Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, Bindman A B
Division of General Internal Medicine, University of California, San Francisco 94143-1364, USA.
N Engl J Med. 1996 May 16;334(20):1305-10. doi: 10.1056/NEJM199605163342006.
Patients who are members of minority groups may be more likely than others to consult physicians of the same race or ethnic group, but little is known about the relation between patients' race or ethnic group and the supply of physicians or the likelihood that minority-group physicians will care for poor or black and Hispanic patients.
We analyzed data on physicians' practice locations and the racial and ethnic makeup and socioeconomic status of communities in California in 1990. We also surveyed 718 primary care physicians from 51 California communities in 1993 to examine the relation between the physicians' race or ethnic group and the characteristics of the patients they served.
Communities with high proportions of black and Hispanic residents were four times as likely as others to have a shortage of physicians, regardless of community income. Black physicians practiced in areas where the percentage of black residents was nearly five times as high, on average, as in areas where other physicians practiced. Hispanic physicians practiced in areas where the percentage of Hispanic residents was twice as high as in areas where other physicians practiced. After we controlled for the racial and ethnic makeup of the community, black physicians cared for significantly more black patients (absolute difference, 25 percentage points; P < 0.001) and Hispanic physicians for significantly more Hispanic patients (absolute difference, 21 percentage points; P < 0.001) than did other physicians. Black physicians cared for more patients covered by Medicaid (P = 0.001) and Hispanic physicians for more uninsured patients (P = 0.03) than did other physicians.
Black and Hispanic physicians have a unique and important role in caring for poor, black, and Hispanic patients in California. Dismantling affirmative-action programs as is currently proposed, may threaten health care for both poor people and members of minority groups.
少数群体的患者可能比其他患者更倾向于咨询同一种族或族裔的医生，但对于患者的种族或族裔与医生供应之间的关系，以及少数群体医生照顾贫困、黑人及西班牙裔患者的可能性，我们了解甚少。
我们分析了1990年加利福尼亚州医生执业地点以及社区种族、族裔构成和社会经济状况的数据。我们还在1993年对来自加利福尼亚州51个社区的718名初级保健医生进行了调查，以研究医生的种族或族裔与他们所服务患者的特征之间的关系。
无论社区收入如何，黑人和西班牙裔居民比例高的社区医生短缺的可能性是其他社区的四倍。黑人医生执业的地区，黑人居民的比例平均几乎是其他医生执业地区的五倍。西班牙裔医生执业的地区，西班牙裔居民的比例是其他医生执业地区的两倍。在我们控制了社区的种族和族裔构成后，与其他医生相比，黑人医生照顾的黑人患者明显更多（绝对差异为25个百分点；P<0.001），西班牙裔医生照顾的西班牙裔患者明显更多（绝对差异为21个百分点；P<0.001）。与其他医生相比，黑人医生照顾的医疗补助患者更多（P=0.001），西班牙裔医生照顾的未参保患者更多（P=0.03）。
在加利福尼亚州，黑人和西班牙裔医生在照顾贫困、黑人和西班牙裔患者方面发挥着独特而重要的作用。按照目前提议取消平权行动项目，可能会威胁到穷人和少数群体的医疗保健。
