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, like all individuals, have their own implicit bias. As noted in the “Hidden Curriculum” article, there is also explicit bias taught within medical curriculum, which can be further propagated by individuals’ biases. As a family medicine physician, and interested in how we can address social needs within health care settings, I am very interested in how we can screen patients for social needs (including how to make patients more comfortable disclosing need), and characteristics of patients currently getting assistance with social needs in clinics (are the patients who are getting assistance being better identified as having a need, more willing to accept assistance, more likely to be screened?). One can imagine that provider level, clinic level, as well as patient level bias can all contribute to whether or not a patient gets screened for social needs or accepts assistance. Figuring out best practices for screening people for social needs, and how best to do so in different contexts and in different patient populations, and then how best to deliver assistance, is highly interesting and important (my bias).
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?
4 structural issues that may contribute to disparities include: transportation/proximity to hospital/specialty care; scheduling; insurance; language/interpreter access. For transportation or proximity to hospital/specialty care, ease of getting to/from appointments and ability to get to referrals/specialists or hospitals (aside from clinic itself) can lead to and exacerbate health care disparities. If clinics are isolated, difficult to get to, and/or unable to assist patients with transportation, lower income patients may be less able to make it to appointments (or less reliably able to make it on time), and their care may suffer. If the clinic needs to outsource specialty care/is not near the hospital, that can provide an added barrier to comprehensive care to patients in need, and disproportionately burden lower income/vulnerable patients, creating more of a gap between those able to afford transportation and those unable. For scheduling, if clinics have inflexible hours, patients working multiple jobs or needing childcare will have increased burden compared to those with more flexible schedules. Clinics that do not allow patients to schedule their own appointments and mail patients’ info about their appointments, without any advance notice or patient input, can create further barriers for patients to access timely/patient-centered care. Clinics that rely on electronic scheduling/texting, can create disparities for patients without access to/familiarity with advanced technologies. Patients who are not informed/savvy about advocating for their rights, may get lost to care, and judged/blamed for missing appointments/not following up, when the system itself is putting them at a disadvantage. Clinics that have more flexibility for drop-in visits, easier to schedule 3rd next available appointments, and with more flexible hours, can help reduce scheduling practices that can exacerbate/cause disparities. The insurance system itself is hugely problematic, dictating what kinds of care/medication/referrals some patients can access more easily than others, creating unfair disadvantages/barriers to patients with less desirable insurance (or no insurance). Health care systems that work to increase insurance coverage and assist patients/providers with navigating the insurance systems can help alleviate some of the burden, but more should be done to ensure equal access to care and coverage of necessary treatments (without the burden of prior authorizations and high co-pays). For language, inadequate access to adequate interpreter services can put non-English speaking patients at a disadvantage, limiting their ability to high quality health care. All of the above are relevant to my area of research, as they all impact access to care and ability to engage patients within the health care system (which impacts ability to screen/deliver social services).