THE ROLE OF BLACK AND HISPANIC PHYSICIANS IN PROVIDING HEALTH-CARE FOR UNDERSERVED POPULATIONS

Background. Patients who are members of minority groups may be more li kely than others to consult physicians of the same race or ethnic grou p, but little is known about the relation between patients' race or et hnic group and the supply of physicians or the likelihood that minorit y-group physicians will care for poor or black and Hispanic patients. Methods. We analyzed data on physicians' practice locations and the ra cial and ethnic makeup and socioeconomic status of communities in Cali fornia in 1990. We also surveyed 718 primary care physicians from 51 C alifornia communities in 1993 to examine the relation between the phys icians' race or ethnic group and the characteristics of the patients t hey served. Results. Communities with high proportions of black and Hi spanic residents were four times as likely as others to have a shortag e of physicians, regardless of community income. Black physicians prac ticed In areas where the percentage of black residents was nearly five times as high, on average, as in areas where other physicians practic ed. Hispanic physicians practiced in areas where the percentage of His panic residents was twice as high as in areas where other physicians p racticed. After we controlled for the racial and ethnic makeup of the community, black physicians cared for significantly more black patient s (absolute difference, 25 percentage points; P<0.001) and Hispanic ph ysicians for significantly more Hispanic patients (absolute difference , 21 percentage points; P<0.001) than did other physicians, Black phys icians cared for more patients covered by Medicaid (P=0.001) and Hispa nic physicians for more uninsured patients (P=0.03) than did other phy sicians. Conclusions. Black and Hispanic physicians have a unique and important role in caring for poor, black, and Hispanic patients in Cal ifornia. Dismantling affirmative-action programs, as is currently prop osed, may threaten health care for both poor people and members of min ority groups.