Senior physicians may care for fewer Medicaid and racial/ethnic minority patients than junior physicians

Senior doctors may avoid seeing racial minorities and low-wage Medicaid patients compared to junior doctors in the same practice, according to a new study led by the Harvard TH Chan School of Public Health.

“It is a widely known ‘secret’ that in some practices, older doctors push patients with lower-paying insurance, and by extension patients of minority races, toward younger doctors in their ranks. clinic. But this is rarely discussed openly,” the official said. author Michael Barnett, associate professor of health policy and management.

“Our study finds evidence to support this hidden practice, which raises concerns about a two-tier system based on physician seniority that promotes racial and economic segregation.”

The study, “Differences by Physician Tenure in Race, Ethnicity, and Insurance Coverage of Patients Treated,” was published in JAMA Open Network.

Researchers used 2017 claims data from athenahealth and 2021 claims data from Medicare – representing more than 134 million patients and nearly 200,000 doctors – to analyze the differences between patients seen by the doctors the most. younger people and patients seen by more experienced doctors.

The researchers classified doctors by type of practice: cognitive (primary care or endocrinology, for example); procedural (any surgical or procedural specialty); or outside the office (emergency medicine or radiology, for example) – and evaluated the patient panels within each group.

The study found discrepancies between patient panels comprised of junior and senior physicians in cognitive and procedural specialties, broken down by patient insurance type as well as race and ethnicity.

In athenahealth data, senior cognitive physicians saw 1.6% fewer Medicaid patients and 1.2% fewer racial/ethnic minority patients compared to their junior counterparts; primary procedural physicians saw 2.9% fewer Medicaid patients and 1.7% fewer racial/ethnic minority patients.

The same trends were observed in the Medicare data, confirming that these results were not the result of a particular data source. Although the largest gaps were observed among physicians performing procedures, no significant gaps were observed among non-office-based physicians, who do not see patients during scheduled visits.

The researchers said the lack of discrepancy in out-of-office physicians’ patient panels suggests that other specialties may exercise discretion over which patients are booked with whom. Cognitive and procedural specialists may be deterred by lower Medicaid reimbursement rates or higher administrative burden and, thus, care for fewer of these patients.

Since Medicaid patients are more likely to be racial and ethnic minorities, this could also lead to racial disparities. The researchers noted that patient choice may also play a role in these discrepancies.

“It is far from clear that senior doctors provide higher quality care than junior doctors,” Barnett said. “But in my experience as a primary care physician, many patients want to see a more experienced doctor. Our study suggests that patients may face barriers to who they can see, even in the same practice, based on who they are and what insurance they have.” Addressing these barriers and expanding patient access to all types and levels of doctors is essential for a more equitable health care system. “