Doctors face disparities in care of blacks

Primary care physicians who treat many black patients were less likely to be board-certified and more likely to struggle to provide high-quality care than physicians who treat white patients, a new study shows.

Researchers said their findings show two unequal health systems. Physicians who treat black patients face greater difficulty getting access for their patients to high-quality subspecialists, diagnostic imaging and hospital admission.

“The doctors don’t seem to be able to provide the same quality of care,” said Peter Bach, MD, lead author of the study in the Aug. 5 New England Journal of Medicine. “There are differences in terms of resources and ease of scheduling, and all of those things affect the quality of care for patients.”

Researchers analyzed 150,391 visits by black and white Medicare patients to 4,355 primary care physicians who participated in a 2000-01 telephone survey. The study was conducted by the Center for Studying Health System Change in Washington, D.C., and New York’s Memorial Sloan-Kettering Cancer Center, where Dr. Bach is a pulmonologist and epidemiologist.

The study found that 22% of doctors accounted for 80% of the black patient visits in the study while the remaining 78% of physicians received the majority of visits by white patients. Thus, black and white patients are largely treated by different physicians, the study said. Doctors who treated blacks more often practiced in low-income neighborhoods.

Physicians who treated black patients were less likely to be board-certified than those who treated white patients. Researchers said previous studies showed that doctors who aren’t board-certified are less likely to follow screening recommendations — a tendency that could mean delayed diagnosis.

Treating the neighborhood: A family physician serves an underserved community

More than a decade ago, then-accountant Michael Malone joined the ranks of future doctors who decide to subject themselves to academic rigor followed by exhausting on-the-job training because he wanted to take care of people.

He gave up his accounting job and took the undergraduate sciences courses needed to apply to medical school and then plowed through the MCAT.

After completing osteopathic school and residency, however, he shunned private practice, electing instead to practice someplace he was really needed — an inner-city neighborhood.

After finishing his residency in a tough neighborhood on Chicago’s West Side, Michael Malone, DO, took a job with Access Community Health Network, which operates 42 health centers in underserved Chicago neighborhoods and the suburbs. The network’s mission statement: Services are available to all who need them without regard to age, race, ethnicity, gender, language, religion, education, sexual orientation, physical condition or ability to pay.

He was assigned to a clinic on Chicago’s South Side where 38% of the residents are living below the poverty level. The Englewood and New City neighborhoods also are home to many working patients who don’t have health insurance through their employers.

He’s been there almost three years.

“I can’t imagine doing it any other way,” Dr. Malone said during a lunch break in the small office that he shares with the other physician assigned to the clinic. “I wanted to be where I was needed. Everybody deserves the right to have medical care.”