High-minority practices see delays, less funding
MDs report impaired delivery of care
A physician working in a clinic that sees a high percentage of minority patients who live in public housing reports a difficult time obtaining reports from other providers; his peers in more affluent parts of town who see fewer minority patients report no such delays. Obtaining an appointment or consult with a specialist for his patients is also significantly more difficult than for his colleagues who work in low-minority practices.
These are just two of the disparities primary care physicians are experiencing based on the racial and ethnic makeup of their practices, according to research published in April by The Commonwealth Fund, a private New York City-based foundation that supports research on health care practice and policy.
"The findings indicate that physicians who treat mostly minorities face challenges in delivering high-quality care," says Anne C. Beal, MD, Commonwealth Fund assistant vice president. But the findings also point to solutions that can reduce disparities and improve access and quality in care provided, she adds.
The findings, published in the journal Health Affairs (available at www.healthaffairs.org), indicate that primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients, and receive lower private insurance payments.
These same physicians also reported more problems providing high-quality care, ranging from inadequate time with their patients to difficulty obtaining specialty care.
More Medicaid = More equality?
The study, conducted by researchers at the Center for Studying Health System Change (HSC) in Washington, DC, examines racial and ethnic health disparities in the United States by identifying characteristics to community and physician practice resources. The study also asked whether higher Medicaid payments might help physicians treating mostly minority patients provide high-quality care and reduce racial and ethnic disparities.
"The findings indicate that the lower resources flowing to physicians treating more minority patients are associated with racial and ethnic disparities," says HSC senior researcher James D. Reschovsky, PhD, a coauthor of the study. "Raising Medicaid payment rates, along with efforts to increase insurance coverage or otherwise increase resources flowing to physicians treating low-income and minority patients, could reduce disparities."
Beal points out that besides identifying problems physicians face when their practices are made up of primarily minority groups, the study also reveals some potential remedies.
"In addition to increasing Medicaid payment levels, other efforts such as quality reporting and financial incentives for improving care, particularly through Medicaid, could also reduce disparities and help move the U.S. toward a high performance health system," she says.
The survey report includes information from 3,320 primary care physicians, including general internists, family and general practitioners, and pediatricians.
About 52% of primary care physicians reported having patient panels with less than 30% minorities; 36% reported 30-70% of their patients were minorities; and 12% reported minorities constituted more than 70% of their patients, confirming previous research showing that relatively small numbers of physicians treat a disproportionately large share of minority patients. Other key study findings include:
Twenty-six percent of physicians in high-minority practices reported being unable to provide high-quality care to all of their patients, compared with 16% of physicians in low-minority practices.
Physicians in high-minority practices reported caring for more patients with whom they had a hard time communicating because they speak a different language (8% of patients in high-minority practices vs. 2% of patients in low-minority practices).
International medical graduates were nearly twice as likely to be found in high-minority practices -- nearly 40% vs. 21% in low-minority practices. Physicians in high-minority practices had fewer years of practice experience (14 years vs. 17 years) and were less likely to be board certified than their counterparts in low-minority practices (80% vs. 89%).
A physician working in a clinic that sees a high percentage of minority patients who live in public housing reports a difficult time obtaining reports from other providers; his peers in more affluent parts of town who see fewer minority patients report no such delays.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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