Do Religious Physicians Disproportionately Care for the Underserved?

Abstract

PURPOSE Religious traditions call their members to care for the poor and marginalized, yet no study has examined whether physicians' religious characteristics are associated with practice among the underserved. This study examines whether physicians' self-reported religious characteristics and sense of calling in their work are associated with practice among the underserved.METHODS This study entailed a cross-sectional survey by mail of a stratifi ed random sample of 2,000 practicing US physicians from all specialties. RESULTSThe response rate was 63%. Twenty-six percent of US physicians reported that their patient populations are considered underserved. Physicians who were more likely to report practice among the underserved included those who were highly spiritual (multivariate odds ratio [OR] = 1.7; 95% confi dence interval [CI], 1.1-2.7], those who strongly agreed that their religious beliefs infl uenced their practice of medicine (OR = 1.6; 95% CI, 1.1-2.5), and those who strongly agreed that the family in which they were raised emphasized service to the poor (OR = 1.7; 95% CI, 1.0-2.7). Physicians who were more religious in general, as measured by intrinsic religiosity or frequency of attendance at religious services, were much more likely to conceive of the practice of medicine as a calling but not more likely to report practice among the underserved.CONCLUSIONS Physicians who are more religious do not appear to disproportionately care for the underserved. INTRODUCTIONC odes of medical ethics have called physicians to care for the poor for centuries, from the birth of the Hippocratic tradition in ancient Greece, 1 through the middle ages in Europe, 2 and into modern America. 3 In spite of such ongoing moral exhortation, many poor patients and communities continue to be medically underserved. [4][5][6][7][8][9] Physicians have compelling reasons to avoid practicing among the poor. Physicians who choose to work in underserved settings often forgo academic opportunities, professional prestige, 7 and free time, 10 and accept reduced salaries, diminished control over the work environment, 4 and increased bureaucratic interference. 10 These and other extrinsic 11,12 and objective 13 workplace characteristics diminish the appeal of underserved settings.Although the poor are underserved, they are not unserved; many physicians choose to practice in underserved settings. Those who do tend to identify intrinsic and intangible rewards of their work, such as making a difference in society, having a positive impact on the lives of patients who are otherwise marginalized, and living in a way congruent with their personal hopes and aspirations. 10,14 These subjective rewards express ways in which physicians may relate to their work among the underserved more as a calling than as a job. R EL IGIOUS PHY SICIA NS A ND T HE UNDER SERV EDThe concept of calling is currently used in the work literature to refer broadly to work done with a sense of inner direction and aimed at improving the world. 13,15 In the words of...

The NERSH International Collaboration on Values, Spirituality and Religion in Medicine: Development of Questionnaire, Description of Data Pool, and Overview of Pool Publications

“…[3] Those physicians who were highly spiritual, who agreed that their religious beliefs influenced their practice of medicine, or who were raised in a family emphasizing needs of the poor were significantly more likely to report practice among the undeserved; those who were more religious were more likely to view their medical practice as a calling, but they were not more likely to practice among the undeserved.…”

“…This article describes the development, contents, and first cross national comparisons based on an international research tool, first developed in 2002 and executed in 2003 with subsequent publications [1][2][3][4][5][6][7][8][9][10], translated into seven languages [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] and optimized in 2013. The data document the impact of Health Professionals' (HPs') religious and secular beliefs and values on the clinical encounter.…”

In This Issue: Clinical Diagnosis and Management

“…A study by Curlin and colleagues fi nds that specifi c aspects of physicians' report of personal spirituality and background, but not general measures of religiosity, are associated with reported care of the underserved. 17 A study of 112 Spanish primary care physicians asks how frequently clinical questions occur and are answered during outpatient visits. 2 In 3,511 videotaped consecutive visits that averaged 8 minutes, they fi nd that physicians searched for answers to 23% of the questions.…”

So Much More Than a Job: A Psychoanalytic Exploration of Healthcare Work

“…By helping and healing others, healthcare workers provide a vital service to society that in turn offers a sense of deep fulfillment (Abbott and Wallace, 1990). Research continues to show that many (if not most) healthcare workers perceive their job as a "calling" (Wrzeniewski et al, 2003;Curlin et al, 2007).…”