Physicians’ Implicit and Explicit Attitudes About Race by MD Race, Ethnicity, and Gender

Abstract

Recent reports suggest that providers’ implicit attitudes about race contribute to racial and ethnic health care disparities. However, little is known about physicians’ implicit racial attitudes. This study measured implicit and explicit attitudes about race using the Race Attitude Implicit Association Test (IAT) for a large sample of test takers (N = 404,277), including a sub-sample of medical doctors (MDs) (n = 2,535). Medical doctors, like the entire sample, showed an implicit preference for White Americans relative to Black Americans. We examined these effects among White, African American, Hispanic, and Asian MDs and by physician gender. Strength of implicit bias exceeded self-report among all test takers except African American MDs. African American MDs, on average, did not show an implicit preference for either Blacks or Whites, and women showed less implicit bias than men. Future research should explore whether, and under what conditions, MDs’ implicit attitudes about race affect the quality of medical care.

Racial Bias in Pain Perception and Response: Experimental Examination of Automatic and Deliberate Processes

“…Other studies have demonstrated general automatic racial biases among clinicians similar to that of the general population. 30,54 However, consistent with the present results, other studies of racial bias in pain perception and response have not found a relationship between traditional measures of general automatic racial evaluations and racial biases in pain perception. 33,64 Therefore, biases in pain perception may be more domain and/or stereotype-specific.…”

“…A large survey employing the Implicit Association Task found the African American physicians did not show general automatic racial biases, where physicians of other races (European/White, Hispanic, and Asian) did reveal culturally congruent racial biases. 54 A patient-physician interaction study found that African American physicians display more positive non-verbal communication with African American patients than do European American physicians, though these researchers also found an ingroup bias among African American physicians such that they displayed fewer positive non-verbal behaviors when interacting with European American patients. 57 Prior research in non-physician samples has demonstrated that African Americans sometimes display general automatic biases against racial ingroup members, 52 particularly under certain circumstances (e.g.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…[39][40][41][42][43] Investigations of clinicians' ethnic and racial attitudes have shown that, similar to the general population, clinicians show little explicit or intentional bias but exhibit substantial bias in their implicit (unconscious) attitudes. [44][45][46] Theoretical models suggest that clinicians' implicit bias may affect their delivery of health care in 3 ways. 42,47,48 First, implicit bias may directly influence clinicians' decisions about their patients' medical treatment, with incorrect, often stereotypical assumptions leading to lower-quality care for minority than for white patients.…”

Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists

“…Our study is the first to demonstrate that >70% of the participating cardiologists associated strength and risk taking with men more than women. Prior studies have shown that the majority of physicians have implicit race/ethnicity bias at rates similar to community samples 12, 46, 51, 52, 53. Physicians may be especially vulnerable to the use of implicit biases in clinical settings characterized by time pressure, brief encounters, and the need to manage very complex situations—the type of situations in which implicit bias is more likely to be applied 17, 50.…”