No substantial increase in proportion of Black physicians since 1900
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The proportion of Black physicians has only grown by 4% from 1900 to 2018, and there are still substantial income differences between Black and white physicians, according to findings published in the Journal of General Internal Medicine.
“Representation matters. Both representation in the physician workforce in general and representation in all specialties in medicine,” Dan P. Ly, MD, PhD, MPP, an assistant professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and a hospitalist at the VA Greater Los Angeles Healthcare System, told Healio Primary Care.
Representation has public health implications, according to Ly.
“Studies such as the one by Marcella Alsan and colleagues show that Black patients are more likely to undergo preventive care by Black physicians, and that increasing the number of Black physicians could therefore reduce Black-white gaps in life expectancy,” Ly said. “So having a physician who looks like you and may better understand you and your experience seems to matter.”
Ly used data from the Decennial Census and American Community Survey to estimate the proportion of people in the U.S. overall and the population of U.S. physicians who were Black between 1900 and 2018 and compare median incomes between Black and white male physicians. Ly wrote that the study’s income measure “focused on male physicians because there are significant racial income differences in this population and because of the small number of Black female physicians in earlier time periods.”
Among 149,840 physicians in the study sample, 4,891 were Black (men, n = 4,891; women, n = 1,605).
At each point in the study, the proportion of Black physicians was lower than the proportion of the general U.S. population, according to the study data. The proportion of physicians who were Black grew from 1.3% in 1900 to 2.8% in 1940 (men, 2.7%; women, 0.1%) and was 5.4% in 2018 (men, 2.6%; women, 2.8%), representing an overall increase of “only 4 percentage points over the course of 120 years,” Ly wrote.
The increase in the proportion of Black physicians from 1940 to 2018 was due to more Black women becoming physicians, according to Ly. There was no statistically significant difference in the proportion of Black men who were physicians from 1940 to 2018, but the proportion of Black women who were physicians grew by 2.7% (95% CI, 2.2-3.1) during the same time period.
Income differences between Black and white physicians were statistically significant each survey year, according to Ly. In 1960, the difference was the equivalent of $68,000; by 2018, Ly wrote that the difference had only “modestly improved” to $50,000.
“Based on the research above, if we care about the health of the population, particularly the health of Black patients, we should care about how small the proportion of our physicians who are Black is and the extremely slow progress we have made as a medical system in increasing that proportion,” Ly said. “Because of how slow progress has been, there needs to be a reexamination of recruiting and retention efforts and the admission process throughout the medical system.”
References:
Ly DP. J Gen Intern Med. 2021;doi:10.1007/s11606-021-06745-1.
National Bureau of Economic Research. Does diversity matter for health? Experimental evidence from Oakland. https://www.nber.org/papers/w24787. Accessed April 22, 2021.
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The aggregate compensation differential observed comparing Black or African American physicians with white physicians has remained relatively consistent at $50,000 since 1960. Further exploration should include determining the willingness of physicians to accept patients who are uninsured, underinsured or have Medicaid and Medicare as their primary source of insurance. In addition, compensation equity analysis within specialties for employed physicians is also warranted.
It’s also important to note that according to the Association of American Medical Colleges, 45% of Black or African American physicians, 43% of Hispanic/Latino physicians, 46% of American Indian physicians and 41% of Asian physicians were practicing primary care as compared to 35% of white physicians.
In addition, nearly 50% of Black or African American, Hispanic/Latino and American Indian physicians were practicing in health professional shortage areas and medically underserved areas as compared to 18% of Asian physicians and 23% of white physicians.
References:
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Association of American Medical Colleges. Analyzing Physician Workforce Racial and Ethnic Composition Associations: Geographic Distribution (Part I). Available at: https://www.aamc.org/media/7616/download. Accessed April 26, 2021.
Association of American Medical Colleges. Analyzing Physician Workforce Racial and Ethnic Composition Associations: Geographic Distribution (Part II). Available at: https://www.aamc.org/media/7621/download. Accessed April 26, 2021.
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