non-English speakers.

Non-white doctors cared for about 54 percent of minority patients, according to an analysis of 7,070 patient surveys from 2010 in which the race of the doctors came from reports by the patients. But minority doctors account for only one-quarter of the U.S. physician workforce, according to a report (PDF) from the Association of American Medical Colleges. Blacks make up just 6.3 percent of physicians, and Hispanics just 5.5 percent.

Patients of black physicians were more likely than patients of white physicians to report fair or poor health, be obese, and go to emergency rooms for care, according to the JAMA research letter. Patients who saw Hispanic or Asian doctors also were more likely to report fair or poor health.

The pattern hasn’t changed much since 1987, the time of the last national study on the subject, according to the authors. And it’s a result, partly, of the choices of both doctors and patients. “It is clear that the preferences of physicians in choosing practice settings and of patients in choosing physicians combine to create an outsized role for minority physicians caring for the disadvantaged,” wrote the researchers from the Harvard Medical School, the Cambridge Health Alliance, and the City University of New York School of Public Health. They suggest that training more doctors who are minorities may help improve care in minority communities: “Building a physician workforce that is more representative of the U.S. population would likely help address inequalities in health and health care.”

It’s worth looking at the racial disparities in health care now as millions of new patients prepare to enter the system under the Affordable Care Act. In the 25 states that aren’t expanding their Medicaid programs, blacks and Hispanics will be disproportionately affected. And if the increase in newly insured patients getting care next year makes it more difficult to actually see a doctor, the problem is likely to be worse in underserved communities where the health system is already stretched thin.

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