Dismantling Structural Racism in the Academic Residency Clinic

Vanjani, Rahul; Pitts, Andrea J.; Aurora, Pranav

doi:10.1056/nejmms2117023

Cited by 9 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is particularly true for patients seen by medical trainees who submit claims under the National Provider Identifiers of interchangeable supervising attending physicians, and prior work has shown that Black and low‐income patients are more often treated by trainees than White patients at the same academic medical center. 47 …”

Section: Discussionmentioning

confidence: 99%

Within‐Physician Differences in Patient Sharing Between Primary Care Physicians and Cardiologists Who Treat White and Black Patients With Heart Disease

Matthews,

Damberg,

Zhang

et al. 2023

JAHA

View full text Add to dashboard Cite

Background Black‐White disparities in heart disease treatment may be attributable to differences in physician referral networks. We mapped physician networks for Medicare patients and examined within‐physician Black‐White differences in patient sharing between primary care physicians and cardiologists. Methods and Results Using Medicare fee‐for‐service files for 2016 to 2017, we identified a cohort of Black and White patients with heart disease and the primary care physicians and cardiologists treating them. To ensure the robustness of within‐physician comparisons, we restricted the sample to regional health care markets (ie, hospital referral regions) with at least 10 physicians sharing ≥3 Black and White patients. We used claims to construct 2 race‐specific physician network measures: degree (number of cardiologists with whom a primary care physician shares patients) and transitivity (network tightness). Measures were adjusted for Black‐White differences in physician panel size and calculated for all settings (hospital and office) and for office settings only. Of 306 US hospital referral regions, 226 and 145 met study criteria for all settings and office setting analyses, respectively. Black patients had more cardiology encounters overall (6.9 versus 6.6; P <0.001) and with unique cardiologists (3.0 versus 2.6; P <0.001), but fewer office encounters (31.7% versus 41.1%; P <0.001). Primary care physicians shared Black patients with more cardiologists than White patients (mean differential degree 23.4 for all settings and 3.6 for office analyses; P <0.001 for both). Black patient‐sharing networks were less tightly connected in all but office settings (mean differential transitivity −0.2 for all settings [ P <0.001] and near 0 for office analyses [ P =0.74]). Conclusions Within‐physician Black‐White differences in patient sharing exist and may contribute to disparities in cardiac care.

show abstract

Section: Discussionmentioning

confidence: 99%

Within‐Physician Differences in Patient Sharing Between Primary Care Physicians and Cardiologists Who Treat White and Black Patients With Heart Disease

Matthews,

Damberg,

Zhang

et al. 2023

JAHA

View full text Add to dashboard Cite

show abstract

“…The Icahn School of Medicine at Mount Sinai's Racism and Bias Initiative offers one such transformational change framework, beginning with a margins-to-center problem-proving approach and transitioning through phases of cultural climate evaluation, tangible actions with measurable outcomes, and iterative cycling to ensure that reforms are achieving their stated goals and can be sustained long-term. 94 Lastly, because segregated care within academic health centers and pervasive price discrimination between hospitals divert resources away from marginalized communities, 95,96,97,98,99,100 fundamental payment reform remains necessary to ensure that academic health centers can equitably fulfill a quadripartite mission of education, research, clinical care, and community engagement. 101,102 Conclusion Current approaches to health equity education frequently fall short, and, as a result, minoritized learners, marginalized communities, and their relationships to academic medical institutions suffer.…”

Section: Status Quo In Health Equity Educationmentioning

confidence: 99%

Using Critical Pedagogy to Advance Antiracism in Health Professions Education

2024

AMA Journal of Ethics

View full text Add to dashboard Cite

This article draws on Paulo Freire's Pedagogy of the Oppressed to model how health professions education can advance health equity. It first introduces 3 well-known frameworks that can be meaningfully applied as critical pedagogy: structural competency, critical race theory, and participatory action research. It then highlights applications of these frameworks that can prepare trainees for reflection and action that motivate health equity.

show abstract

Section: Introductionmentioning

confidence: 99%

“…In a discussed but little-studied practice, senior physicians preferentially treat patients with more generous commercial insurance, whereas junior physicians treat more patients with Medicaid. 1 , 2 Medicaid has less generous payments but disproportionately includes Black or Hispanic patients. A 2-tiered system by physician seniority could act as an institutional mechanism for racial and economic segregation, limiting access to more experienced physicians.…”

Section: Introductionmentioning

confidence: 99%