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?
I did a study at the beginning of medical school with an economist in which we looked at length of stay for patients based on race at 5 different hospitals in the US. There was little difference between groups based on length of stay. However, when we then controlled for patient preference, we saw that patients who were white and wanted to stay, got to stay; whereas patients who were self-identified as black or Hispanic, did not get to stay when they wanted to stay an extra day. We controlled for insurance status and commodities. What it came down to was physician bias and institutional racism: providers were just able to hear the preferences of white people more than blacks in our study. It could be that providers also were worried that their patients of color might get charged for an extra day—we could not test for this. But, either way, the assumptions about their patients by race played into differential treatment based on race. I think similar studies like this can be done to understand the effect of individual physicians on health disparities. One could also look at race concordance rather than just the individual physician and see how bias changes based on race concordance.
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?
Structural issues that contribute to disparities are race concordance of provider and patient, financial access to health care resources that differ by race, how health literacy and language differ and hospital locations and access. In terms of access to family planning and abortion, all of these issues play out. Given how stigmatizing family planning and abortion services are, it is important that patients have trust their providers and feel as if their providers can understand and support them. Trust and feeling heard and understood has been shown to increase with racial concordance. Additionally, we know that hospitals and clinics that offer services need to be accessible, but if they are not located in the places where people live (like in the south), then geography ends up driving access. In terms of health literacy and language, people will not be able to understand how to take their medicines or use their contraception if they are not able to understand the labels or their providers or be able to access internet or other methods of learning about reproductive health. Finally, there are only some states that cover abortion with Medicaid dollars. This limits who can access abortion services and family planning services. Since race intersects with financial wealth, this also affects some people being able to access family planning and abortion services and others not having the ability to access them.