Equal care for all: Fighting on many fronts

Health care disparities returned to the medical headlines recently with the publication of a study concluding that physicians who treat black patients are more likely to struggle to provide high-quality care than those who treat white patients.

Physicians surveyed for the study, which appeared in the New England Journal of Medicine, said they face greater difficulty getting access to high-quality subspecialists, diagnostic imaging and hospital admission for their black patients.

This news is not particularly surprising. After all, it comes on the heels of a series of studies on the topic. Two of the most noteworthy were released by the federal government: the 2002 Institute of Medicine Report, "Unequal Treatment: Confronting Racial and Ethnic Disparities," and the U.S. Agency for Healthcare Research and Quality's 2003 "National Healthcare Quality Report" and "National Healthcare Disparities Report."

The NEJM study nevertheless serves to remind us that health care disparities are entrenched in our system and will not be easy to eradicate. But the AMA and several other leaders of organized medicine are not about to let the difficulty factor discourage them. They know that the situation is undermining quality of care in this country as well as threatening the trust at the foundation of the physician-patient relationship. And they are determined to solve the problem. Indeed, AMA President John C. Nelson, MD, MPH, has signaled that health care disparities are to be a top focus of his term.

The AMA, National Medical Assn. and Hispanic Medical Assn. are leading a coalition of 38 organizations that will initially deal with the clinical aspects of disparities. The coalition is designed to improve communication among groups working on the issue as well as explore whether working collaboratively can achieve greater results than they get when each of them works alone.

The AMA also has created a program on health care disparities that coordinates its efforts in science, ethics and medical education to address the issue. It is partnering with the AMA Foundation to help physicians become aware of and manage low health literacy among their patients. It has joined with outside groups as well, including the Henry J. Kaiser Family Foundation and the Robert Wood Johnson Foundation on campaigns to raise physicians' awareness of racial and ethnic health care disparities.

One AMA program that doesn't get enough recognition is its Doctors Back to School Program, which sends minority physicians to schools and community groups to help young minority children realize that they, too, can aspire to a career in medicine. Since studies show that minorities are most likely to trust a physician of their own race or ethnicity, getting these children interested in practicing medicine is a highly personalized way to address the disparities issue and one that could yield positive results.

The American College of Physicians has recently weighed in on the issue with a position paper published in the Annals of Internal Medicine. The college's programs are a mix of leadership-directed activities and grassroots movements, and the paper signals that reducing health care disparities is now one of the college's No. 1 priorities.

All of this is welcome news. As statistics have highlighted, these disparities translate into matters of life and death for some minority patients. For them, a disparities-free future cannot come soon enough.