Separate and Unequal
Disparities in nearly all aspects of health care received by minorities versus nonminorities in the United States are well documented. Because the majority of care for minority patients is provided by a relatively small number of clinics, the authors examined characteristics of primary-care clinics whose clientele is primarily minorities. In order to compare such clinics with comparable clinics serving mostly nonminorities, the authors used cross-sectional data from surveys of 96 clinic managers, 388 primary care physicians, and 1,701 adult patients with hypertension, diabetes mellitus, or congestive heart failure. These data were part of the Minimizing Error, Maximizing Outcome (MEMO) study. Of the 96 clinics examined, 27 clinics had at least 30 percent minority patients and 69 had less than 30 percent minority patients.
The authors' hypothesis that clinics serving more minorities would have more challenging working environments was supported. For example, physicians from clinics with at least 30 percent minority patients reported less access to medical supplies and to referral specialists than physicians from the other clinics, as well as worse access to pharmacy services, fewer patient examination rooms per physician, and limited availability of written educational materials for patients with hypertension and congestive heart failure. No significant differences were found between the two types of clinics as far as telephone access, follow-up appointments, electronic medical records, patient registration procedures, test and diagnostic imaging scheduling, and several other care factors. Physicians from the high-minority clinics were more likely to be female, four times as likely to report a chaotic workplace, were more likely to report having patients with substance-abuse problems, and were half as likely to report high job satisfaction.
Results of this study have implications for formation of national policies to address health disparities. These data suggest that the work environment itself can contribute to disparities, by contributing to physician burnout and frustration. In addition, surveys showed that physicians in high-minority clinics reported more patients with complex medical and psychosocial issues. Attention to issues specific to women physicians may play an important role in addressing issues arising at clinics that serve a high proportion of minority patients.