Patient Experience Better When Patients Visit Docs of Same Race

Patient experience scores tend to be at their highest when patients visit a physician who is the same race as they are, underscoring one way race plays a factor in patient experience, according to researchers out of the Perelman School of Medicine at the University of Pennsylvania.

The study findings, reported in JAMA Network Open, also highlight a need for health systems to address racial implicit bias in medical settings, the study authors concluded.

“What it comes down to is that patients who see physicians of their own race or ethnicity are more likely to rate their physicians higher than patients who see physicians of a different race or ethnicity,” study corresponding author Junko Takeshita, MD, PhD, MSCE, an assistant professor of Dermatology and Epidemiology in the Perelman School of Medicine at the University of Pennsylvania, said in a statement.

The researchers looked at just under 120,000 patient experience survey scores for an urban academic medical center, zeroing in specifically on the “likelihood to recommend” domain. The survey asks patient respondents to rate each domain on a five-point scale, with one representing little likelihood to recommend a provider to family or friends and a five representing high likelihood to recommend.

The researchers then stratified each survey by patient-provider racial dyad, or whether patients and providers were of the same race or not.

By and large, patients were more likely to give providers of the same race a five on the “likelihood to recommend” scale than providers who were of a discordant race. Just about 86 percent of physicians in a concordant patient-provider racial dyad received top marks in this domain, compared to only 82 percent of physicians in a discordant patient-provider racial dyad.

White patients were the most likely to give their physicians the highest “likelihood to recommend” score regardless of physician race, the researchers found. Other racial demographics, however, showed preference for physicians who were of the same race.

Among Black patients, for example, the average rating for White physicians was 0.03 points lower than it was for Black physicians. In other words, Black patients were more likely to report a better experience when visiting another Black physician.

And that slight difference—0.03 points—could have an enormous impact, Takeshita explained.

“Even a 0.02 difference in the mean score for the Press Ganey survey could take a physician from the 100th percentile down to the 70th percentile in terms of rankings,” Takeshita said.

This study did not specifically look into why patient experience scores for concordant patient-provider racial dyads were higher than for discordant ones, but there are a few possible explanations. As noted above, these study results give credence to anecdotal evidence stating that Black patients are more comfortable visiting with another Black provider, for example.

“Our study lends further support to the clinical benefits that others have found to be associated with racially/ethnically concordant patient-physician interactions,” the research team explained. “These benefits include better patient-physician communication, patient care, and outcomes and have been suggested to be attributable to decreased bias between patients and physicians.”

The study results may also be indicative of the racial implicit bias Black patients experience in healthcare. While their White counterparts do not experience that implicit bias—and may be less likely to give poor experience score—Black patients may experience bias that translates into a poor patient experience score.

“In a healthcare setting, racial and ethnic biases can affect health care delivery and ultimately, lead to health disparities,” Takeshita said.

What’s more, these study results could serve as a warning for healthcare organizations that lean to heavily on patient experience scores for assessing and in some cases rewarding or compensating physicians.

Physicians who see more White patients, for example, will be more likely to see high experience scores. And Black physicians, when removing scores from other Black patients, are less likely to see high patient experience scores.

“Although these patterns may reflect truly different patient experiences, they also raise the possibility that there are racial/ethnic differences in patient expectations of or biases toward their physicians that may influence PG scores,” the researchers said.

Ultimately, these findings add to the literature suggesting that cultural competency and efforts to address implicit bias in healthcare are essential to quelling health disparities. Part of those efforts, the Penn Medicine researchers concluded, should include employing clinicians and physicians of all races and cultures.