Doctors face disparities in care of blacks

Primary care physicians who treat many black patients were less likely to be board-certified and more likely to struggle to provide high-quality care than physicians who treat white patients, a new study shows.

Researchers said their findings show two unequal health systems. Physicians who treat black patients face greater difficulty getting access for their patients to high-quality subspecialists, diagnostic imaging and hospital admission.

"The doctors don't seem to be able to provide the same quality of care," said Peter Bach, MD, lead author of the study in the Aug. 5 New England Journal of Medicine. "There are differences in terms of resources and ease of scheduling, and all of those things affect the quality of care for patients."

Researchers analyzed 150,391 visits by black and white Medicare patients to 4,355 primary care physicians who participated in a 2000-01 telephone survey. The study was conducted by the Center for Studying Health System Change in Washington, D.C., and New York's Memorial Sloan-Kettering Cancer Center, where Dr. Bach is a pulmonologist and epidemiologist.

The study found that 22% of doctors accounted for 80% of the black patient visits in the study while the remaining 78% of physicians received the majority of visits by white patients. Thus, black and white patients are largely treated by different physicians, the study said. Doctors who treated blacks more often practiced in low-income neighborhoods.

Physicians who treated black patients were less likely to be board-certified than those who treated white patients. Researchers said previous studies showed that doctors who aren't board-certified are less likely to follow screening recommendations -- a tendency that could mean delayed diagnosis.

Physicians treating blacks more often said they lacked adequate access to health care resources, including high-quality diagnostic imaging, high-quality subspecialists, elective hospital admissions and good ancillary services. Doctors of white patients had less trouble in each of these access areas.

Black medical leaders agreed with the findings.

In a statement that also called for greater attention to improving access to quality care for blacks, the National Medical Assn. and four predominantly black medical colleges said the study "confirms the American medical system's tragic negligence to provide minority patients with the high-quality medical care they deserve."

"We've recognized a dual health care system for many years," said Winston Price, MD, a New York pediatrician and president of the National Medical Assn., which represents black physicians. "Our most sick and our most at-risk patients are receiving the lowest level of health care. The study really points out the flaws in the system."

In an editorial that accompanied the study, Arnold M. Epstein, MD, said the study was a reminder that "integration is not complete and separate is not equal."

Dr. Epstein said differences in patient care appeared to stem more from geography than from choice of physician. Disparities between black and white patients reflected the place in which patients sought care, rather than the doctor they chose in that place, he said.

Stephen Thomas, PhD, said medical leaders should view health care disparities as unacceptable and strive for system change.

"It's a system problem that must be solved with a system solution," said Dr. Thomas, director of the University of Pittsburgh's Center for Minority Health.

Until change occurs, physicians will continue to struggle to provide quality care, leaders said.

"These physicians are the firemen running into the fires of health care disparities," Dr. Price said. "If those physicians didn't run in with those fire hoses, then the fire wouldn't be put out."