This caveat in the discussion highlights an important area of policy and research for the impact of structural racism:

> We also acknowledge that we did not explore the site of care where these patients received their surgeries given that previous investigators have shown that minority patients tend to receive care in low-quality, minority-serving hospitals. Site of care is a critical variable that appears to mediate the pathway of the association of race with postoperative morbidity and mortality. Unfortunately, the [National Surgical Quality
Improvement Program-Pediatrics] program strongly discourages attempts to identify specific hospitals in the database. Given that site of care is an important potentially modifiable variable and the established
knowledge that disparities in surgical care is a pervasive and long-standing problem in our health care system, improving access to high-quality care across every hospital is an important step to reduce the persistent racial disparity in health outcomes in
the US.

But let's not forget that many American doctors, individually, are despicable racists who treat black children worse than animals[1]:

> An estimated 0.94 (95% CI, 0.78-1.10) million children were diagnosed as having appendicitis. Of those, 56.8% (95% CI, 49.8%-63.9%) received analgesia of any type; 41.3% (95% CI, 33.7%-48.9%) received opioid analgesia (20.7% [95% CI, 5.3%-36.0%] of black patients vs 43.1% [95% CI, 34.6%-51.4%] of white patients). When stratified by pain score and adjusted for ethnicity, black patients with moderate pain were less likely to receive any analgesia than white patients (adjusted odds ratio = 0.1 [95% CI, 0.02-0.8]). Among those with severe pain, black patients were less likely to receive opioids than white patients (adjusted odds ratio = 0.2 [95% CI, 0.06-0.9]). In a multivariable model, there were no significant differences in the overall rate of analgesia administration by race. However, black patients received opioid analgesia significantly less frequently than white patients (12.2% [95% CI, 0.1%-35.2%] vs 33.9% [95% CI, 0.6%-74.9%], respectively; adjusted odds ratio = 0.2 [95% CI, 0.06-0.8]).

And that many American doctors are plain racist cranks[2]:

> Study 2 demonstrates that, similar to white laypersons in study 1, many white medical students and residents hold beliefs about biological differences between blacks and whites, many of which are false and fantastical in nature, and that these false beliefs are related to racial bias in pain perception. Furthermore, study 2 also reveals that white medical students and residents who endorsed false beliefs showed racial bias in the accuracy of their pain treatment recommendations. Specifically, participants who endorsed more of these beliefs reported that a black (vs. white) target patient would feel less pain and they were less accurate in their treatment recommendations for the black (vs. white) patient. Although the effect sizes for these findings were not large (η2p = 0.03 and 0.04), the practical importance is significant: those endorsing more false beliefs rated the pain of a black (vs. white) patient half a scale point lower and were less accurate in their treatment recommendations 15% of the time.

[1] https://jamanetwork.com/journals/jamapediatrics/article-abst...
[2] https://www.pnas.org/content/113/16/4296