It is well documented that the under-represented often suffer from less than ideal health care in the U.S. This has been apparent for more than a century and is one of the reasons the U.S. has the worst health care outcomes compared to all other developed countries. It is also well-documented that concordance between patients and providers in race, ethnicity, and, in some cases, gender leads to better health care outcomes. One study reviewed U.S. and European biases of physicians and nurses compared to the general population. The study by Fitzgerald and Hurst concluded the biases are the same with medical professionals as within the general population. The striking difference demonstrated between the two continents was that in the U.S., bias is based on skin color, whereas in Europe, it is based on country of origin.
What is less known, and discussed in the U.S. is that physicians that identify as Black, Indigenous, and people of color (BIPOC) also suffer greatly from bias, which negatively impacts the whole health care system. Skin color is an issue for patients and doctors of color working in medicine. Black doctors make up only 5 percent of the medical student population, yet 20 percent of resident physicians disciplined and dismissed from training are black, and less than 1 percent hold leadership roles. Kohatsu et al. showed that the California Medical Board is more likely to discipline doctors of color from non-U.S. medical schools (foreign medical graduates). Multiple authors have shown “sham peer review” (when a doctor is reviewed for a concocted or innocuous outcome, behavior, and subject to discipline) is carried out more often on BIPOC doctors, and the reviewers rendering judgment are often white.
BIPOC doctors are disciplined or forced to resign via constructive discharges or terminated without cause at much higher rates than white doctors. They are often subjected to “professional improvement plans” (PIPs) without justification by white doctors who serve as administrators. These have been documented to be a form of levying abuse or controlling doctors veiled as patient safety concerns or not following protocol, when the real reasons are professional jealousy, turf battles, medical license jeopardization, and outright racism. Just as with black doctors, leadership advancement for BIPOC staff is limited. In fact, in the U.S., Asians make up 20 percent of the physician workforce, and less than 4 percent are in medical leadership, according to an op-ed in 2022.
Health care access and physician burnout are already at crisis levels in the U.S. Sham peer review, physician bias, and professional jealousy are all toxic behaviors that are cancers within the U.S. health care system. Female BIPOC physicians are particularly impacted.
Cultural competence is not only critical in improving U.S. patient outcomes, it is also needed in medical administration and leadership particularly if white doctors are overseeing BIPOC doctors in the U.S. This prejudice in medicine must be addressed and rectified immediately by trained non-biased entities, such as independent third parties, who act as mediators. Otherwise, legal battles will consume more U.S. health care resources for costly items such as litigation that could be better spent to improve its population health.
Amol Saxena is a podiatrist.
