Racial inequity in medical care persists even in training

February 10, 2021.
Minorities still have trouble getting equal medical treatment. (AP Photo/Mark Humphrey)

Minorities still have trouble getting equal medical treatment. (AP Photo/Mark Humphrey)

Health care disparities between racial groups not only persist in clinical settings, but they continue even at the level of resident trainees and physicians-in-training, according to new research out of Yale University.

The study, published Jan. 25 in Academic Psychiatry, examined medication orders written by 111 psychiatry residents over an 18-month period, from July 2018 to December 2019. These broke down into 6,133 unique patient encounters during that time, from which patterns based on race and ethnicity emerged.

At large, Black and Latinx patients had lower odds of receiving antidepressants when compared to white patients, despite the same diagnosis. Nearly 32% of white patients received an antidepressant prescription, while only 19.6% of Black and 24.5% of Latinx patients received such a prescription. Additionally, Black patients were more than twice as likely to receive a diagnosis of psychosis, rather than depression, when compared to white patients.

“[It’s] surprising that it is happening with residents,” Ignacio Cerdeña, a psychiatry resident at Yale and an author of the study, said of the findings that residents may be perpetuating these health disparities. “Not much of the health disparities research looks at trainees — it’s either nationally representative data sets or it’s a whole health system. To show that it’s happening in a training setting is pretty unique.”

Part of the reason why these issues persist is that the health care system in the U.S. doesn’t always afford clinicians the time that might be needed to properly address the individual needs of patients in these ethnic groups who may need additional care, Cerdeña said. He added that for many clinicians, dealing with patients who may be resistant to starting medication might be simply recommending a follow-up appointment and moving on, rather than spending additional time to answer questions or address the stigma about mental health they may be dealing with.

“For patients who are prone to being at the short end of health disparities, it takes more work, more time, a longer clinical encounter, maybe a repeat visit,” Cerdeña said. “Right now, we don’t have a health system that really reimburses that, promotes that … We need to have live metrics of this happening so people are more inclined to work against the system that is not meant to have you spend more time with patients unless you have to.”

The study suggests that quality improvement educational interventions, such as prescriber profiles, should be presented to residents and clinicians so that they can have a better sense of any disparities among their patients and accordingly provide more equitable care. Additional research will likely be necessary to determine how best to use such interventions and to see how effective they are in addressing inequity within clinical care.

Though the findings are concerning, Cerdeña said that increased levels of diversity within medical residents, with higher percentages of women and people of color than before, may lead to stronger efforts to promote equity within medical care.

“We’ve known these things have existed for generations, and nothing’s changed, right? Every generation has a wakeup period where there’s a lot of op-eds written and there’s a call for change, but then fast forward years later, and you’re still finding many of the same results,” Cerdeña said. “I’m hopeful that maybe this time will be different.”

The article, “Racial and Ethnic Differences in Psychiatry Resident Prescribing: a Quality Improvement Education Intervention to Address Health Equity,” was published on Jan. 25, 2021 in Academic Psychiatry. It was authored by Ignacio Cerdeña, Terrell Holloway, Jessica Cerdeña, Angelina Wing, Tobias Wasser, Frank Fortunati, Robert Rohrbaugh and Luming Li, all of Yale University.

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