If you are a black Medicare patient in the United States, you are more likely than a white Medicare patient to be treated by a primary care physician who reports being unable to provide consistently high-quality medical care to all patients.
A study of primary care physicians by researchers at Memorial Sloan-Kettering Cancer Center and the Center for Studying Health System Change published in the August 5 New England Journal of Medicine found that black and white Medicare patients are, to a large extent, treated by a different group of physicians who have unequal access to necessary parts of the healthcare system.
“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.”