Commentary
SAN DIEGO – About 25% of Fellows of the American College of Emergency Physicians acknowledged that health care disparities exist in their practices, according to a survey completed by 945 ACEP fellows in 36 states.
Doug Brunk/MDedge News
Cheryl K. Zogg
In conjunction with the American College of Emergency Physicians, Cheryl K. Zogg, MSPH, MHS, and her colleagues surveyed a nationally representative subset of ACEP fellows between September and December of 2017 to determine the extent to which emergency medicine physicians perceive that various forms of disparities exist and that there is “strong evidence” to support the existence of disparities.
The results were reported in an abstract presented during the annual meeting of the American College of Emergency Physicians.
“The existence of disparities in medicine has been widely acknowledged,” she said. “A lot of the modern conversation began in 2002, when the Institute of Medicine published its now-famous report, ‘Unequal Treatment.’ Since that time, a growing body of literature has discussed the existence of disparities in various medical fields and related to a number of factors including but not limited to race and ethnicity.”
The survey contained questions about perceptions of disparities related to insurance status, type of insurance, ability to speak English, educational attainment, race/ethnicity, sexual identity, and sexual orientation as well as the perceived strength of the evidence to support the existence of disparities in medicine in general and in emergency medicine specifically.
Ms. Zogg, an MD-PhD candidate at Yale University, New Haven, Conn., found that disparities of insurance status (85.6%) and type of insurance (81.3%) were the most widely acknowledged, followed by variations in care as a result of patients’ ability to speak English (73.7%) and level of educational attainment (61.5%).
Slightly more than half of respondents (51.9%) acknowledged the existence of disparities based on race/ethnicity in United States, but only 20.9% believe that such disparities exist in their hospitals and even fewer (3.9%) believe that they exist in their own personal practices. At the same time, more than one-third of respondents (40.6%) acknowledged the existence of disparities based on gender identity in the United States, but 22.4% believe that such disparities exist in their hospitals and even fewer (5.7%) believe that they exist in their own practices. Similar percentages were observed when respondents were asked about issues of sexual orientation (33.7%, 10.6%, and 2.3%, respectively).
Perceived strength of the evidence supporting the existence of disparities followed a similar trend. Between 74.7% and 82.2% of respondents believe there is strong evidence in medicine to support the existence of racial disparities in insurance status and insurance type, respectively. However, between 47% and 49.4% of respondents rated such evidence as strong in emergency medicine, and between 25.9% and 26.5% rated such evidence as strong in their own personal practices.
“While acknowledgment of disparities in the U.S. was strongly associated with perceived strength of the evidence in medicine in general (P less than .001), acknowledgment of disparities in one’s own practice was not associated with perceived strength of evidence in emergency medicine or with medicine in general,” Ms. Zogg said. “As evidence documenting disparities continues to increase, action is needed to address disparities in emergency care. This is important because as frontline providers of care, emergency physicians often act as the first point of contact for these patients within the U.S. health system. Ultimately, despite recognition of health care providers as a contributing factor to the existence of disparities and evidence to suggest the presence of disparities in emergency medicine, only one-fourth of FACEP openly acknowledge the potential for disparities in their personal practice.”
Ms. Zogg is supported by a National Institutes of Health Medical Scientist Training Program grant. The study was supported in part by a grant from the Emergency Medicine Foundation and the Society for Academic Emergency Medicine.
SOURCE: Zogg C et al. Ann Emerg Med. 2018 Oct;72(4):S118-9. doi: 10.1016/j.annemergmed.2018.08.306.