Email me back: Examining provider biases through email return and responsiveness.

Abstract

The majority of research on accessing and utilizing mental health services has focused on patient barriers to care. Few studies have explored possible provider biases that may impact client access at point of entry. Using the audit method, we conducted an email-based field experiment to investigate the responsiveness of psychotherapy providers to inquiries from simulated patients with different backgrounds (i.e., race, gender, diagnosis, and ability to pay). A total of 725 therapists (176 men, 549 women) practicing in Chicago, Illinois were identified from an online therapist directory and randomized to receive emails requesting therapy appointments. Overall, 21.7% of providers did not return prospective client email inquiries; 32.5% of providers were somewhat responsive in that they returned an email despite not being able to take on the client; and 45.7% were highly responsive in that they returned an email and offered an appointment or the opportunity to discuss the matter further. Male providers were less responsive to African American and Latinx simulated clients and most responsive to White clients, whereas female providers were more likely to respond similarly to all simulated clients. Moreover, regardless of the providers' gender, they were more responsive to simulated patients with depression than to simulated patients with schizophrenia or borderline personality disorder (BPD). Finally, providers were more responsive to those who could pay the full fee than to those who requested a sliding scale. Educating providers on these possible biases is important because it could help reduce biased behaviors and improve access to care for vulnerable populations. Public Significance StatementEthnic minorities face many individual and structural barriers to accessing treatment. This study found that providers can act as a barrier to patient care by not being responsive to email inquiries, and that providers may be less responsive to stigmatized disorders and those requesting financial accommodations. Moreover, we found that male providers were less responsive than female providers to ethnic minority patients. Addressing provider biases through cultural competency trainings is important to improving access to care.