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Previous Volume 334:1305-1310 May 16, 1996 Number 20 Next

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ABSTRACT

Background Patients who are members of minority groups may be more likely than others to consult physicians of the same race or ethnic group, but little is known about the relation between patients' race or ethnic group and the supply of physicians or the likelihood that minority-group physicians will care for poor or black and Hispanic patients.

Methods We analyzed data on physicians' practice locations and the racial and ethnic makeup and socioeconomic status of communities in California in 1990. We also surveyed 718 primary care physicians from 51 California communities in 1993 to examine the relation between the physicians' race or ethnic group and the characteristics of the patients they served.

Results Communities with high proportions of black and Hispanic residents were four times as likely as others to have a shortage of physicians, regardless of community income. Black physicians practiced in areas where the percentage of black residents was nearly five times as high, on average, as in areas where other physicians practiced. Hispanic physicians practiced in areas where the percentage of Hispanic residents was twice as high as in areas where other physicians practiced. After we controlled for the racial and ethnic makeup of the community, black physicians cared for significantly more black patients (absolute difference, 25 percentage points; P<0.001) and Hispanic physicians for significantly more Hispanic patients (absolute difference, 21 percentage points; P<0.001) than did other physicians. Black physicians cared for more patients covered by Medicaid (P = 0.001) and Hispanic physicians for more uninsured patients (P = 0.03) than did other physicians.

Conclusions Black and Hispanic physicians have a unique and important role in caring for poor, black, and Hispanic patients in California. Dismantling affirmative-action programs, as is currently proposed, may threaten health care for both poor people and members of minority groups.

Source Information

From the Division of General Internal Medicine (M.K.), the Institute for Health Policy Studies (M.K., K.G., A.B.B.), the Medical Effectiveness Research Center for Diverse Populations (M.K., K.G., M.D., K.V., A.B.B.), the Department of Family and Community Medicine (K.G.), and the Office of the Associate Dean for Medical School Admissions (M.D.), University of California, San Francisco; the Division of General Internal Medicine (K.V., D.K., A.B.B.) and the Primary Care Research Center (M.K., K.G., K.V., D.K., A.B.B.), San Francisco General Hospital, San Francisco; and the University of Minnesota Schools of Medicine and Public Health and Hennepin County Medical Center, Minneapolis (N.L.).

Address reprint requests to Dr. Komaromy at UCSF Box 1364, Primary Care Research Center, San Francisco, CA 94143-1364.

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