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Patients prefer doctors who share their same race/ethnicity

The findings underscore the need for health systems to address issues of implicit biases and to diversify the physician workforce.

Jeff Lagasse, Associate Editor

Patients who shared the same racial or ethnic background as their physician were more likely to give the maximum patient rating score, according to a new analysis of 117,589 patient surveys from 2014 to 2017. The findings, from a team of Penn Medicine researchers, were published in JAMA Network Open.

At its core, the data indicates that patients who see physicians of their own race or ethnicity are more likely to rate them higher than those who see physicians of a different ethnicity.

These findings underscore the need for health systems to address issues of implicit biases and to diversify the physician workforce, since these biases can affect healthcare delivery and ultimately lead to disparities among certain groups.

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WHAT'S THE IMPACT

In order to improve patient-centered care, health systems have made strides to both measure and publicly share patient ratings for individual physicians, sometimes linking these ratings to promotion and compensation decisions. The Press Ganey Outpatient Medical Practice Survey is one such tool used by many practices to evaluate the patient experience. 

Despite its wide use, the relationships between the patient experience and patient, physician, and clinical encounter characteristics are not completely understood, particularly when it comes to whether racial/ethnic concordance leads to higher Press Ganey scores.

To explore the relationships between race/ethnicity, as well as gender and patient experience, the research team examined 117,589 Press Ganey surveys collected following adult outpatient visits across various medical specialties within the University of Pennsylvania Health System between July 2014 and May 2017. The patients were predominantly white (81.6%), followed by Black (12.8%), Asian (3.4%) and Hispanic (2.3%).

The surveys queried patients on six domains: access, moving through the visit, nurse/assistant, care provider, personal issues and overall assessment. Patients can rate their experience in each domain, ranging from one (very poor) to five (very good). The researchers focused on the responses for the "likelihood of your recommending this care provider to others" in the care provider domain of the survey.

They found that 87.6% of physicians from racially/ethnically concordant patient-physician pairs received the maximum score for this question, while only 82.1% of physicians from discordant pairs received the maximum score.

At the level of specific patient-physician racial/ethnic pairs, among Black patients, for example, the average ratings for white physicians were 0.03 points lower than those for Black physicians. These seemingly small differences are significant, since even a 0.02 difference in the mean score could drag a physician from the 100th percentile down to the 70th percentile in terms of rankings.

Along with examining racial/ethnic concordance, the authors also investigated gender concordance as a factor that might affect the patient experience. But unlike the racial/ethnic concordance data, analyses incorporating gender did not reveal statistically significant differences in ratings.

While a valuable tool and reflection of the patient experience, there are limitations to the Press Ganey survey. In particular, it was not meant to be used to evaluate and compare individual physicians to one another.

Even so, the findings suggest that racial/ethnic concordance does in fact play a role in patient-physician interactions, and the team hopes this will generate discussion and action to improve cultural competency among all physicians so they're prepared to care for a diverse patient population.

THE LARGER TREND

A poll released in January found online physician ratings don't hold as much sway among people over the age of 50 who tend to use the most healthcare. In all, 43% of people between the ages of 50 and 80 said they had looked up a doctor online to see how others rated him or her, or what was said in their reviews. One-third of them had done so at least once in the past year.

What mattered more to older Americans than the number of stars a doctor received online? According to the poll, 61% said the wait time for an appointment was very important, and about 40% said the same about recommendations from other doctors or the physician's level of experience.

Meanwhile, a December 2019 analysis of online Yelp reviews found that while doctors, hotels and restaurants each average a 3.5 star rating out of five stars possible on the business review website, a doctor is 64% more likely to receive a five star review but 194% more likely to receive a one-star review. The data suggests that while people's experiences with doctors are distinctly polarizing, their expectations of restaurants and hotels are more nuanced.

The good news for providers, though, is that doctors' online reviews do not rate generally better or worse than other businesses. Rather, the polarizing effects of a disappointing patient experience are more dangerous to medical practices than other businesses.

And in a new study released this week, researchers from The University of Texas at Dallas investigated whether patient-generated online reviews of physicians accurately reflect the quality of care. While many patients utilize online reviews to decide which physicians they should see, some physicians have become wary of review websites, with some even filing defamation lawsuits over negative patient reviews. In short, patients tend to trust the reviews while physicians don't.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com