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?
Looking at the big picture, I think our structural systems do more to exacerbate and perpetuate health care disparities because our systems were not created or designed to serve the populations most disadvantaged, vulnerable, and marginalized. I believe that physicians contribute to health care disparities on the individual level, as evidenced by many implicit bias papers that have come out over the years including the paper by Chapman et al, and I also think that physicians contribute to health disparities on the macro level by working within a larger system with many structural issues that actually widen health disparities as opposed to reducing them. In my specific area of my research of addiction medicine, one major health disparity is how whites are more likely to have access to quality treatment for use disorders than POC communities (https://www.ama-assn.org/delivering-care/opioids/black-patients-less-likely-get-treatment-opioid-use-disorder, https://ucsf.idm.oclc.org/login?url=https://doi.org/10.1377/hlthaff.2011.0983).
One way to decrease this effect is ensuring that all income levels and insurance types have adequate access to medications to treat use disorders, and that they should be offered to all patients as viable options regardless of race/ethnicity. Studies could look at rates of access to care and treatment distribution throughout the country, to make sure that there were adequate pathways to addiction treatment in the highest need areas.
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?
1) Electronic patient portals and televisits - patients who are higher SES are more likely to have computers or cell phones that allow them to have increased access to their medical records and communication with their providers. This advantage is a large inequity for patients who can't afford to purchase electronic devices, especially as physicians are moving away towards "analog" forms of communication and are favoring communicating with their patients through electronic means.
2) Prescription labels not provided in other languages - pharmacies that provide medication labels in other languages are incredibly rare, and my patients not being able to read their medicine bottles contribute to large inequities in their health literacy, their safety in their ability to take their medications accurately, and their ability to communicate with their providers on what medications they're taking when meeting new health care providers who may not have access to the patient's old records.
3) PDMPs (prescription drug monitoring programs) - PDMPs (or CURES as it's known in California) allows for tracking of all scheduled medications for patients and can be accessed not only by health care providers but also law enforcement officers without the patient's consent. This is highly concerning given patients do not have protection of their privacy around their health information and law enforcement agencies could then use this health information to target individuals with histories interacting with the criminal justice system. We've know that African American minorities are disproportionately targeted for minor drug offenses and many concerns have been raised on how PDMPs can be misused by law enforcement parties to target communities of color.
4) Insurance billing - our current insurance system is fraught with mistakes and often requires patients to make phone calls to their insurance companies to ask questions about their prior authorizations, make changes to their plan, follow up on prior bills, protest certain charges, etc. These actions require time and follow up resources which are not always abundantly available to all groups, especially less so in those with lower SES.