"When we looked at the primary care physicians who treated black patients and white patients, we saw that they were different physicians who did not have equal access to the same resources for their patients," explained Peter B. Bach, MD, of the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering and the study's first author. Dr. Bach's earlier studies of racial disparity in cancer outcomes demonstrated that the poor quality healthcare received prior to a black patient's cancer diagnosis contributed, in part, to their lower rates of cancer survival. "It seems clear that if we are to reach the goals of eliminating racial and ethnic disparities in healthcare, we must begin by examining the resources available in primary care to coordinate a patient's medical treatment."
The researchers in this study did an analysis of 150,391 visits for medical "evaluation and management" by black and white Medicare beneficiaries to 4355 primary care physicians who had participated in an earlier telephone survey (2000-2001 Community Tracking Study Physician Survey) conducted by the Center for Studying Health System Change. They found that 27.8 percent of visits by black patients, compared to 19.3 percent of visits by white patients, were to physicians who said that they were not able to deliver high-quality care consistently to their patients. In addition, the black patient visits were concentrated in a specific group of doctors with 22 percent of those surveyed responsible for 80 percent of the visits.
"Everything we looked at suggests there is a difference between the physicians treating the two groups," said Dr. Bach. "The physicians who treat black patients face several obstacles, in that they do not have access to the best local services or connections with other specialists. In the study, we also found that they are less likely to be board certified, which may contribute to the poorer quality of care black patients receive."
The physicians treating blacks more often reported that they lacked sufficient access to major health care resources for their patients including high-quality diagnostic imaging (24.4 % vs. 16.6 % for physicians treating whites), sub-specialists of high quality (24.0 % vs. 17.9%), elective hospital admissions (48.5% vs. 37.0%), good ancillary services (36.6% vs. 27.7%), and an adequate number of inpatient days for the workup and evaluation of medical problems (48.5 % vs 37.0 %).
The study's findings reflected the characteristics of healthcare in the community where the patients were treated. "The care of black and white patients rests to a large extent in the hands of different physicians, and health disparities may be driven by these two groups of physicians differing in their ability to provide high-quality care because of community differences such as the availability of important health care services," said Hoangmai H. Pham, M.D., M.P.H., a coauthor and senior health researcher at Center for Studying Health System Change.
The study was co-authored by Deborah Schrag, MD, MPH, and Ramsey C. Tate, BS, of Memorial Sloan-Kettering Cancer Center and J. Lee Hargraves, PhD of the Center for Studying Health System Change. It was supported by grants from the National Cancer Institute, the Robert Wood Johnson Foundation, the American Cancer Society, and the American Lung Association of New York City.
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Journal
New England Journal of Medicine