Race in Healthcare and Medicine: From Patient-Doctor Relations to Health Disparities

Since the death of George Floyd in May, the subject of race, racism, and race relations has been saturated in almost every conversation in America. But the topic of race doesn’t just exist in politics — in fact, race is integrated in many aspects of our lives, including healthcare.

Newly-minted physicians take an oath to treat all of their patients equally once they start practicing medicine after medical school. However, despite this, not all patients are treated equally. While most physicians are not explicitly racist and commit to treating all of their patients equally, implicit biases (subconscious prejudices) may also exist and affect a patient’s quality of care.

Being a physician means working with people from every background you can think of, at every hour of your career, for every day of your life. For a physician, the most important aspect of their career is the patient-doctor relationship. A good patient-doctor relationship consists largely of trust — trust that the physician knows their ethical responsibility to place their patients’ needs above their self-interests or obligations to others, to use sound judgment on the patients’ behalf, and to advocate for their patients’ well-being. However, according to a factorial survey analysis that analyzes African American women’s perceptions of physician trustworthiness, African Americans are documented as one of the racial/ethnic minority groups with the lowest levels of trust in physicians. It is also well-documented that there are some healthcare providers who express discrimination and prejudice, which contributes to the low trust among African Americans.

To improve the healthcare experience for African Americans, many agreed that patient-provider race concordance — that is, when the patient and provider share the same race and/or ethnicity—would be an effective solution. Studies have shown that this has been linked to higher trust, better communication, more shared medical decision making, higher satisfaction, greater use of medical care, and less perceived stigma and discrimination in the delivery of medical care. Therefore, to ensure that everyone is receiving the care they need while increasing the trust between a doctor and their patient, it is crucial to increase diversity in the pool of physicians in the United States. Fifty-six percent of all active physicians in 2018 were white and 17.1% were Asian. Meanwhile, only 5.0% of physicians were Black or African American.

One of the reasons why we don’t have such a large group of Black or African American physicians is not because few Black people want to become doctors but for another reason. Many pre-medical students can agree that the pre-med process is expensive and incredibly time-consuming, which is a dealbreaker for some initially aspiring pre-meds. However, it is most definitely a dealbreaker for those who come from disadvantaged backgrounds. For starters, if a Black/African American student from a low-income family wished to pursue the pre-med track, one of the things they must do along with the other pre-med students is to take the MCAT. The MCAT is not only expensive to take, but it is incredibly time-consuming to study for. It typically involves three months of studying and preparation for the MCAT, and not all students have the luxury of not working and staying home for three months to study. Many students already have their hands full with not just classes but also part-time jobs to make ends meet. Additionally, buying MCAT prep material and tutoring is costly.

Let’s say the student did great on his MCAT and starts applying to medical school. Each medical school varies, but typically application fees can be upwards to at least $100 for the first application and a smaller fee for each additional application afterward (if applying through AMCAS). Next, let’s say the student did well on their application and received invitations to interview. Expenses for traveling to various medical schools and finding a place to stay at need to be considered, as well. Finally, let’s say he did well in his interviews and got into medical school. The student will most likely have to take out thousands of dollars of loans to pay for his schooling. On top of the mental burden he has to go through when studying for his classes and the MCAT, the pre-med process adds an additional financial burden that disproportionately affects those coming from a low-income background, many of which are minorities.

Statistics show that in terms of health conditions, African Americans often get the short end of the stick. African Americans have the highest mortality rate for all cancers combined compared with any other racial and ethnic group. Additionally, for every 1000 live births among Black Americans, there are 11 infant deaths—this is almost twice the national average of 5.8 infant deaths per 1000 live births. These statistics are not caused by chance nor biology—socioeconomic and political factors play a part in one’s way of living and thus their well-being.

Explicit racism and implicit biases are not the only forms of racism to play in the healthcare system. Systemic racism is also a large contributor to the existence of health disparities in society and unethical treatment, especially among minorities. Racism was (and in some parts, still is) institutionalized in a way that permits the establishment of practices and policies in healthcare that consistently penalizes people because of their race, color, culture, or ethnic origin. Historically, the U.S. government legalized and engaged in legalized segregation and discrimination of patients based on race and ethnicity. While they are no longer legal today, their repercussions still persist, leading to inequities in access to and quality of healthcare that result in racial and ethnic health disparities. Additionally, some organizations discriminate based on insurance status. Knowing that a large majority of those in poverty—who usually cannot afford the expensive premiums of privatized health insurance—consist of non-white populations, this further drives the health disparities that already exist.

There are also social and economic factors in which racism affects that may also indirectly affect healthcare. For example, healthy food and water, livable wages, health insurance, and quality education are some of the things many minorities have little access to. Having livable wages would provide access to clean water and healthy food, both of which contribute to our health. Having livable wages will also allow you pay for health insurance, which increases access to quality healthcare by protecting you from unexpected, high medical costs and allowing you to receive affordable to free preventative care such as vaccines, and screenings. For those who have existing conditions that may be serious, having health insurance is even more important because you can visit the doctor more frequently for preventative services without worrying about high costs, and you can be treated sooner rather than later and prevent the condition from worsening simply because you are unable to pay for it.

There is much work left needed to be done to increase access to quality healthcare and improving the lives and well-beings of our Black and African American citizens. Through continued education and advocacy, we can make the progress necessary to increase equity and decrease the health disparities present in our nation.