Momentum building to end health care disparities

Washington -- Physicians are getting the message that they have a major role to play in eliminating disparities in health care, and many are already looking to their own practices to address this concern.

A national survey conducted by the AMA Institute for Ethics found that 55% of physicians believe that minority patients generally receive a lower quality of care than non-minority patients, and 75% said they are in a good position to improve that care.

These results indicate a deepening understanding of the challenges at hand.

In 2002, an Institute of Medicine report found that inequities existed across a broad range of clinically necessary treatments in several areas of care, including diabetes, cardiovascular disease and mental illness.

The IOM report came soon after a Kaiser Family Foundation survey was released suggesting that the majority of physicians believe that racial and ethnic disparities rarely or never happened.

That information helped propel physician involvement in the issue, and the American Medical Association, the National Medical Assn. and the National Hispanic Medical Assn. announced the formation of the Commission to End Health Care Disparities in January. The three groups joined with more than 30 other health-related organizations in forming the commission.

The survey was the commission's first activity.

"There is a great deal of work to be done to end health care disparities, but this survey is encouraging," said AMA President John C. Nelson, MD, MPH. "It shows that physicians of all races are eager to learn how they can do more to eliminate disparities in medical care."

Nearly 2,000 primary care physicians responded to the survey, and many of them practiced in communities in which a high proportion of racial and ethnic minorities reside.

"Past studies have indicated that physicians thought health disparities were unrelated to their own work, or were caused by social factors that physicians couldn't impact," said Gary Puckrein, PhD, executive director of the National Minority Health Month Foundation. "This survey shows a significant evolution in this attitude."

The survey results were presented April 25 as part of the National Minority Health Month Foundation's Second Annual Leadership Summit on Health Disparities in Washington.

"This survey strongly suggests that momentum among physicians is growing strong to improve the health and health care of racial and ethnic minority patients," said Randall W. Maxey, MD, PhD, immediate past president of the National Medical Assn. and co-chair of the commission.

The findings

The survey found that many physicians are either expressing an interest or are actively participating in educational or community activities to address health care disparities. For example, within the previous month, 32% of the physicians surveyed said they had spoken to colleagues about ways to address specific health care needs of their minority patients, and 44% had spoken to community health workers about the health needs of patients in their practice community.

Within the previous six months, 19% of the doctors said they had attended an educational event, and 54% said they had read a journal article on improving the health of minority patients. Physicians surveyed also reported that they had the skills and training to care for minority patients. Eighty-eight percent said they had cared for minority patients during their training "often" or "very often."

Seventy percent said they were well-informed about possible cultural differences between themselves and their patients, 41% reported that they were fluent in a language other than English, 21% said they speak a foreign language with patients "often" or "very often" and 87% said they had cared for a patient within the past month who did not speak English very well.

As for barriers to care, poverty in the communities in which minority patients live was reported by 20% of physicians, financial problems were cited by 21% and time constraints by 41%. The survey and the commission are funded in part by the Robert Wood Johnson Foundation.