The Predictors of Patient–Physician Race and Ethnic Concordance: A Medical Facility Fixed-Effects Approach

Affirmative action programs and other recruitment and retention efforts in health care may reduce disparities by allowing more patients to have access to medical professionals from similar linguistic and cultural backgrounds (Saha et al. 2000). Currently, African Americans and Hispanics make up 25 percent of the U.S. population, but only 6 percent of the physician workforce (Cooper et al. 2006). Owing to the low proportion of underrepresented physicians, African American and Hispanic patients are more likely than white patients to be treated by a physician from a dissimilar racial or ethnic background. While race is a social and political construction, that is, racial categorization is not based on biological differences between groups but on continually changing and contextual relationships between groups, it is widely documented that unequal treatment stemming from physician uncertainty or bias and linguistic and cultural barriers may negatively influence health outcomes for patients of color (van Ryn 2002; Smedley et al. 2003;). Increasing opportunities for racial/ethnic match between minority patients and physicians can have important consequences. Studies have found that minority patients in race/ethnic concordant relationships are more likely to use needed health services, are less likely to postpone or delay seeking care, and report a higher volume of use of health services (Saha et al. 2000; LaVeist and Nuru-Jeter 2002;). Patients in race concordant patient–provider relationships also report greater satisfaction (LaVeist and Nuru-Jeter 2002) and better patient–provider communication (Cooper-Patrick et al. 1999; Cooper et al. 2006;). Studies on patient preferences for a same race/ethnicity physician have found that African American and Hispanic patients who have a choice are more likely to choose a same-race physician. Not surprisingly, patients who report that their choice in physician is influenced by race or ethnicity are more likely to be in concordant relationships (Saha et al. 2000; Laveist and Nuru-Jeter 2002;). Blacks and Hispanics with strong beliefs about racial discrimination in health care are also more likely to prefer a race/ethnic concordant physician (Chen et al. 2005). Patients are not the only actors influencing disproportionate racial match for minority patients. Minority physicians often locate their practices in neighborhoods with larger minority populations and disproportionately care for disadvantaged patients with worse health and lower socioeconomic status (Moy and Bartman 1997). Few previous studies have examined the influence of medical facility workforce diversity on patient–physician race concordance or have focused on patients with chronic illnesses. Arguably, the predictors of concordance might differ in acute versus chronic care. This paper builds on previous research on patient–physician racial match by examining whether patients who choose their physicians are more likely to have a same-race/ethnicity physician after controlling for medical facility racial and ethnic diversity of the physician workforce. We also examine the association between patient language, socioeconomic and health status, and patient–physician concordance. Unlike previous studies, we conducted a series of race stratified logistic regression models that account for geographic and medical facility factors by including the medical facility where a patient receives care as a fixed effect.