The American Medical Association (AMA) Code of Ethics urges physicians to "advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being."
But how achievable is that level of physician activism in today's highly divisive US society? The differing attitudes among doctors, and how those attitudes shape actions taken or avoided, are shown in the Medscape Physicians' Views on Racial Disparities Issues Report 2022.
Survey respondents and commenters on the report expressed opinions that often sharply differed about the impact of racial disparities, how they influence delivery of patient care, and how they affect healthcare providers and staff.
How Dialed Into Racism Are Doctors?
Medscape surveyed doctors about 10 leading social issues. They ranked racial disparities third in terms of importance, behind healthcare access and substance/opioid abuse. Non-White survey respondents ranked racial disparities as an important issue somewhat more frequently than their White peers did.
"Even in extremely reputable professions like medicine, people are facing racism," one pediatrician respondent wrote. A family medicine physician respondent asserted: "We in medicine need to do better. I encourage insight about ourselves to learn about how to rectify injustice."
But other doctors felt certain social issues like racial disparities are disconnected from their professional duties. One commenter opined, "This topic is simply not our job as a physician. Keep your eye on the ball."
A Complex and Multifaceted Issue
Several commenters and respondents feel racial differences in healthcare delivery cannot be examined in a vacuum; rather, they are one element in a broader network of disparities. "Race is a single data point," one commenter said.
A survey respondent who is a public health physician expanded on that context. "Most of the [racial] inequality is really based on social issues that affect the [general] availability of adequate healthcare, no matter the racial or community makeup. But these financial, safety, educational, and local issues affect the minority communities to a greater extent."
Even some physicians who feel racial issues affect the quality of patient treatment implied they might contribute to the problem. "My treatment does change based on issues around insurance," a gastroenterologist wrote. "I agree that a minority is more likely to be uninsured/underinsured, but it is not my care that changes." A critical care physician added, "Racial disparities have their root in inequality in the social fabric into which people are born. In other words, people don't get started in life on equal footing."
But other respondents noted inherent racial biases apart from socioeconomic issues.
"I have seen acceptance of pain and lack of motivation to take extraordinary measures to fix a medical problem in African American patients that I'm sure would have been handled differently if the patient had been rich and White," one respondent asserted. "In my last job," an oncologist added, "the different treatment of both staff and physicians, and patients [based on race] were grotesque."
Region and Setting Matter
Physicians' feelings about the impact of racial disparities vary by where they practice. For example, in the Medscape survey, doctors in New York and Pennsylvania were likelier to consider racial disparities to be an important social issue than were their counterparts in Texas and Oklahoma.
Setting also matters. One military physician reported that racial discrimination "is unfortunately alive and well" in that work setting. An internist respondent described the Veterans Administration as a "cesspool of discrimination and retaliation against anyone who speaks up about a concern" such as racial bias.
Discrimination Spied From All Corners
Many respondents of color reported experiencing racial discrimination at work. "My previous employer had a noticeable pay gap between myself, a Black man, and non-Black peers," a psychiatrist recounted.
A gastroenterologist described being "surprised and disturbed to encounter pretty overt discrimination in hiring practices, covered with a veneer of legitimacy." And a pediatrician reported witnessing "distrust in non-White American doctors by [other] doctors without a reason."
On the other hand, survey responses included numerous complaints about discrimination toward White physicians and grumbling about affirmative action taken to extremes. "I've noticed more discrimination toward White physicians being falsely accused of providing poor care for minorities," an internist wrote.
Similar complaints were made about race-based hiring, promotion, and grants selection. But a public health physician respondent noted a "lack of diversity in qualified candidates, especially for positions requiring advanced degrees. It often appears that people from some groups are still either prevented or discouraged from pursuing" the necessary education.
Where More Progress Is Needed
A family medicine physician respondent said, "America has done amazing work on race." But other doctors, while conceding some progress, believe "there is still a long way to go," and further education and dialogue are critically needed to reduce disparities.
"I believe we need to have freer discussions," a psychiatrist wrote, "in our own race but also across races, about the difficulties people encounter in understanding and sometimes respecting others' cultures and how these impact the delivery of healthcare."
Added a public health physician respondent: "I truly believe that the vast majority of healthcare providers strive to achieve equal treatment of all patients and staff. [But] our cultural backgrounds may lead to inadequate recognition of the most effective way to deliver that care. We need to be trained on how to recognize those inadequacies and develop more effective ways to deliver the care."
Batya Swift Yasgur MA, LSW is a freelance writer with a counseling practice in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).
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Cite this: Physicians React: When and How Racial Disparities Shape Healthcare - Medscape - Oct 31, 2022.