Background In the United States, black patients generally receivelower-quality health care than white patients. Black patientsmay receive their care from a subgroup of physicians whose qualificationsor resources are inferior to those of the physicians who treatwhite patients.
Methods We performed a cross-sectional analysis of 150,391 visitsby black Medicare beneficiaries and white Medicare beneficiaries65 years of age or older for medical "evaluation and management"who were seen by 4355 primary care physicians who participatedin a biannual telephone survey, the 2000–2001 CommunityTracking Study Physician Survey.
Results Most visits by black patients were with a small groupof physicians (80 percent of visits were accounted for by 22percent of physicians) who provided only a small percentageof care to white patients. In a comparison of visits by whitepatients and black patients, we found that the physicians whomthe black patients visited were less likely to be board certified(77.4 percent) than were the physicians visited by the whitepatients (86.1 percent, P=0.02) and also more likely to reportthat they were unable to provide high-quality care to all theirpatients (27.8 percent vs. 19.3 percent, P=0.005). The physicianstreating black patients also reported facing greater difficultiesin obtaining access for their patients to high-quality subspecialists,high-quality diagnostic imaging, and nonemergency admissionto the hospital.
Conclusions Black patients and white patients are to a largeextent treated by different physicians. The physicians treatingblack patients may be less well trained clinically and may haveless access to important clinical resources than physicianstreating white patients. Further research should be conductedto address the extent to which these differences may be responsiblefor disparities in health care.
Source Information
From the Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York (P.B.B., D.S., R.C.T.); and the Center for Studying Health System Change, Washington, D.C. (H.H.P., J.L.H.).
Address reprint requests to Dr. Bach at the Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 221, New York, NY 10021.
King, W D, Minor, P, Ramirez Kitchen, C, Ore, L E, Shoptaw, S, Victorianne, G D, Rust, G
(2008). Racial, gender and geographic disparities of antiretroviral treatment among US Medicaid enrolees in 1998. J. Epidemiol. Community Health
62: 798-803
[Abstract][Full Text]
Rooks, R. N., Simonsick, E. M., Klesges, L. M., Newman, A. B., Ayonayon, H. N., Harris, T. B.
(2008). Racial Disparities in Health Care Access and Cardiovascular Disease Indicators in Black and White Older Adults in the Health ABC Study. J Aging Health
20: 599-614
[Abstract]
Smith, A. K., Ladner, D., McCarthy, E. P.
(2008). Racial/Ethnic Disparities in Liver Transplant Surgery and Hospice Use: Parallels, Differences, and Unanswered Questions. AM J HOSP PALLIAT CARE
25: 285-291
[Abstract]
Baker, R. B., Washington, H. A., Olakanmi, O., Savitt, T. L., Jacobs, E. A., Hoover, E., Wynia, M. K.
(2008). African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide. JAMA
300: 306-313
[Abstract][Full Text]
Rhee, M. K., Ziemer, D. C., Caudle, J., Kolm, P., Phillips, L. S.
(2008). Use of a Uniform Treatment Algorithm Abolishes Racial Disparities in Glycemic Control. The Diabetes Educator
34: 655-663
[Abstract][Full Text]
Powe, N. R.
(2008). Let's Get Serious About Racial and Ethnic Disparities. J. Am. Soc. Nephrol.
19: 1271-1275
[Abstract][Full Text]
Wesson, D. E.
(2008). Is the Ethnic Disparity in CKD a Symptom of Dysfunctional Primary Care in the US?. J. Am. Soc. Nephrol.
19: 1249-1251
[Full Text]
Campbell, R. J.
(2008). Meeting Seniors' Information Needs: Using Computer Technology. Home Health Care Management Practice
20: 328-335
[Abstract]
Morris, A. M., Billingsley, K. G., Hayanga, A. J., Matthews, B., Baldwin, L.-M., Birkmeyer, J. D.
(2008). Residual Treatment Disparities After Oncology Referral for Rectal Cancer. JNCI J Natl Cancer Inst
100: 738-744
[Abstract][Full Text]
Adams, A. S., Trinacty, C. M., Zhang, F., Kleinman, K., Grant, R. W., Meigs, J. B., Soumerai, S. B., Ross-Degnan, D.
(2008). Medication Adherence and Racial Differences in A1C Control. Diabetes Care
31: 916-921
[Abstract][Full Text]
Reschovsky, J. D., O'Malley, A. S.
(2008). Do Primary Care Physicians Treating Minority Patients Report Problems Delivering High-Quality Care?. Health Aff (Millwood)
27: w222-w231
[Abstract][Full Text]
Schackman, B. R., Teixeira, P. A., Weitzman, G., Mushlin, A. I., Jacobson, I. M.
(2008). Quality-of-Life Tradeoffs for Hepatitis C Treatment: Do Patients and Providers Agree?. Med Decis Making
28: 233-242
[Abstract]
Lurie, N., Somers, S. A., Fremont, A., Angeles, J., Murphy, E. K., Hamblin, A.
(2008). Challenges To Using A Business Case For Addressing Health Disparities. Health Aff (Millwood)
27: 334-338
[Abstract][Full Text]
Gaskin, D. J., Spencer, C. S., Richard, P., Anderson, G. F., Powe, N. R., LaVeist, T. A.
(2008). Do Hospitals Provide Lower-Quality Care To Minorities Than To Whites?. Health Aff (Millwood)
27: 518-527
[Abstract][Full Text]
Jha, A. K., Orav, E. J., Zheng, J., Epstein, A. M.
(2008). The Characteristics And Performance Of Hospitals That Care For Elderly Hispanic Americans. Health Aff (Millwood)
27: 528-537
[Abstract][Full Text]
Pani, L. N., Nathan, D. M., Grant, R. W.
(2008). Clinical Predictors of Disease Progression and Medication Initiation in Untreated Patients With Type 2 Diabetes and A1C Less Than 7%. Diabetes Care
31: 386-390
[Abstract][Full Text]
Howell, E. A., Hebert, P., Chatterjee, S., Kleinman, L. C., Chassin, M. R.
(2008). Black/White Differences in Very Low Birth Weight Neonatal Mortality Rates Among New York City Hospitals. Pediatrics
121: e407-e415
[Abstract][Full Text]
Blustein, J.
(2008). Who Is Accountable for Racial Equity in Health Care?. JAMA
299: 814-816
[Full Text]
Brown, D. R., Hernandez, A., Saint-Jean, G., Evans, S., Tafari, I., Brewster, L. G., Celestin, M. J., Gomez-Estefan, C., Regalado, F., Akal, S., Nierenberg, B., Kauschinger, E. D., Schwartz, R., Page, J. B.
(2008). A Participatory Action Research Pilot Study of Urban Health Disparities Using Rapid Assessment Response and Evaluation. Am. J. Public Health
98: 28-38
[Abstract][Full Text]
Saha, S., Shipman, S. A.
(2008). Race-Neutral Versus Race-Conscious Workforce Policy To Improve Access To Care. Health Aff (Millwood)
27: 234-245
[Abstract][Full Text]
Smith, W. R., Betancourt, J. R., Wynia, M. K., Bussey-Jones, J., Stone, V. E., Phillips, C. O., Fernandez, A., Jacobs, E., Bowles, J.
(2007). Recommendations for Teaching about Racial and Ethnic Disparities in Health and Health Care. ANN INTERN MED
147: 654-665
[Abstract][Full Text]
Ferrer, R. L.
(2007). Pursuing Equity: Contact With Primary Care and Specialist Clinicians by Demographics, Insurance, and Health Status. Ann Fam Med
5: 492-502
[Abstract][Full Text]
Landon, B. E., Schneider, E. C., Normand, S.-L. T., Scholle, S. H., Pawlson, L. G., Epstein, A. M.
(2007). Quality of Care in Medicaid Managed Care and Commercial Health Plans. JAMA
298: 1674-1681
[Abstract][Full Text]
Curtis, L. H., Al-Khatib, S. M., Shea, A. M., Hammill, B. G., Hernandez, A. F., Schulman, K. A.
(2007). Sex Differences in the Use of Implantable Cardioverter-Defibrillators for Primary and Secondary Prevention of Sudden Cardiac Death. JAMA
298: 1517-1524
[Abstract][Full Text]
Davis, A. M., Vinci, L. M., Okwuosa, T. M., Chase, A. R., Huang, E. S.
(2007). Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions. Med Care Res Rev
64: 29S-100S
[Abstract]
Peek, M. E., Cargill, A., Huang, E. S.
(2007). Diabetes Health Disparities: A Systematic Review of Health Care Interventions. Med Care Res Rev
64: 101S-156S
[Abstract]
Chien, A. T., Chin, M. H., Davis, A. M., Casalino, L. P.
(2007). Pay for Performance, Public Reporting, and Racial Disparities in Health Care: How Are Programs Being Designed?. Med Care Res Rev
64: 283S-304S
[Abstract]
Heisler, M., Faul, J. D., Hayward, R. A., Langa, K. M., Blaum, C., Weir, D.
(2007). Mechanisms for Racial and Ethnic Disparities in Glycemic Control in Middle-aged and Older Americans in the Health and Retirement Study. Arch Intern Med
167: 1853-1860
[Abstract][Full Text]
Bloche, M. G.
(2007). Consumer-Directed Health Care And The Disadvantaged. Health Aff (Millwood)
26: 1315-1327
[Abstract][Full Text]
Smith, D. B., Feng, Z., Fennell, M. L., Zinn, J. S., Mor, V.
(2007). Separate And Unequal: Racial Segregation And Disparities In Quality Across U.S. Nursing Homes. Health Aff (Millwood)
26: 1448-1458
[Abstract][Full Text]
Berndt, S. I., Carter, H. B., Schoenberg, M. P., Newschaffer, C. J.
(2007). Disparities in Treatment and Outcome for Renal Cell Cancer Among Older Black and White Patients. JCO
25: 3589-3595
[Abstract][Full Text]
Bailey, J. E., Sprabery, L. R.
(2007). Inequitable Funding May Cause Health Care Disparities. Arch Intern Med
167: 1226-1228
[Full Text]
Hasnain-Wynia, R., Baker, D. W., Nerenz, D., Feinglass, J., Beal, A. C., Landrum, M. B., Behal, R., Weissman, J. S.
(2007). Disparities in Health Care Are Driven by Where Minority Patients Seek Care: Examination of the Hospital Quality Alliance Measures. Arch Intern Med
167: 1233-1239
[Abstract][Full Text]
Bickell, N. A., LePar, F., Wang, J. J., Leventhal, H.
(2007). Lost Opportunities: Physicians' Reasons and Disparities in Breast Cancer Treatment. JCO
25: 2516-2521
[Abstract][Full Text]
Jha, A. K., Orav, E. J., Li, Z., Epstein, A. M.
(2007). Concentration and Quality of Hospitals That Care for Elderly Black Patients. Arch Intern Med
167: 1177-1182
[Abstract][Full Text]
Casalino, L. P., Elster, A., Eisenberg, A., Lewis, E., Montgomery, J., Ramos, D.
(2007). Will Pay-For-Performance And Quality Reporting Affect Health Care Disparities?. Health Aff (Millwood)
26: w405-w414
[Abstract][Full Text]
Rodriguez, R. A., Sen, S., Mehta, K., Moody-Ayers, S., Bacchetti, P., O'Hare, A. M.
(2007). Geography Matters: Relationships among Urban Residential Segregation, Dialysis Facilities, and Patient Outcomes. ANN INTERN MED
146: 493-501
[Abstract][Full Text]
Crew, K. D., Neugut, A. I., Wang, X., Jacobson, J. S., Grann, V. R., Raptis, G., Hershman, D. L.
(2007). Racial Disparities in Treatment and Survival of Male Breast Cancer. JCO
25: 1089-1098
[Abstract][Full Text]
Pham, H. H., Schrag, D., O'Malley, A. S., Wu, B., Bach, P. B.
(2007). Care Patterns in Medicare and Their Implications for Pay for Performance. NEJM
356: 1130-1139
[Abstract][Full Text]
Lurie, N., Dubowitz, T.
(2007). Health Disparities and Access to Health. JAMA
297: 1118-1121
[Full Text]
Rust, G., Cooper, L. A.
(2007). How Can Practice-based Research Contribute to the Elimination of Health Disparities?. J Am Board Fam Med
20: 105-114
[Abstract][Full Text]
Sequist, T. D., Cullen, T., Hays, H., Taualii, M. M., Simon, S. R., Bates, D. W.
(2007). Implementation and Use of an Electronic Health Record within the Indian Health Service. J. Am. Med. Inform. Assoc.
14: 191-197
[Abstract][Full Text]
Losina, E., Wright, E. A., Kessler, C. L., Barrett, J. A., Fossel, A. H., Creel, A. H., Mahomed, N. N., Baron, J. A., Katz, J. N.
(2007). Neighborhoods Matter: Use of Hospitals With Worse Outcomes Following Total Knee Replacement by Patients From Vulnerable Populations. Arch Intern Med
167: 182-186
[Abstract][Full Text]
Hambidge, S. J., Emsermann, C. B., Federico, S., Steiner, J. F.
(2007). Disparities in Pediatric Preventive Care in the United States, 1993-2002. Arch Pediatr Adolesc Med
161: 30-36
[Abstract][Full Text]
Zapka, J. G., Carter, R., Carter, C. L., Hennessy, W., Kurent, J. E., DesHarnais, S.
(2006). Care at the end of life: focus on communication and race.. J Aging Health
18: 791-813
[Abstract]
Sassi, F., Luft, H. S., Guadagnoli, E.
(2006). Reducing Racial/Ethnic Disparities in Female Breast Cancer: Screening Rates and Stage at Diagnosis. Am. J. Public Health
96: 2165-2172
[Abstract][Full Text]
Gorin, S. S., Heck, J. E., Cheng, B., Smith, S. J.
(2006). Delays in breast cancer diagnosis and treatment by racial/ethnic group.. Arch Intern Med
166: 2244-2252
[Abstract][Full Text]
Ferraro, K. F., Thorpe, R. J. Jr, McCabe, G. P., Kelley-Moore, J. A., Jiang, Z.
(2006). The color of hospitalization over the adult life course: cumulative disadvantage in black and white?. J. Gerontol. B Psychol. Sci. Soc. Sci.
61: S299-S306
[Abstract][Full Text]
Liu, J. H., Zingmond, D. S., McGory, M. L., SooHoo, N. F., Ettner, S. L., Brook, R. H., Ko, C. Y.
(2006). Disparities in the utilization of high-volume hospitals for complex surgery.. JAMA
296: 1973-1980
[Abstract][Full Text]
Winker, M. A.
(2006). Race and Ethnicity in Medical Research: Requirements Meet Reality. J Law Med Ethics
34: 520-525
Schnittker, J., Liang, K.
(2006). The promise and limits of racial/ethnic concordance in physician-patient interaction.. Journal of Health Politics, Policy and Law
31: 811-838
[Abstract]
Sirovich, B. E., Gottlieb, D. J., Welch, H. G., Fisher, E. S.
(2006). Regional Variations in Health Care Intensity and Physician Perceptions of Quality of Care. ANN INTERN MED
144: 641-649
[Abstract][Full Text]
Lemon, S. C., Zapka, J. G., Estabrook, B., Benjamin, E.
(2006). Challenges to Research in Urban Community Health Centers. Am. J. Public Health
96: 626-628
[Abstract][Full Text]
McGinnis, S., Moore, J., Continelli, T.
(2006). Practice patterns of underrepresented minority nurse practitioners in new york state, 2000.. Policy Politics Nursing Practice
7: 35-44
[Abstract]
Lathan, C. S., Neville, B. A., Earle, C. C.
(2006). The Effect of Race on Invasive Staging and Surgery in Non-Small-Cell Lung Cancer. JCO
24: 413-418
[Abstract][Full Text]
Trivedi, A. N., Sequist, T. D., Ayanian, J. Z.
(2006). Impact of Hospital Volume on Racial Disparities in Cardiovascular Procedure Mortality. J Am Coll Cardiol
47: 417-424
[Abstract][Full Text]
Adams, A. S., Zhang, F., Mah, C., Grant, R. W., Kleinman, K., Meigs, J. B., Ross-Degnan, D.
(2005). Race Differences in Long-Term Diabetes Management in an HMO. Diabetes Care
28: 2844-2849
[Abstract][Full Text]
Konrad, T. R., Howard, D. L., Edwards, L. J., Ivanova, A., Carey, T. S.
(2005). Physician-Patient Racial Concordance, Continuity of Care, and Patterns of Care for Hypertension. Am. J. Public Health
95: 2186-2190
[Abstract][Full Text]
Walker, A. R P, Walker, B. F
(2005). Socio-economic status: an insufficiently appreciated component of US health. The Journal of the Royal Society for the Promotion of Health
125: 254-254
Kressin, N. R.
(2005). Separate but Not Equal: The Consequences of Segregated Health Care. Circulation
112: 2582-2584
[Full Text]
Skinner, J., Chandra, A., Staiger, D., Lee, J., McClellan, M.
(2005). Mortality After Acute Myocardial Infarction in Hospitals That Disproportionately Treat Black Patients. Circulation
112: 2634-2641
[Abstract][Full Text]
McCullough, M. L., Feigelson, H. S., Diver, W. R., Patel, A. V., Thun, M. J., Calle, E. E.
(2005). Risk Factors for Fatal Breast Cancer in African-American Women and White Women in a Large US Prospective Cohort. Am J Epidemiol
162: 734-742
[Abstract][Full Text]
Schelbert, E. B., Rosenthal, G. E., Welke, K. F., Vaughan-Sarrazin, M. S.
(2005). Treatment Variation in Older Black and White Patients Undergoing Aortic Valve Replacement. Circulation
112: 2347-2353
[Abstract][Full Text]
Krumholz, H. M.
(2005). The Year in Epidemiology, Health Services, and Outcomes Research. J Am Coll Cardiol
46: 1362-1370
[Full Text]
Hershman, D., McBride, R., Jacobson, J. S., Lamerato, L., Roberts, K., Grann, V. R., Neugut, A. I.
(2005). Racial Disparities in Treatment and Survival Among Women With Early-Stage Breast Cancer. JCO
23: 6639-6646
[Abstract][Full Text]
Lu, P.-J., Singleton, J. A., Rangel, M. C., Wortley, P. M., Bridges, C. B.
(2005). Influenza Vaccination Trends Among Adults 65 Years or Older in the United States, 1989-2002. Arch Intern Med
165: 1849-1856
[Abstract][Full Text]
Lanting, L. C., Joung, I. M.A., Mackenbach, J. P., Lamberts, S. W.J., Bootsma, A. H.
(2005). Ethnic Differences in Mortality, End-Stage Complications, and Quality of Care Among Diabetic Patients: A review. Diabetes Care
28: 2280-2288
[Abstract][Full Text]
Vaccarino, V., Rathore, S. S., Wenger, N. K., Frederick, P. D., Abramson, J. L., Barron, H. V., Manhapra, A., Mallik, S., Krumholz, H. M., the National Registry of Myocardial Infarction Inv,
(2005). Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002. NEJM
353: 671-682
[Abstract][Full Text]
Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., Ayanian, J. Z.
(2005). Trends in the Quality of Care and Racial Disparities in Medicare Managed Care. NEJM
353: 692-700
[Abstract][Full Text]
Baldwin, L.-M., Dobie, S. A., Billingsley, K., Cai, Y., Wright, G. E., Dominitz, J. A., Barlow, W., Warren, J. L., Taplin, S. H.
(2005). Explaining Black-White Differences in Receipt of Recommended Colon Cancer Treatment. JNCI J Natl Cancer Inst
97: 1211-1220
[Abstract][Full Text]
Thomas, A. J., Eberly, L. E., Davey Smith, G., Neaton, J. D., Stamler, J., for the Multiple Risk Factor Intervention Trial Re,
(2005). Race/Ethnicity, Income, Major Risk Factors, and Cardiovascular Disease Mortality. Am. J. Public Health
95: 1417-1423
[Abstract][Full Text]
Pham, H. H., Schrag, D., Hargraves, J. L., Bach, P. B.
(2005). Delivery of Preventive Services to Older Adults by Primary Care Physicians. JAMA
294: 473-481
[Abstract][Full Text]
Carroll, K. N., Griffin, M. R., Gebretsadik, T., Shintani, A., Mitchel, E., Hartert, T. V.
(2005). Racial Differences in Asthma Morbidity During Pregnancy. Obstet Gynecol
106: 66-72
[Abstract][Full Text]
Armstrong, K., Micco, E., Carney, A., Stopfer, J., Putt, M.
(2005). Racial Differences in the Use of BRCA1/2 Testing Among Women With a Family History of Breast or Ovarian Cancer. JAMA
293: 1729-1736
[Abstract][Full Text]
Sabatine, M. S., Blake, G. J., Drazner, M. H., Morrow, D. A., Scirica, B. M., Murphy, S. A., McCabe, C. H., Weintraub, W. S., Gibson, C. M., Cannon, C. P.
(2005). Influence of Race on Death and Ischemic Complications in Patients With Non-ST-Elevation Acute Coronary Syndromes Despite Modern, Protocol-Guided Treatment. Circulation
111: 1217-1224
[Abstract][Full Text]
Smith, D. B.
(2005). Racial And Ethnic Health Disparities And The Unfinished Civil Rights Agenda. Health Aff (Millwood)
24: 317-324
[Abstract][Full Text]
Williams, D. R., Jackson, P. B.
(2005). Social Sources Of Racial Disparities In Health. Health Aff (Millwood)
24: 325-334
[Abstract][Full Text]
Eichner, J., Vladeck, B. C.
(2005). Medicare As A Catalyst For Reducing Health Disparities. Health Aff (Millwood)
24: 365-375
[Abstract][Full Text]
Moy, E., Dayton, E., Clancy, C. M.
(2005). Compiling The Evidence: The National Healthcare Disparities Reports. Health Aff (Millwood)
24: 376-387
[Abstract][Full Text]
Brach, C., Fraser, I., Paez, K.
(2005). Crossing The Language Chasm. Health Aff (Millwood)
24: 424-434
[Abstract][Full Text]
Frist, W. H.
(2005). Overcoming Disparities In U.S. Health Care. Health Aff (Millwood)
24: 445-451
[Abstract][Full Text]
Terrell, D. R., Johnson, K. K., Vesely, S. K., George, J. N.
(2005). Is immune thrombocytopenic purpura less common among black Americans?. Blood
105: 1368-1369
[Full Text]
King, T. E. Jr, Wheeler, M. B.
(2004). Inequality in Health Care: Unjust, Inhumane, and Unattended!. ANN INTERN MED
141: 815-817
[Full Text]
Aaron, H. J., Fernandez, A., Goldstein, L., Wheeler, M. B., Bach, P. B., Schrag, D., Pham, H. H.
(2004). Primary Care Physicians Who Treat Blacks and Whites. NEJM
351: 2126-2127
[Full Text]
Rathore, S. S., Krumholz, H. M.
(2004). Differences, Disparities, and Biases: Clarifying Racial Variations in Health Care Use. ANN INTERN MED
141: 635-638
[Abstract][Full Text]
Winker, M. A.
(2004). Measuring Race and Ethnicity: Why and How?. JAMA
292: 1612-1614
[Full Text]
(2004). U.S. Healthcare: Separate and Unequal. Journal Watch Dermatology
2004: 12-12
[Full Text]
(2004). U.S. Health Care: Separate and Unequal. JWatch General
2004: 1-1
[Full Text]
Epstein, A. M.
(2004). Health Care in America -- Still Too Separate, Not Yet Equal. NEJM
351: 603-605
[Full Text]
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