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 providers and other clinicians may contribute to healthcare disparities by attributing (often unconscious) negative group stereotypes to individual patients, and by implicitly drawing on these stereotypes in their clinical decision-making processes. As Chapman et al. describe, such implicit biases may be present even in the absence of explicit or consciously held biases or stereotyping beliefs, and can exist along lines of race/ethnicity, age, gender, weight, and other dimensions of discrimination. As demonstrated by various studies that Chapman et al. review, implicit bias correlates with unequal treatment, which can perpetuate disparities in healthcare and health outcomes.
Recruitment programs designed to draw practicing providers or health professions students to rural practice have received considerable attention as one possible means to redress rural shortages of healthcare professionals. In contrast to “grow your own” initiatives, which recruit high schoolers or college graduates who grew up in rural areas for healthcare professions training, general recruitment programs draw from diverse geographical backgrounds. Many rural recruitment programs are relatively new, so outcomes research is in early phases. Outcomes measures have focused on number of healthcare professionals recruited to rural areas, number of years practicing in rural areas after recruitment, and, occasionally, healthcare professionals’ satisfaction with rural practice. As recently as one year ago, there was no outcomes research on healthcare quality or patient satisfaction with care when providers from diverse geographical backgrounds are recruited to practice with rural populations. Other research has demonstrated an urban-rural bias, where rural populations are perceived more negatively than their urban counterparts on a number of characteristics, including some that are pertinent to health behaviors. With the increasing emphasis on rural recruitment programs and the existing literature on implicit bias and healthcare provision, it will be important moving forward to understand if, and how, providers from non-rural geographic backgrounds differ in their attitudes toward rural patient populations, compared to providers from rural 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?
Structural issues in healthcare delivery include amount and type of health insurance coverage; provider-patient or provider-population ratio; availability and distribution of medical technologies; and the number and proximity of hospitals. In rural healthcare delivery, structural factors are typically related to access/availability and quality, and rural healthcare systems are often negatively impacted by multiple structural elements. Looking at healthcare availability in rural areas, research has identified patient-provider ratio and hospital closures as key structural factors in rural health and healthcare disparities.