Mayo Study Defining The Role Of Unconscious Doctor Bias In Minority Health Care
Do unconscious biases about race, gender and body shape that students bring with them into medical school carry over when they enter their residencies, thus contributing to the huge and costly disparities in the health outcomes of minorities?
That’s what prominent Mayo researcher Michelle Van Ryn is trying to find out in leading a new federally funded study meant to build on the results of an earlier nationwide probe documenting how medical school training affects students’ biases about racial and sexual minorities and obese patients.
Medical training is being looked at closely as the U.S. government struggles to understand racial disparities in health care. The situation not only carries high social and human costs, but economic ones as well, estimated at hundreds of billions of dollars per year in terms of direct medical expenses and indirect consequences such as lost productivity.
Indeed, these disparities are frequently cited as one of the main contributors to rising health care costs. That’s because those in racial and sexual identity minorities consistently score disproportionately higher in morbidity and mortality from chronic diseases such as cancer, heart disease, diabetes and stroke.
Van Ryn, director of Mayo’s Research Program on Equity and Inclusion in Health Care, was one of the lead authors of a major longitudinal study tracking med students that wrapped up last year, called the Medical Student Cognitive Habits and Growth Evaluation Study, or CHANGES. Among its findings was that academic training in racial bias, negative role-modeling, interracial contact and diversity climate all predicted changes in implicit racial bias in students between their first and fourth years of medical school.
Now Van Ryn is breaking new ground in following the same cohort of 3,650 medical students from the CHANGES study into their residency years. The new effort, called “the Impact of Residency Factors on Racial, Size & LGBT Bias in Physician Trainees,” is the first known study of how attitudes about race, sexual orientation and obesity affects the actual provision of medical care.
The study has so far received $1.74 million in National Institutes of Health funding.
“Physician behavior and decision-making is a key contributor to the extensively documented racial disparities in health care,” the Mayo researcher writes in her description of the study. “Despite evidence that physicians are motivated to provide high-quality care to all of their patients, implicit (unconscious) biases may still be expressed subtly and indirectly — for example in physicians' assumptions about patient characteristics that affect treatment recommendations.”
These implicit biases, Van Ryn states, can have a “systematic” but largely unintentional impact on treatment and care. Although many medical school and residency training programs have implemented programs in hopes of preventing racial and other biases in trainees, their approaches are scattered and not well evaluated, meaning that little is actually known about how formal training interacts with informal norms and values.
This latest study is seeking to address these knowledge gaps by assessing the impact of the residency experience on implicit and explicit bias in the cohort of 3,650 graduating medical students.
The ultimate hope is that by understanding how new physicians' social beliefs and attitudes are shaped across their medical training—particularly in the final stages in which they prepare for practice—can provide actionable strategies promoting more effective health care for historically stigmatized groups.
And there’s much evidence that more effective health care is needed for those groups if costs are to be brought under control. A 2011 study conducted by the Johns Hopkins Center for Health Disparities Solutions found that between 2003 and 2006, a stunning $1.24 trillion was spent on the combined costs of health inequalities and premature death.
The evidence showed that eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion for the years 2003-2006, and that eliminating health inequalities for minorities would have reduced indirect costs associated with illness and premature death by more than $1 trillion during those same three years.
It also determined that 30.6 percent of direct medical care expenditures for African Americans, Asians, and Hispanics during that period were excess costs due to health inequalities.