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?
The area of health care I am interested in is mental health care. While my undergraduate degree and research are focused on mental health care, I have not had the chance to be a clinician or observe how mental health clinicians interact with patients, and how they would contribute to health care disparities. Consequently, it is important for me to mention that any information or suggestions I come up with are anecdotal. I definitely believe that individual physicians contribute to health care disparities via several mechanisms such as their communication style, the treatment they provide, their quality of care, and more. For example, if a particular clinician intrinsically believes that ethnic minorities typically experience more severe psychological disorders and are more often than not likely to experience relapse and not adhere to treatment, those heuristics—I would imagine—would affect their quality of care and the degree of effort they put into treating patients of ethnic minorities. There is a dearth of research regarding health care disparities in mental health care. More specifically, research tends to focus on the existence and significance of health disparities, but not focusing on identifying the mechanism(s) to which such disparities exist or exploring ways to reduce those disparities. Based off of my limited experience, I think it would be crucial to study physicians’ attributions, attitudes, and thoughts regarding patients of different ethnic backgrounds. I understand that it is very difficult to attain honest responses or avoid reactivity (i.e., subjects/clinicians react in a way that they think researchers want them to) when administering self-reported surveys. Perhaps, the survey—which would be completed anonymously—could involve certain scenarios/dilemmas faced in clinical practice, and the responses (in the form of multiple choice) would give us an idea about the clinicians’ mindset/attitude towards mental health care disparities. Other research should focus on identifying the mechanisms to which health disparities exist—looking for mediators/effect modifiers that drive the association between individual clinicians and health care disparities. Organizational level research is also very important—I think the clinic/hospital itself plays a vital role in contributing to health care disparities. The organization's values, type of training/supervision, and quality of care not only affect the patients but also how the physicians deal with patients. Even if a clinician acknowledges health care disparities and genuinely wants to reduce health disparities, he/she would not be able to create an organizational change without the support of the organization itself. There is so much that could be done and a short response is not enough to do this topic justice. To sum it up, systematic monitoring and QI research/interventions would be a great way to reduce these 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?
There are various structural issues within health care delivery that effect health care disparities—I’ve listed four that I can think of:
1) Cost of health care: obtaining high quality care is expensive making it an impediment to individuals of low SES, and unfortunately this is another disadvantage to ethnic minorities who also come from a low income household (i.e., low SES).
2) Accessibility: this might be a geographical concern in a sense that health care facilities may not be available in certain neighborhoods that have a higher proportion of an ethnic minority. However, it becomes a structural issue when there are no means of getting access to high quality of care. For example, providing online support for people who cannot attend the health care facility regularly, providing some sort of transportation, figuring out ways to deliver care to such neighborhoods, etc.
3) Multicultural Competence/Training: I think multicultural training is probably one of the most difficult components of training because we cannot really tell what “multicultural competence” truly is or what the ideal training should look like. However, training in ways that help clinicians judge patients as individuals rather than social categories, and provide equal quality of care to all individuals could be helpful. The organizational mindset could truly make the biggest difference.
4) Diversity of Staff: this is also probably very difficult, but diversifying health care institutions could be a way to address health disparities or make patients feel that they belong and are represented. I cannot think of an ideal way to make that happen, but incentivizing clinicians that would practice in an area of need is one way to tackle this. Encouraging more students of ethnic minorities to study/work in health care fields is another.
When it comes to mental health care, I believe all four structural issues mentioned would definitely apply. There is a serious mental health stigma surrounding ethnic minorities, which could discourage them from seeking help in the first place. That stigma also affects the way clinicians treat such patients. Addressing the aforementioned structural issues could potentially reduce mental health disparities.