Minorities underrepresented in California doctor work force

But 40% of the state's minority physicians are in primary care, compared with 30% of white physicians, medical board data showed.

By Myrle Croasdale — Posted June 23, 2008

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California's population is much more racially and ethnically diverse than its physicians, according to a report by the Center for California Health Workforce Studies. That's a concern, the study stated, because minority physicians play a key role in the minority community's access to care.

The report found that Hispanics made up 32% of the state's general population but only 5% of its practicing physicians. Blacks accounted for 7% of the population and 3% of physicians. Native Americans were 1% of the population and 0.6% of physicians.

As a group, Asian and Pacific Islanders were not underrepresented, making up 11% of the general population and 26% of physicians. However, there were shortages in Asian subgroups such as the Hmong, Samoans and Cambodians.

"The gap between the growing California population and the physician ethnic composition is even bigger than we thought," said Kevin Grumbach, MD, lead report author and director of the Center for California Health Workforce Studies.

The state needs to increase funding for minority pipeline programs and improve incentives for physicians to practice in underserved communities, the report recommended.

The report is the first data analysis since legislation, passed in 2001, required the Medical Board of California to collect information on doctors' work hours, specialties, ethnicity, languages spoken and practice location. The measure was sponsored by the California Medical Assn. to develop a reliable database on the state's physician work force.

The survey did not include osteopathic physicians, who are licensed by a separate board, but plans are under way to conduct similar research through the Osteopathic Medical Board of California, the report said.

Research showed that the 63,015 physicians included 38,859 white physicians and 16,644 Asian or Pacific Islander doctors. The state's population is more than 35 million.

Practicing in minority communities

In language skills, 18% of physicians said they spoke Spanish. Of this group, 55% were white and 30% were Hispanic.

The report, released in April, also showed that underrepresented minority physicians were more likely to practice in minority communities than are white physicians. Minority physicians were more likely to be generalists, with 40% going into primary care compared with 30% of white doctors.

Dr. Grumbach said the study confirmed the findings of smaller studies examining physician characteristics and practices.

"Because of the large scale of this study, we can say these patterns are real and hold up across specialties," he said.

José Alberto Arévalo, MD, Sutter Independent Physicians' medical director and vice chair of the California Medical Assn. Foundation's Network of Ethnic Physician Organizations, said the study underscored the need for more underrepresented minorities in health care.

"This report clearly shows that minority physicians play a key role in serving minority communities like mine," Dr. Arévalo said. "If we are to address the needs of these populations, we have to have physicians who understand their needs."

Anmol S. Mahal, MD, past CMA president, stressed that the study emphasized the need for strong pipeline programs for minority and economically disadvantaged students, and for financial incentive programs to encourage physicians to practice in underserved communities.

"Just training more health care professionals will not solve the problem," he said. "We need to offer incentives to these new physicians and new health care workers to encourage them to serve in the rural and inner-city areas where Californians have limited access."

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Diversity in medicine

An analysis of California's physician work force found that minorities were more likely to go into primary care than were whites. Here is a breakdown of physician specialty by minority status. Underrepresented minorities include blacks, Hispanics and Native Americans. Non-underrepresented minorities include Asians and Pacific Islanders.

White Non-underrepresented minorities Underrepresented minorities
Facility-based 11.00% 11.09% 7.74%
Generalists 29.38% 42.34% 45.44%
Medical subspecialty 10.80% 12.77% 8.96%
Ob-gyn 5.19% 4.34% 6.87%
Psychiatric 8.32% 5.26% 6.07%
Surgical subspecialty 17.66% 11.32% 11.51%
Other 14.53% 9.24% 10.39%
Mixed subspecialty 3.12% 3.64% 3.01%

Source: "Physician Diversity in California: New Findings from the California Medical Board Survey," Center for California Health Workforce Studies

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