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WEDNESDAY, Aug. 4 (HealthDayNews) -- Doctors who treat black patients have less training and less access to important lifesaving resources than physicians who treat white patients do, new research concludes.

"Not all physicians are the same," said study author Dr. Peter B. Bach, an epidemiologist at Memorial Sloan-Kettering Cancer Center in New York City. "Just because they take Medicare doesn't mean they have the clinical tools at their fingertips that they can provide to patients."

Much research on racial disparities in health care has focused on characteristics of the patients, such as their ability to afford care.

The authors of this study, from both Sloan-Kettering and the Center for Studying Health System Change, hypothesized that disparities might also be due to differences in doctors.

"We were motivated because of the observation that white and black patients don't get the same treatment but also aren't diagnosed at the same time," Bach explained. "The question is why. Could it be that a black patient is more likely to be treated by a physician who says, 'I have trouble getting into facilities where treatment can begin?'"

To test the theory, Bach and his colleagues analyzed 150,391 visits by black and white Medicare beneficiaries who were seen by 4,355 primary-care physicians for medical "evaluation and management." The physicians had all taken part in a biannual telephone survey.

"We looked at what resources primary-care physicians said they had access to," Bach said. "Resources were important for the evaluation of patients with symptoms of illnesses, specialists, elective admission to a hospital, radiology, adequate hospital stay. Those are the things that primary-care physicians need to have to provide the best care to patients."

The survey found that 80 percent of visits by black patients were to 22 percent of physicians. These same physicians provided only a small percentage of care to white patients. Only 77.4 percent of the physicians whom black patients visited were board-certified, compared with 86.1 percent of doctors visited by white patients.

The doctors treating black patients were also more likely to report that they were unable to provide high-quality care to all their patients (27.8 percent vs. 19.3 percent). Finally, they also reported greater difficulties in gaining access to high-quality subspecialists, diagnostic imaging and nonemergency hospital admission.

"Care for minority patients is really concentrated," said Dr. Arnold M. Epstein, author of an accompanying editorial in the journal. He's also chairman of the department of health policy and management at the Harvard School of Public Health.

If a primary-care physician has less access to necessary resources, it's likely it will take longer to diagnose a problem and start treatment, which presumably will affect a patient's health. The cancer mortality rate for blacks, for instance, is 30 percent higher than for whites.

"There's a disproportionate amount of advanced heart disease in African-American patients," added Dr. Lynne Perry-Bottinger, a board-certified interventional cardiologist with Columbia University and Weill Medical College of Cornell University, and a board member of the Association of Black Cardiologists. Perry-Bottinger cited studies showing that disparities in outcomes between black and white heart patients were due solely to whether they had access to a board-certified cardiologist.

So what can be done? The study, Bach said, "suggests that there is a group of doctors that we could identify as those who face obstacles when trying to provide high-quality care, and direct resources and other sorts of things towards them so that when any patient comes to see them they have more to offer."

Any solution is likely to be multi-pronged and complex, however.

"My own guess is that there's nothing going to be a single smoking gun," Epstein said. "Racial disparities are complicated and complex, and solutions are complicated and complex."

More information

For more on minority health and racial disparities, visit the Agency for Healthcare Research and Quality.

(SOURCES: Peter B. Bach, M.D., physician and epidemiologist, Memorial Sloan-Kettering Cancer Center, New York City; Lynne Perry-Bottinger, M.D., interventional cardiologist, Columbia University and Weill Medical College of Cornell University, both in New York City; Arnold M. Epstein, M.D., John H. Foster professor and chairman, department of health policy and management, Harvard School of Public Health, Boston; Aug. 5, 2004, New England Journal of Medicine)

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