Black physicians push for reforms to make Medicare access more equitable.
The study caused a stir at the annual meeting of the National Medical Association, the nation's largest organization of black physicians. NMA leaders joined with the deans of four historically black medical schools at the meeting to call for Medicare reforms to provide equitable access to high-quality health care for all patients.
The cross-sectional analysis of 150,391 visits to 4,355 primary care physicians by black and white Medicare patients found that 80% of visits by black patients were with a small group of physicians (22% of the total) who handled only 22% of visits by white patients, said Dr. Peter B. Bach and his associates at Memorial Sloan-Kettering Cancer Center, New York.
Among the physicians who accounted for most of the care to black patients, 77% were board certified, compared with 86% of physicians who handled most of the white patient visits. Patient data came from Medicare records; physician data came from a previous telephone survey.
Physicians treating black patients were more likely than those seeing white patients to say that they could not provide high-quality care to all of their patients--28% vs. 19%. Physicians treating black patients found it harder to arrange patient access to high-quality subspecialists, high-quality diagnostic imaging, and nonemergency hospital admissions regardless of patient insurance (N. Engl. J. Med. 351:575-84, 2004).
The disparities in high-quality care available to black and white patients were a result of the geographic areas in which they lived, not their choice of doctors, Dr. Arnold M. Epstein noted in an editorial (N. Engl. J. Med. 351:603-05, 2004).
The study shows that 50 years after the start of the civil rights movement, "the United States is still a society in which racial and ethnic characteristics are strongly associated with socioeconomic class and opportunity," said Dr. Espstein of Harvard School of Public Health, Boston. "In health care, integration is not complete and separate is not equal.
Physicians who practice in underserved areas face greater hurdles in providing care, NMA President Randall W. Maxey of Los Angeles told this newspaper. "They deserve respect. We need to fix this system so that it's not harder to practice medicine in underserved areas than it is in the Beverly Hills."
The study's first conclusion, that "physicians treating black patients may be less well trained clinically," struck a nerve with some NMA members who already felt beleaguered by the medical system. A symposium at the start of the meeting called "Black Physicians Under Attack" addressed the possibility that physician profiling by the Federation of State Medical Boards could work against black physicians if they don't guard against "improper attachments" to their profiles.
In other sessions, physicians warned about a growing trend among insurers and managed care organizations to offer cash rewards for meeting clinical goals, such as immunization rates. These policies reward already affluent practices and penalize physicians working in low-income areas, where clinical goals can be harder to meet and where many black patients live. Minority physicians are more likely than white physicians to practice in these underserved areas, studies have shown.
Dr. Maxey noted that the current study did not measure clinical outcomes. "The paper did seem to imply that one was a better physician if one had board certification. There is no evidence for that," he said.
The joint statement by the NMA and deans of Howard University. Morehouse School of Medicine, Meharry Medical College, and Charles R. Drew University of Medicine and Science pointed out that the physicians who saw black patients were not necessarily black themselves. The majority of both black and white patient visits (60% and 85%, respectively) were to white physicians.
BY SHERRY BOSCHERT
San Francisco Bureau
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|Publication:||Internal Medicine News|
|Date:||Sep 15, 2004|
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