Half of Healthcare Staff Report Racism & Discrimination Against Patients

Nearly half of healthcare providers have borne witness to healthcare discrimination, doubling down on a patient experience and health equity problem that’s shown to impact patients of color and folks with limited English proficiency, according to a survey from the Commonwealth Fund.

The survey, completed in partnership with the African American Research Collaborative, showed that 47 percent of healthcare providers have seen their patients be discriminated against inside their facility. Another 52 percent of respondents said healthcare discrimination and racism against patients is a major problem or crisis for the industry.

“The study shines a light on the discrimination and racism health care workers observe and the implications for negative health outcomes of patients in many communities,” Henry Fernandez, CEO of AARC and the report’s lead author, said in a statement. “Understanding this connection at a national level is critical to measuring and addressing discrimination in the health care system to mitigate harm to patients and produce better health outcomes overall.”

As the medical industry has turned its attention toward health equity, the question of racism and discrimination has come front and center. Structural racism is at the heart of many of the nation’s deepest health disparities, most experts agree, but interpersonal racism, discrimination, and implicit bias also taint outcomes and experiences for racial minorities and folks with LEP.

Separate studies have found that racism and discrimination are prevalent in the healthcare industry. Numerous patient surveys have shown that racism is common in the medical setting, with a December 2023 KFF report showing that Black, Hispanic, American Indian/Alaska Native (AI/AN), and Asian people are more likely to report discrimination than their White counterparts.

Overall, 18 percent of Black people, 11 percent of Hispanic people, 12 percent of AI/AN people, and 10 percent of Asian people said they were treated unfairly or disrespected by a healthcare provider due to their race in the past three years. This compares to just 3 percent of White people who said the same.

This latest survey from the Commonwealth Fund and AARC used qualitative and quantitative research strategies to gather the provider perspective on racism in the medical setting. In particular, the researchers asked six focus groups of healthcare providers and surveyed 3,000 healthcare workers about how often they see patients discriminated against in their facilities.

The results were staggering.

Around half of respondents said racism against patients is a major problem (33 percent) or a crisis (19 percent) for the industry. Only 18 percent said it’s not a problem at all. Another 47 percent said they’ve witnessed discrimination against patients inside the healthcare facility.

Healthcare workers said discrimination is mostly against Black patients (70 percent), while 61 percent said racism is mostly against Latino patients. Fewer (43 percent) said they’ve witnessed discrimination primarily against White patients. Half said they’ve seen discrimination but not against a particular racial majority.

Broken down further, healthcare provider respondents said they think patients of different races or ethnicities can receive different interpersonal treatment from their providers. For example, 48 percent of healthcare workers said they think providers might be more accepting of White patients advocating for themselves than Black patients. For Black respondents, that figure was 68 percent.

“[For] the non-person of color, it is seen as advocating for themselves . . . and wanting the care they deserve, whereas a person of color doing that is seen as aggressive or belligerent,” one Black male doctor told the researchers in qualitative interview.

And it’s not just discrimination based on race. Provider respondents also reported seeing healthcare discrimination based on language.

More than half (57 percent) of respondents said patients who speak a language other than English may not always get the same level of treatment from healthcare providers as English-speaking patients do. For Latino respondents, that figure was 72 percent.

“Some physicians won’t take the time to really explain things to the Spanish population the way that they should,” a Latina nurse from a Florida hospital stated.

Witnessing racism in the medical setting is proving not just distressing for patients, many of whom develop a distrust of medical institutions and can disengage from care as a result of racism, but also for the providers themselves.

Nearly half (47 percent) of all healthcare provider respondents said they experience some or a lot of stress because of racial and ethnic discrimination in healthcare. Stress was more common for providers practicing at facilities with more Black (65 percent report stress) and Latino (73 percent report stress) patients.

Of note were the generational differences in reports of racism and discrimination against patients, the researchers said. Younger healthcare workers were more likely than their older peers to say they’ve witnessed racism or discrimination against patients. This is a key area for further research, the team said.

Moving forward, healthcare organizations need to build out better, anonymous reporting structures for providers and patients to report instances of racism. This can be fortified by staff training in spotting discrimination.

Embedding cultural competence courses and classes about racism at the medical school level and creating peer learning opportunities will also be crucial, the researchers advised.

“If we are going to build truly equitable health care systems, we have to start by listening to voices of those on the front lines,” Laurie C. Zephyrin, MD, senior vice president for Advancing Health Equity at the Commonwealth Fund and report coauthor, said in a statement.

“Understanding what health care workers are experiencing, and what they want and need from their employers and colleagues to address discrimination, is critical to successful and sustainable change.”