Tackling healthcare inequities

As physicians, we strive to earn the trust and respect of our patients and colleagues. We want them to recognize our compassion and skill in diagnosing, treating, and healing. But in 2022, the color of our skin still factors into our ability to be regarded and evaluated equally. This same inequality applies to patients as they access care for chronic conditions or preventative reasons.

The global pandemic has highlighted - and exacerbated - the chasm of racial and ethnic disparities doctors and patients of color have long experienced. What are the challenges we face? And how can we foster necessary changes?

Underrepresentation - and discrimination - persist in our profession

Looking at all active physicians by race and ethnicity, there continues to be a significant lack of diversity. Only nine percent of current physicians identify as black or African American, Native American or Alaska Native, and Hispanic or Latino, according to the Association of American Medical Colleges. This is startling, since half of the U.S. population will consist of social, ethnic, or racial minorities by 2045.

Disproportionately small numbers of minority physicians are just part of the story. In a study published in Family Medicine, nearly one-fourth of physicians of color surveyed reported that a patient had directly refused their care due to their race. Overall, most of the physicians had experienced racism from patients, colleagues, and their institutions. As a physician of color, I have anecdotally learned of instances of such behavior throughout my career. It is shocking and profoundly saddening.

Refusal of care keeps physicians of color not only from doing their jobs and affects their health; it also can have implications on their careers. After years of study and training, how would you feel about your chosen profession when a patient wonders if you are there to clean the room instead of examining them? Dr. Kimberly Manning, an African American female doctor, told The New York Times, “People might not realize you’re offended, but it’s like death by a thousand paper cuts. It can cause you to shrink.”

What perpetuates microaggressions and other forms of racial discrimination? Insufficient diversity, equity and inclusion (DEI) training and cultural competency. If our biases and fundamental lack of understanding of all groups are not addressed in medical school, internships and residencies, it only makes sense that they will inform our professional practices.

COVID-19 has focused a light on patient healthcare inequities

People of color have long found it difficult to obtain quality medical care and health insurance. Two reports from the Surgeon General in the early 2000s - calling out inconsistencies in tobacco use and access to mental health care by race and ethnicity - helped raise awareness of the gaps in our healthcare system. We have recognized healthcare disparities for decades, yet they persist and continue to take a toll on high-risk populations.

• African American women are three times more likely to die from complications of pregnancy than White women,
• African Americans are likely to wait longer for transplants and surgeries than White patients, and
• From 1990 to 2020, rural hospital closures were more likely to occur in counties with more non-White residents.

The statistics describe a reality that shows little signs of improvement, and one that has been magnified by the pandemic. People of color find it harder to access vaccines (due to lack of child care or transportation, job commitments and language barriers) and life-saving care. Additionally, underlying medical conditions that increase risk for severe COVID-19 illness are more common among people from racial and ethnic minority groups. One study published in Radiology found that these groups usually are suffering from more severe COVID-19 disease when they are admitted to a hospital than non-Hispanic White people.

It is time to change the narrative by breaking down barriers

Inequality does not have to be the norm. We need more training, preventative measures, and support for practicing physicians and marginalized minorities. How do we make a difference for physicians of color? Looking at best practices, I would recommend:

• Recruiting more ethnic and racial minority students to medical practice,
• Mentoring and encouraging minority colleagues, if you are a physician of color,
• Listening to and learning from non-White doctors, If you are not a minority physician,
• Calling out racial discrimination and educating those who perpetuate it,
• Watching for burnout among minority physicians and urging clinicians to seek counseling, and
• Mandating DEI programs in medical school curricula and your practice.

If we work to reduce discrimination against doctors of color, that trend should help minority patients. What else can we do to promote greater healthcare equality? I would also suggest that we:

• Participate in local efforts to improve factors that directly affect healthcare such as housing, employment, education, transportation, and nutrition,
• Engage with and inform racial and ethnic minorities via trusted sources like community and religious organizations,
• Diversify our vendor portfolios to include minority-owned businesses, and
• See all our patients through the same lens - and provide uniform care.

The color of one’s skin should never be a death sentence or greatly impact health outcomes. I am passionate about making sure we acknowledge this and practice our profession wisely to save and improve the lives of all people.

Anton C. Bizzell, M.D., is President and Chief Executive Officer of The Bizzell Group, LLC, a strategy, consulting, and technology firm. He works to deliver data-driven, research-informed, innovative solutions to the world’s most complex healthcare challenges. Dr. Bizzell addresses a broad range of issues facing the U.S. and international communities including healthcare disparity, access, and quality, behavioral health, and substance use disorders prevention and recovery.