Texas Tech agreement to abandon race in med school admissions will worsen health disparities
This article was originally published by STAT on April 25, 2019. Interested in staying up to date with J-PAL North America and the Health Care Delivery Initiative? Sign up for our monthly newsletters here.
A recent agreement between the medical school of Texas Tech University Health Sciences Center and the Trump administration that forces the school to stop considering race as a factor in its admissions processes is a step backward for improving health care in the United States.
The agreement ends a 14-year investigation by the U.S. Department of Education’s Office for Civil Rights into the university’s use of race in admissions. It represents a sharp reversal to the university’s holistic applicant review process, which includes the consideration of race and ethnicity. The agreement is, however, consistent with the current administration’s advocacy of “race-neutral” admission policies as well as its efforts to rescind Obama-era policies on affirmative action.
It is the first agreement between the Trump administration and a school to stop using race as an admissions factor, and comes as new research shows that greater minority representation in medicine can improve health for African-Americans.
While the Texas Tech agreement focuses on medical school admissions, we were interested as researchers and physicians in what happens further downstream: Does a more diverse physician workforce affect patient health?
That question is motivated by policy statements from leading medical organizations such as the American Medical Association, the Association of American Medical Colleges, and the National Academies of Medicine that call for an increase in the number of minority physicians to better reflect the U.S. population and potentially reduce health disparities. Doctors with similar backgrounds to those they serve might be more efficient at building trust and communicating with patients — crucial components to medical care. Yet only around 4% of U.S. physicians are African-American even though this group accounts for 13% of the U.S. population. The gap is even wider for Hispanics, who make up 4% of physicians and 18% of the U.S. population.
With our co-author, Grant Graziani, we designed a study to test whether increasing representation among minority physicians would improve health for minority patients, focusing on the U.S. demographic group with the lowest life expectancy: African-American men.
To do this, we conducted a community-based, randomized controlled trial that recruited more than 1,300 African-American men from local barbershops and flea markets to attend a free clinic we set up in Oakland, Calif. When participants checked into the clinic, they were randomly assigned to see a male doctor who was African-American or non-African-American (white or Asian).
After meeting with the doctor, participants randomly assigned to see African-American doctors were much more likely to take up preventive services, especially those that involved a more invasive procedure like a finger prick for a blood sample or an injection. For instance, there was a 49% increase in blood tests to screen for diabetes and a 71% increase in cholesterol testing among participants paired with a doctor of the same race.
Better communication was the primary driver of the results. During clinic encounters, participants were more likely to discuss their health problems with an African-American doctor, and African-American doctors were more likely to write detailed notes about their patients.
There was no evidence of discrimination by either participants or doctors, something the study was designed to detect. For example, participants selected a similar number of screening tests after seeing photos of their doctor. It was only after in-person consultations that those assigned to African-American physicians chose to have more services. Moreover, patient feedback was consistently positive no matter the race of the physician.
Based on our results and mortality rates from the Centers for Disease Control and Prevention, we calculated that increasing the supply of minority physicians has the potential to reduce the number of African-American men dying from cardiovascular disease by 19%. This is particularly important because cardiovascular disease is responsible for nearly half of the five-year life-expectancy gap between non-Hispanic black and white men.
Profound health disparities exist in the U.S. for many reasons, ranging from lack of insurance to differences in behavioral and environmental risk factors and unequal early life circumstances. Our study shows that increasing the representation of American-Americans in the physician workforce should be included as an evidence-based approach to close these gaps in health outcomes.
More young people of color should be encouraged to pursue the field of medicine. Policies designed to increase diversity in the physician workforce should be protected, not dismantled.
Marcella Alsan, M.D., is an associate professor of medicine and (by courtesy) of economics at Stanford University. Owen Garrick, M.D., is CEO of Bridge Clinical Research, which aims to diversify clinical trials.
This is the fourth post in our five-part blog series on the J-PAL North America Health Care Delivery Initiative (HCDI). The first post shares reflections from Amy Finkelstein, J-PAL North America Co-Scientific Director and HCDI Chair, on the role of RCTs in US health care delivery. The second post highlights results from rigorous research on workplace wellness programs and discusses why we should be skeptical of their impact. The third post explores results from an evaluation testing whether a doctor’s race affects black men’s demand for preventive health services. Stay tuned for a final post on Friday on an RCT that is informing critical policy decisions at scale.