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Last updated July 21, 2020. 8 minute read

Why Black patients treated by Black doctors fare better

Black patients with Black physicians can potentially avoid dealing with racial biases of non-Black doctors/HCPs, which can negatively impact their quality of care.

Written by Tiffany Onyejiaka
Reviewed by Dr. Mike Bohl, MD, MPH

Health disparities hurt many different people, but they especially hurt Black, Indigenous, and People of color. Black people, especially black men, have higher rates of chronic disease. In 2011, Black men and women had a life expectancy that respectively was 4.4 and 2.8 years shorter than white men and women across the United States (Bond, 2016). 

Vitals

  • Black doctors/HCPs can potentially provide a higher quality of care for Black patients compared to non-Black doctors/HCPs, such as by reducing wait times for treatments.
  • Black patients may feel more comfortable discussing health with Black doctors/HCPs, which can help increase their compliance and adherence to medical advice.
  • Black patients with Black physicians can potentially avoid dealing with racial biases of non-Black doctors/HCPs, which can negatively impact their quality of care.

America has many examples of race-based health disparities. Some of the most serious ones involve Black people dying faster or earlier than white people for the same condition. A prime example of this is that in the middle of the ongoing Coronavirus disease of 2019 pandemic, a community in Louisiana with a 31% Black population had Black people make up 76.9% of their COVID-19 hospitalizations and 70.6% of their COVID-19 deaths (Price-Haywood, 2020). While in this case, the in-hospital mortality rates between Black and white patients were similar, the lack of access to care in the first place that Black patients often face likely drove up the disproportionate death rate.

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Many factors drive health disparities in the United States. One major cause is that many Black people can not access Black doctors or healthcare providers (HCPs).

Black people make up 13% of the American population, but a 2018 AAMC survey found that only 5% of active physicians identified as Black (AAMC, 2018). This survey did identify the race of 13.7% of American physicians, so the true number of Black physicians could be slightly higher, but likely not proportional to that of the general population.

Importance of diversity in medicine

Black doctors/HCPs are more likely to practice in high need areas

Poverty is a big problem in America. Unfortunately, Black people are hit especially hard by it. Black doctors/HCPs are more likely than white doctors/HCPs to provide healthcare in underserved areas (Smedley, 2001) and treat a higher proportion of Medicaid patients (Lyndonna, 2014). It follows that Black doctors/HCPs are more likely to provide healthcare to the neediest Black populations compared to white doctors/HCPs.

Black doctors/HCPs can potentially provide a higher quality of care for Black patients than non-Black doctors/HCPs

A simple reason Black patients may fare better with Black doctors/HCPs is because Black doctors/HCPs could potentially provide them a higher standard of care.

A 2019 study compared the short term health outcomes of Black men assigned to Black doctors/HCPs against those of Black men assigned to non-Black doctors/HCPs. The results illuminated that Black patients with Black doctors/HCPs got more invasive, preventative services, and care from their doctors/HCPs 

Black male patients showed increased comfort in fully discussing their healthcare problems with Black doctors/HCPs (Alsan & Garrick, 2018). On the provider side, the Black doctors/HCPs wrote more additional notes about their patients’ cases compared to the non-Black doctors/HCPs (Alsan & Garrick, 2018). The Black doctors/HCPs spent more time with the Black male patients, largely because the patients agreed to take more potentially life-saving screenings and tests with them (Alsan & Garrick, 2018).

The study suggested that uptake in life-saving healthcare services taken by Black men with Black doctors/HCPs could improve health outcomes enough to potentially decrease the cardiovascular mortality gap between Black men and white men by up to 19% (Alsan & Garrick, 2018).

In certain cases, when a patient receives care is crucial to how successful the outcome will be. Some research has shown that having a Black doctor can mean Black patients get treatments quicker.

A 2004 study found that HIV positive Black patients with white doctors/HCPs had a median wait time of 119 more days to receive protease inhibitor treatments compared to HIV positive Black patients with Black doctors/HCPs (King, 2004). HIV medications must be taken as prescribed to prevent HIV drug resistance. Doctors/HCPs tend to delay prescribing HIV treatments to patients they suspect will not take them properly (Wong, 2004). This study hypothesized that one reason for the difference in treatment times could potentially be that white doctors/HCPs are more likely to assume that Black patients will not take medication properly and therefore delay their treatment compared to Black doctors/HCPs who are less likely to have those biases or assumptions (King, 2004). 

Black patients tend to trust, communicate and comply more with Black health care providers

Another perk for Black patients with Black doctors/HCPs is that Black patients tend to trust and take their recommendations more seriously.

A recent study found that even when Black and white doctors/HCPs used the same words and communication style, Black patients were more receptive to a surgical recommendation by the Black physician (Saha, 2020). 

Having a Black doctor could also potentially help a Black patient better understand health risks. This study showed that Black patients had an improved awareness of lung cancer risk when interacting with physicians they perceived as Black (Persky, 2013).

Black patients sometimes adhere to medications better under Black physicians as well. This study found that Black people with Black physicians had higher adherence to their cardiovascular medicines than Black people with non-Black physicians (Traylor, 2010).

Different research studies suggest that a Black doctor can help increase important healthcare communication with Black patients, which can help with healthcare compliance, which could lead to offsetting some negative health outcomes.

So is it just Black patients that do better with doctors/HCPs of the same race? Not exactly.

Studies suggest that when it comes to patient satisfaction, patients can be happier when visiting a provider of the same race. A 2002 study of white, Black, Hispanic, and African-American patients found that each race and ethnicity reported the highest level of satisfaction with a provider from their same racial or ethnic background.

In terms of outcomes, however, it’s not as clear. One study found that white, Hispanic, and Asian patients had similar levels of medication adherence irrespective of provider race (Traylor, 2010). Another study, though found that Asian and Hispanic patients with providers of the same race and ethnicity were more likely to seek preventative care services and visit providers for new health problems (Ma, 2019)

Black patients can avoid facing bias with non-Black doctors/HCPs

Some Black patients encounter racial bias from white doctors/HCPs (Hagiwara, 2017). Black patients who experience bias from doctors/HCPs tend to report a lower standard of quality care and a higher level of distrust and dissatisfaction with the doctor (Penner, 2014). When Black patients go to Black doctors/HCPs, they can potentially avoid implicit biases that could negatively impact their healthcare journey.

There is a history of tension between the Black community and white medical professionals

Historically, there has been some mistrust between the Black community and the medical community. Doctors/HCPs used to medically experiment on enslaved Africans (Wall, 2006). A study found that, even in the modern-day, Black people tend to trust research medical professionals less than white people (Braunstein, 2008). 

The Tuskegee study remains a notable example of experimentation on Black Americans without consent. The United States Public Health Service conducted the Tuskegee Study of Untreated Syphilis in the Negro Male from 1932 to 1972 (Alsan & Wanamaker, 2018). The research team wanted to see how untreated syphilis would affect the body (Alsan & Wanamaker, 2018). However, they instead told participants that they would be treated for “bad blood” (Alsan & Wanamaker, 2018). 

This team denied the patients the right to informed consent and access to penicillin treatment for syphilis. Many died or developed syphilis-related complications such as blindness or dementia (Alsan & Wanamaker, 2018). The revelation of this experiment led to increased medical distrust in the Black community and decreased physician visits for older black men (Alsan & Wanamaker, 2018). This study led to an overhaul of research practices in the medical and public health community. This study was a colossal public health failure that showed just how damaging racism could be in a research setting.

Increasing the number of Black doctors/HCPs in medicine (starts with medical schools)

Black doctors/HCPs play a very important role in reducing health disparities that affect the Black community. Sadly, America does not have enough of them. The low numbers of Black doctors/HCPs start with the low numbers of Black medical students. In 2019, only 7.3% of American medical students were Black (AAMC, 2019).

Some medical schools have recognized the importance of training minority physicians in an increasingly diverse country. Some medical schools, like The University of Kentucky, have created diversity initiatives that help recruit more Black medical students into their programs (Achenjang, 2016). Unfortunately, other medical schools, like Texas Tech, have received pushback against affirmative action policies implemented to create a diverse class of future doctors/HCPs (Jaschik, 2019). 

Studies demonstrating the improved health outcomes, health education, and treatment adherence of Black patients with Black doctors/HCPs highlight how powerful diversity is to the healthcare system as a whole. Black doctors/HCPs can lead to Black patients navigating healthcare systems to live longer, healthier lives.