December 11, 2019
Doctor diversity matters
Having more black physicians could lead to better health among black men.
African American men were more likely to take up preventive care services after meeting with a black doctor, according to new research.
Daniel Ernst
Being a black man in America means living with a lot of health risks.
Black men have the lowest life-expectancy among any group and experience a higher rate of heart disease, diabetes, and other chronic conditions.
Policymakers have sought to expand preventive care to vulnerable populations. But that won’t matter if black men don’t visit with a doctor and trust their advice.
Pairing them with a black physician could help, according to a paper in the December issue of the American Economic Review.
In a randomized clinical trial, researchers Marcella Alsan, Owen Garrick, and Grant Graziani found that black men in Oakland, Calif., were much more likely to seek preventive care and discuss their health problems when they met with a physician of the same race. The research underscores the importance of boosting diversity in the profession to improve care for at-risk populations.
“Diversity does matter,” said Alsan, a professor of public policy at Harvard’s Kennedy School. “It made a difference to African American men to be randomly assigned to a doctor from their background.
Diversity does matter. It made a difference to African American men to be randomly assigned to a doctor from their background.
Marcella Alsan
African American men live on average 4.5 fewer years than their white counterparts, the difference largely attributed to higher rates of chronic diseases. Better access to preventive healthcare services would help close the gap, but black men are less likely to visit the doctor or even get a flu shot.
The authors set out to understand whether a physician’s race played a role. African Americans tend to distrust the health care system more than whites, and not without reason. They have been the victims of notorious racist experiments like the Tuskegee Study, the legacy of which has been lasting institutional skepticism by African Americans toward health institutions.
Garrick, an African American doctor himself, partnered with Alsan and Graziani to understand whether black physicians would have more success building trust with black patients.
If they were going to get enough patients for the study, though, the researchers would first have to get black men willing to trust them.
Part of that involved going out into the community, doing focus groups to determine the best locations and methods for recruiting patients. The feedback was invaluable to helping them craft a strategy, Alsan said.
“If you’re trying to understand the populations that are marginalized in some way, there’s no substitute for meeting them where they are,” Alsan said.
Lacking Representation
The racial composition of primary care physicians in the United States is disproportionately skewed to white and Asian doctors. Meanwhile, the share of black and Hispanic physicians is much smaller than their share of the overall population. Click on the buttons below to see the racial breakdown in the population (2013) and among PCPs.
Source: National Institutes of Health
Ultimately, they ended up going out into barbershops and a few flea markets around Oakland, asking black men to fill out questionnaires and offering coupons for a free health screening. More than 1,300 men were recruited. Half of them ended up visiting their clinic, where they were randomly assigned to either a white or black doctor who would offer preventive care like measuring their BMI and blood pressure and screening for diabetes and cholesterol. They would also encourage patients to get a flu shot.
Though doctors of all races received positive reviews from their patients, black men who met with black doctors were 18 percentage points more likely to use prevention services. This was especially true for invasive tests that carried more risk to the patient. Subjects assigned to black doctors increased use of diabetes and cholesterol screenings (which require a blood sample) by 49 and 71 percent, respectively. They were also 29 percent more likely to talk about issues outside of preventive care.
The authors believe the reason why comes down to better communication. Certainly, that involves a lot of signals, both verbal and non-verbal, so it’s tough to say what communication methods exactly worked the best.
“But in the context of actual clinical encounter, there was more information exchange occurring [with black doctors],” Alsan said.
They did not find, however, that personal prejudices were getting in the way. White doctors were still highly rated by black male patients, and there was no evidence that they were withholding services during the consultations.
And so, the question is how to boost the number of African Americans in the medical profession.
Blacks make up 13 percent of the US population but only 4 percent of physicians. There aren’t any easy answers, but Alsan said perhaps medical schools and the profession should look at what other professions have done to boost the share of minorities in top level positions. She referenced the NFL’s “Rooney Rule,” which boosted the share of black coaches in professional football and has been adopted by other professions.
“Obviously pipeline issues are key,” Alsan said. “Extensions to this work are really important because there are lots of good jobs in healthcare that don’t need a medical degree. Would (distrust in the healthcare system) also be the case if we had more ancillary staff that weren’t physicians, but who came from the community and could make a difference?”
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“Does Diversity Matter for Health? Experimental Evidence from Oakland” appears in the December issue of the American Economic Review.