Racial/ethnic disparities in primary care: the role of physician-patient concordance

Abstract

Background: Research suggests that racial/ethnic concordance (matching) between patients and physicians improves quality of care for minority patients by reducing discrimination in the clinical encounter.

Objective: Examine the impacts of patient and physician race/ethnicity, and racial/ethnic concordance, on primary care outcomes including blood pressure, tobacco use, and cholesterol screening and tobacco use counseling.

Research design: Multivariate regression analysis of 8160 visits by white and minority patients to 661 primary care physicians using the 2001 to 2003 National Ambulatory Medical Care Survey. I estimated models based on physicians who see both white and minority patients and include physician fixed-effects to correctly measure the contribution of concordance.

Results: Conditional on accessing a primary care physician, patient race does not explain differences in rates of these guideline-recommended preventive screenings. Concordance is generally not an important predictor of outcomes, though it is associated with rates of cholesterol screening 2 to 3 times higher among black and Hispanic men compared with whites. In contrast, practice patterns vary quite markedly by physicians' race/ethnicity.

Conclusions: Given that physician race is a more powerful predictor of preventive screening than patient-physician concordance, minority patients may receive some guideline-recommended care at lower rates in concordant pairs. Addressing physician education and training to ensure practice that is consistent with preventive care guidelines may be important. Forms of discrimination in the clinical encounter thought to be modified by concordance do not appear to drive disparities in these outcomes.