Racial and ethnic concordance between patients and physicians–that is having a doctor who looks like you or shares your ethnic heritage–has been repeatedly shown to improve patient satisfaction, adherence, and potential health outcomes. Conversely, discordant relationships often display biases on the part of both the patient and the physician that might contribute to different treatment decisions and some of the racial disparities in care all too prominent in the United States.
But what factors explain whether a patient is seen by a same-race or same-ethnicity physician? That’s just what Ana Traylor, Julie Schmittdiel, Connie Uratsu, Carol Mangione, and Usha Subramanian sought to find out in a study published in the June 2010 issue of Health Services Research. The authors examined a sample of diabetics enrolled in Kaiser Permanente’s Northern California region, did some standard logistic regressions (i.e., fancy statistics) and found some pretty common sense, yet important associations.
For starters, patients who were free to choose their physician (rather than having it assigned by the HMO) were more likely to have a same-race or same-ethnicity physician. This makes sense, given that one assumes patient-physician racial-ethnic concordance to be a preference of most patients. In addition, the availability of a same-race provider was a strong determinant of a concordant relationship. This makes sense, too, because, frankly, if there are fewer of “your kind” to choose from, then you’re less likely to get what you want. Conversely, if there are more of “your kind” then you stand a better chance of getting what you want–again, especially if you’re free to choose. There were also more practical factors. For instance, Hispanic and Asian patients with limited English proficiency were significantly more likely to have a same-race or same-ethnicity physician. After all, if you can’t talk to your doctor, why even bother going?
This study basically does three things. First, and foremost, it shows that patients seem to have a preference for physicians who share their same racial and/or ethnic background. If this were not so, it isn’t likely that patients who could choose their doctors would more often choose doctors who looked like them. Second, it shows that the racial and ethnic makeup of the physician workforce is an important factor in making sure that patients are able to get what they want. Given the disproportionately low number of African-American and Hispanic physicians vis-a-vis their proportion of the patient population, more work needs to be done to bolster minority presence in the workforce. Finally, it shows that there may be some practical–not just preferential–aspects, such as the ability to communicate effectively with their physician, that lead patients to seek concordant relationships.