October 2001 Bulletin

Minority doctors find admissions, referrals difficult

Increasing the supply of minority physicians and expanding insurance coverage are not enough to increase access to medical care and improve the health of ethnic minority patients, say authors of the first national survey to examine minority physicians’ ability to obtain needed care for their patients.

The stark reality disclosed in the survey is that African American and Hispanic physicians have more difficulty than white physicians in obtaining referrals to specialists. Further, 1-in-3 of the minority physicians reported difficulty in obtaining hospital admissions for their patients, compared to 1-in-4 white physicians.

The survey was conducted by the Center for Studying Health System Change (HSC), a Washington, D.C. nonpartisan policy research organization, funded by The Robert Wood Johnson Foundation. A sample of 12,304 active, nonfederal, office- and hospital- based physicians was drawn from the American Medical Association and the American Osteopathic Association master files. Telephone surveys were conducted between August 1998 and November 1999; the response rate was 61 percent.

Primary care and specialist physicians were asked "How often are you able to obtain referrals to specialists of high quality when it is medically necessary" and "How often are you able to obtain nonemergency hospital admissions when it is medically necessary."

Twelve percent of African American physicians and 14.7 percent of Hispanic physicians said they were "never, rarely or sometimes" able to obtain referrals to specialists for their patients, while 7.5 percent of white physicians gave similar responses.

Thirty-six percent of African American physicians and 32 percent of Hispanic physicians reported that they "never, rarely or sometimes" were able to get their patients admitted for nonemergency inpatient treatment. Twenty-four percent of white physicians gave similar responses.

The analysts delved into the data to determine whether differences among the practice characteristics of the three groups of physicians might explain the minority physicians’ ability to obtain needed care for their patients. Minority physicians were less likely than white physicians to work in larger group practices, and more likely to have more of their revenue from Medicaid and to have more of their practice revenue from capitated managed care contracts. Hispanic physicians practiced in settings with fewer specialists than white physicians. African American physicians were more likely than white physicians to practice in locations with moderate levels of managed care participation.

Controlling for physician characteristics and market characteristics, the analysis showed 31.5 percent of African American physicians and 28.6 percent Hispanic physicians reported difficulty arranging for hospital admissions, compared with 24 percent of white physicians.

The differences in minority and white physicians obtaining medical services for their patients, "cannot be systematically explained by physicians’ personal, practice, environmental or patient payment characteristics," said the study authors J. Lee Hargraves, PhD; Jeffrey J. Stoddard, MD; and Sally Trude, PhD. "The differences may or may not be related to one or more of the following unmeasurable variables: prestige or clout of individual physicians; proximity of specialists/hospitals to physicians and their patients; or discrimination directed at either minority physicians, their patients or both."

Policies to reduce or eliminate disparities in access to medical care has produced remedies such as supporting minority physician training, encouraging physicians to practice in underserved areas and providing increased insurance coverage to uninsured populations. But Hargraves and colleagues said these remedies are not enough. "One-size-fits-all policies will not address disparities in access to care and the health of racial and ethnic minority persons," they said. "A better understanding of the healthcare system and how it affects ethnic minority physicians and their patients will assist in reducing barriers to care."

How often physicians could obtain specialist referrals

 

African American

Hispanic

White

Never

0.0 %

0.0 %

0.0 %

Rarely

2.6

1.9

0.9

Sometimes

9.4

12.8

6.6

Frequently

20.5

19.6

16.8

Almost always

42.1

37.4

46.6

Always

25.1

28.2

29.0

How often physicians could obtain hospital admissions

 

African American

Hispanic

White

Never

5.3 %

5.2 %

2.6 %

Rarely

10.2

11.2

7.4

Sometimes

20.4

15.9

14.0

Frequently

19.2

13.3

16.2

Almost always

28.8

29.1

33.9

Always

16.2

25.2

26.0

Source: Center for Studying Health System Change


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