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March 28, 2022

Patients of color are less likely to have a provider of the same race, new study finds.

Daily Briefing

Patients of color are significantly less likely than white patients to have a health care provider of the same race, according to a study released by the Robert Wood Johnson Foundation—a disparity that could negatively impact both patient-provider relationships and health outcomes.

Study details and key findings

For the study, which was conducted by the Urban Institute, researchers analyzed the April 2021 edition of the organization's Health Reform Monitoring Survey, which had more than 9,000 adult participants between the ages of 18 and 64.

Overall, the researchers found that patients of color are significantly less likely to have a health care provider of the same race than white patients. Compared with 73.8% of white adults, only 22.2% of Black adults and 34.4% of adults of additional races reported being the same race as their health care providers.

In addition, less than a quarter of Hispanic/Latinx adults (23.1%) reported that they had a provider of the same race and ethnicity who also spoke to them in their preferred language.

However, the researchers noted some limitations to the study, including how not all respondents reported having a usual health care provider.

"About 30% of all respondents and 45% of Hispanic/Latinx respondents indicated they did not have a usual healthcare provider," the researchers wrote. "This likely reflects systemic factors including lower access to affordable employer coverage due to the nature of a person's job, eligibility restrictions and immigration concerns."

Comments

Based on the study's findings, the researchers recommended several actions policymakers could take to improve provider representation and ensure patients will receive culturally competent care.

"Steps to address the [racial] imbalance [between patients of color and providers] include making medical education more affordable for underrepresented groups, diversifying the healthcare teams serving people of color and those with limited English proficiency, and holding providers accountable for providing culturally effective care to patients in the language they prefer," said Dulce Gonzalez, a research associate at the Urban Institute and the study's lead author.

According to Fierce Healthcare, the Biden administration has recently taken steps to get more providers who represent underserved areas to participate in value-based care programs to help improve overall health equity in the country.

"We are building in elements of health equity into everything that we do from development of models and how we evaluate the models and data collecting," said Liz Fowler, head of the Center for Medicare and Medicaid Innovation.

"Trust is part of the foundation of good patient-provider relationships and is especially important for communities of color, who have long been discriminated against in healthcare," said Jacquelynn Orr, the program officer for the Robert Wood Johnson Foundation. "Having a provider who looks like you and shares your experiences builds trust." (King, Fierce Healthcare, 3/24; Gooch, Becker's Hospital Review, 3/23; Gonzalez et al., Robert Wood Johnson Foundation, 3/23)

 

Advisory Board's take

How to increase your workforce diversity (from organizations who actually did)

Rachel ZuckermanBy Rachel Zuckerman

While simply having a provider of the same race and ethnicity does not guarantee a trusting relationship, as this study and others show, there is evidence that having a provider that shares the patient's race or language improves overall patient care. Patients deserve a choice in who they seek care from; representation in our clinical workforce is critically important.

It's unsurprising that Black and Hispanic/Latinx adults were less likely to report racial concordance with their usual provider, since only ~5.8% of physicians in the United States are Hispanic and only ~5% are Black or African American. This underrepresentation is certainly related to segregation and discrimination in medical schools, as the study's authors note, but also to systemic racism and economic injustice that have led Black and Hispanic people to be over-represented in the low socioeconomic status population. People who have their basic needs met, sufficient financial resources, and strong social capital are much better positioned to navigate the many hurdles on the way to becoming a physician.

Health care organizations must act—here's how

Building a diverse and representative workforce is crucial, and health care organizations are partly responsible for making this happen.

Advisory Board recently hosted an event inviting health care organizations to share innovative strategies they've used to successfully increase the diversity of their workforce to better reflect their community's demographic makeup in clinical and leadership roles. Eight organizations were selected to present as finalists during the virtual showcase.

The winner of the showcase was Family Care Specialists (FCS) Medical Group for their programs to train underrepresented minority students to become clinicians. FCS has taken a particularly robust approach, establishing a family medicine residency program that has trained 226 doctors over the past 30 years, 65% of whom identify as underrepresented minorities. While not everyone can start a new residency program, FCS has taken two steps that any health care provider organization can replicate:

  1. Develop a robust network of partnerships with community organizations to support students' non-clinical needs. FCS maintains dozens of partnerships with community-based organizations, academic enrichment and tutoring groups, scholarship funds, afterschool programs, and more. This network of partners is informed by three decades of patient interaction and data analysis. FCS serves as a coordinator, linking patients and students to these partner organizations to address non-clinical needs that might create barriers to becoming clinicians.

     

  2. View every student in your community as a potential future clinician. FCS has designed multiple “entry points” to reach students early and encourage them to consider careers in health care. For example, FCS clinicians begin talking to patients when they’re children about health care professions and education as a path to economic stability. FCS has cultivated partnerships with local high schools and colleges. After making initial connections with students interested in pursuing a health care career, FCS provides educational support, summer jobs, and research assistantships, as well as linking students to the community partner organizations mentioned above. While FCS is particularly well positioned to support students in becoming physicians, FCS also actively supports students on other health professions tracks.

To review an in-depth look into FCS' efforts, including how they secured financial support for this work, review our coverage here.

It takes every part of the health care industry

No matter where you sit in the health care industry, whether provider, payer, life sciences, education, you have a role to play.

Take L.A. Care Health Plan, for example, the third-place winner of the showcase. While L.A. Care does not directly recruit or pay physicians, they identified several ways they were uniquely positioned to address the lack of diversity of physicians practicing within the L.A. safety net. In 2018, L.A. Care launched the Elevating the Safety Net initiative, committing $155M dollars over five years to address the shortage and lack of diversity of practicing physicians in safety net settings. Part of the ESN initiative, the Provider Loan Repayment Program (PLRP) awards primary care providers up to $180,000 in exchange for a three-year commitment to practicing in the safety net. Over 100 physicians have received a PLRP award to date, with 65% of awardees identifying with an underrepresented racial and ethnic group in medicine.

Parting thoughts

Building a diverse, equitable, and representative clinical workforce is one of the most important efforts you can make in our shared commitments to health equity.

While we shared just two examples of how health care organizations are actively working to advance racial and ethnic representation in the clinical workforce, there are countless people working across the health care industry to create a more diverse and equitable workforce. For more, check out the rest of the finalists from the showcase and review four lessons to increase representation in your clinical workforce.

Advisory Board's Andrew Mohama helped contribute to this piece.

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