Primary-care physician shortage in Black, Latino neighborhoods
Last month, Medical News Today discussed a study that showed that African Americans and Latinos are more likely than whites or Asians to live in neighborhoods that are low-income, inner-city, or rural, and have access to few or no primary care physicians.
The article reported on a study published in Health Services Research that found that African Americans and lower-income Latinos are more likely to live in neighborhoods with few or no primary care physicians. Dr. Darrell J. Gaskin, lead author and deputy director of the Hopkins Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health, said, “What this says to us is that we really need to encourage physicians to locate in these areas.” The study used data collected by the U.S. Census and American Medical Association from 2000 to 2006. An area with a shortage of health professionals was defined as having one or no physician per 3,500+ people in an area. The results found African Americans and Latinos were 25.6 percent and 24.3 percent, respectively, more likely to live in an area with few or no primary care physicians, compared with 13.2 percent of whites and 9.6 percent of Asians.
In a health system based on fee-for-service payments to physicians and hospitals, the market will drive physicians and other clinicians away from communities with large numbers of uninsured, unemployed, and low-income people — in other words, working-class African-American, Latino, and other minority neighborhoods; as well as rural areas, even those with predominantly white population. As Gaskin noted, “You can’t pay physicians less for a service under Medicaid and expect them to want to practice in that kind of area. We’re talking about areas where doctors won’t be able to practices because they can’t sustain themselves.”
In addition to this maldistribution of the physician workforce resulting from capitalist market forces, I believe that African Americans and Latinos also lack primary-care health services because of racial discrimination. One of the main drivers of this discrimination is the continued residential segregation of these communities. The June 2012 issue of Health Services Research is dedicated to exploring health disparities in the United States and includes an article on the effect of racial residential segregation on health.
Financial incentives, such as loan repayment, increased payment for Medicaid, or increased payment for services provided to underserved communities, would help shift the distribution of the clinical workforce. However, a better solution would be eliminating the fee-for-service payment structure. Pay clinicians for keeping whole populations or communities healthy, rather than paying us for doing things to people.