1) How do individual physicians contribute to health care disparities? Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?
Individual physicians can contribute to health care disparities in a number of ways. I am particularly interested in recommended follow-up for radiology examinations and possible disparities among different demographic groups related to age, gender, race/ethnicity, and neighborhood socioeconomic status, among other factors. There are a number of different opportunities where conscious or unconscious bias can affect the successful execution of a follow-up recommendation. These include 1) radiologist perceptions toward the patient which may be influenced by the “sound” of the patient’s name, health insurance status, neighborhood socioeconomic status, referring clinician relationship, and/or “VIP status” and 2) similar perceptions of referring clinicians tasked with communicating the need for an additional exam to the patient. I am interested in pursuing research evaluating differences in reporting of follow-up recommendations (for the same types of lesions) and execution of follow-up recommendations (time to event) which may be related to social determinants. Once these social determinants and the specific type of follow-up recommendations are identified, interventions can be designed to intervene on the particular patient-clinician-radiologist axes that may be most prone to health disparities.
2) Structural issues within health care delivery are implicated in health care disparities. Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?
Health insurance status: There are wide differences in what imaging tests insurance companies are willing to pay for and this may directly contribute to disparities among patients in terms of the scheduling and completion of a follow-up radiology examination. Health care is complex and if the suggested imaging follow-up doesn’t fall perfectly into a pre-determined algorithm, patients with lesser levels of coverage are more likely to be unable to obtain the suggested follow-up studies.
Neighborhood socioeconomic status: Neighborhood socioeconomic status affects a number of key factors allowing successful interaction with the health care system both with respect to distance to clinics and imaging facilities as well as social support for leaving work or making arrangements for childcare in order to successfully be able to attend follow-up appointments.
Language barriers: While access to language translation has improved in many sectors of the health care system in recent years, persistent gaps can create problems, particularly for non-standardized communications such as communications of the need for follow-up radiology examinations.
Cultural barriers: Longstanding mistrust of the health care system in a variety of communities may contribute to patients being less likely to adhere to follow-up recommendations and perhaps differences in understanding of the clinical significance of the reason for the suggested exam.