The Association Among Specialty, Race, Ethnicity, and Practice Location Among California Physicians in Diverse Specialties

Abstract

Background Minority physicians are more likely than their counterparts to work in underserved communities and care for minority, poor, and uninsured patients, but much of this research has examined primary care physicians alone. Few have investigated whether non–primary care specialists of minority backgrounds are more likely to serve the underserved than nonminority specialists. Objective We examined whether underrepresented minority (URM) physicians from a wide variety of specialties are more likely than non-URM physicians to practice in underserved communities. Methods Using California Medical Board Physician Licensure Survey (2007) data for 48 388 physicians, we geocoded practice zip codes to medically underserved areas (MUAs) and primary care health professional shortage areas (HPSAs). Logistic regression models adjusting for age, gender, specialty, and other characteristics were used to explore associations with race, ethnicity, specialty, and designated underserved areas. Results We found that African American, Latino, and Pacific Islanders were more likely to work in MUAs and HPSAs than were white physicians (adjusted odds ratio, 1.22–2.25; p < .05). Similar patterns of practice in MUAs and HPSAs by physician race and ethnicity were found when performing the analyses separately among primary care physicians and physicians in non–primary care specialties. Conclusion In summary, our study underscores the importance of underrepresented minority physicians in all specialties for the physician workforce needs of disadvantaged communities. To improve health care for underserved communities, continued efforts to increase physician diversity are essential.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review

“…12–14,16,17,31,36,37,43,55,57,59 In a national study, Rabinowitz et al demonstrated that URM generalists were nearly three times more likely to practice in an underserved area when compared with non-URM physicians. 36 State-level studies indicated that black and Latino physicians were more likely to practice in a shortage area when compared with their non-URM colleagues.…”

“…36 State-level studies indicated that black and Latino physicians were more likely to practice in a shortage area when compared with their non-URM colleagues. 13,43 …”

Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer

“…[22] It has been demonstrated that despite an overall physician shortage in AA and Hispanic communities, AA and Hispanic physicians are more likely to care for AA and Hispanic patients in medically underserved areas, provide more effective care due to lack of cultural or language barriers, and more likely to care for patients with Medicaid or no insurance. [23, 24] However, efforts to increase AA and Hispanic representation in medical and public health schools so that they reflect the general population have been thwarted by attacks on affirmative action programs. [25] These attacks have a direct, negative impact on the most economically and medically vulnerable populations who will continue to have poor outcomes unless institutional diversity is addressed in health policy, health delivery and medical education systems.…”

The Racial and Ethnic Composition and Distribution of Primary Care Physicians

“…7,8 For example, research indicates medically underrepresented minority physicians are important for delivery of primary care, provide care to indigent and minority populations, and improve access to health care services in underserved communities. 9,10,11,12 …”