About three-quarters of White patients have access to a doctor of the same race, but only one in five Black patients can say the same, a medical workforce diversity trend that researchers from the Urban Institute said is hampering health equity efforts.

This comes as separate research indicates that visiting with a provider of the same race can improve patient experience, particularly for patients of color. A lengthy history of maltreatment for populations of color, as well as implicit bias and denial of patient pain and experience has resulted in limited patient trust among Black and Brown people, the researchers said.

“Perceptions of a shared identity between patients and their health care providers could be one way to improve the patient-provider relationship and foster trust and better communication,” the researchers wrote.

Particularly, the researchers cited studies indicating racial and language concurrence between patient and provider can improve patient access to and engagement in care, better patient experience scores, and better patient reports of clinical quality.

But that ideal of patient-provider racial concordance isn’t usually happening, at least for racial and ethnic minorities. While 73.8 percent of White patients said they are the same race as their healthcare providers, only 22.2 percent of Black patients said the same. About a third (34.4 percent) of patients of other races said they are also the same race as their healthcare providers.

For Latino patients, having a provider who’s both the same race and speaks the same language is also a rarity. About a quarter of Latino patients said they are the same race as their provider, and 29 percent said they’re the same ethnicity. It’s even harder for Latino patients to see a provider who speaks the same language; 23.1 percent said they have a clinician who is the same race/ethnicity and who speaks to them in their preferred language.

That language concordance has a tangible through line to patient experience and outcomes. Patients who do not speak English as their preferred language may experience limited health literacy and have healthcare navigation challenges. November 2020 research found that patients who speak Spanish as their preferred language said the patient intake process was hard, and other said they have to feign understanding of medical concepts.

None of that is conducive to a positive patient experience of good clinical outcomes, experts agree.

Limited language and racial concordance could be due to a vastly under-diversified healthcare workforce, a problem which stems back to medical education, the researchers said. It wasn’t until 1964 that Black people could gain admission to predominantly White medical schools, making it hard for them to pursue their MDs and creating a largely non-Hispanic White workforce.

And today, the high cost of tuition, access to undergraduate education and prerequisite, and limited guidance and support during the admissions process also serve as barriers to medical school. That lack of diversity also expands to other clinicians, like nurses, nurse practitioners, and physician assistants.

“Diversifying the teams who facilitate or provide care to people of color and patients with limited English proficiency could further improve culturally and linguistically effective care,” the researchers wrote. “Given the greater diversity among health care technicians and support staff, such as medical assistants, providing more pathways for these professionals to obtain medical degrees or other advanced training could be an efficient way to diversify the physician workforce.”

Building up a diverse medical workforce cannot happen overnight, the researchers acknowledged, but near-term changes can help promote equity today. Emphasizing health equity and cultural competency may improve patient experiences even when racial concordance cannot be attained, the researchers said.

Additionally, expanding access to credible interpretive services—not relying on family members for interpretation—can support patients with limited English proficiency.

“Stronger enforcement of language access regulations and higher reimbursement for medical interpretation services by health insurance payers could improve language access in health care,” the researchers recommended.

“Improving multilingual capabilities among health care workers is another way to bridge language gaps,” the researchers added in conclusion. “Although some medical schools recommend students be fluent in a language other than English, making this a requirement or a heavily positively weighted factor for medical school admissions could also help diversify the languages spoken in the health care workforce.”

Source: PatientEngagementHIT