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Author List:
Burgess DJ (Minneapolis VAMC; University of Minnesota)
Friedemann-Sanchez G (Minneapolis VAMC)
Malat J (University of Cincinnati)
van Ryn M (Minneapolis VAMC; University of Minnesota)
Objectives:
To better understand physicians’ and nurses’ experiences working with non-white patients and to assess their awareness of and explanations for racial/ethnic disparities in healthcare.
Methods:
Qualitative research methods were employed, consisting of semi-structured interviews, based on a carefully constructed and pretested interview guide, with 40 physicians and nurses within and outside the Minneapolis VA Medical Center.
Results:
Despite numerous recent reports documenting of racial/ethnic disparities in healthcare, within and outside of the VA, the majority of providers we interviewed were unaware of research demonstrating racial/ethnic disparities in healthcare. Many VA providers believed that disparities were unlikely to occur in the VA, because of the lack of access barriers to care. Moreover, providers’ explanations for disparities tended to focus on patient-level differences between whites and non-whites, such as whites being better educated about and better able to communicate their healthcare needs and more demanding about their treatment preferences than non-whites. Moreover, despite documented evidence of a provider contribution to disparities, few nurses or physicians suggested provider-level explanations. However, a minority of providers suggested that providers harbored “misconceptions” about African Americans (such as the idea that African Americans are more likely to misuse narcotics) that could result in unequal treatment. Interestingly, a number of providers also raised the issue of racial/ethnic biases among patients toward staff.
Implications:
Among providers at the Minneapolis VA, there was little awareness of the existence of racial/ethnic disparities in the healthcare system, within and outside of the VA, and little awareness as to the possibility that providers might inadvertently contribute to disparities
Impacts:
Interventions to ameliorate racial/ethnic disparities should start by raising levels of awareness of the evidence for disparities within and outside of the VA, along with suggestions for what providers could do to help ameliorate the problem.
