Doctor: Racism Lurks in Obamacare

Monday, 26 May 2014 04:59 PM

By Sandy Fitzgerald

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Obamacare ties payments to doctors and hospitals in with patient satisfaction scores, a plan that is going to hurt minority doctors, a Los Angeles internist says, noting that studies show that even many people with the best of intentions still harbor racial bias.

"I have been an Obama supporter, Dr. Daniela Drake, a board-certified internist in Los Angeles, writes in an opinion piece for The Daily Beast. "But it'd be disingenuous if I didn't conclude that we're faced with the fascinating paradox that the signature policy of the first black president may indeed serve to increase our racial divides."

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Under Obamacare, the Medicare program is authorized to reduce pay to hospitals paid under the Centers for Medicare & Medicaid Services based on patient satisfaction. Initially, the program was to focus on patients readmitted to the hospital for high-cost conditions, including heart attack and pneumonia.

Readmissions could be caused by inadequate treatment during a hospital stay, inadequate care and worsening of disease, the Medicare program's website says.

Such patient surveys could be swayed, however, by people who are openly racist or just biased, said Drake, daughter of a black mother and a white father. She noted she has experienced extreme racism on the job and has learned to adapt.

But, she notes, researchers determined years ago that at least 70 percent of people have an implicit racial bias no matter how unbiased they may think they are.

The influence of race was ignored when Obamacare tied satisfaction scores to doctors' pay, and patients' racism is difficult to assess, Drake writes, because many people have learned to hide their bias behind other phrases.

"For black doctors to get to the top 1 to 2% in patient satisfaction — like I did when I worked in assembly-line medicine — it requires a certain talent to combat those relentless micro-aggressions," writes Drake.

Getting patients to trust a minority doctor isn't easy, she said, as it's "an exhausting and unrelenting Bojangles routine — requiring every ounce of intellectual and emotional skill to both soothe and delight."

Studies show patients are more satisfied with doctors of the same race, with black patients being 140 percent more likely to give a black doctor higher ratings. Meanwhile, white patients with white doctors are 63 percent more likely to give that person a higher rating.

"A hard-working doctor (of any race) has rendered careful, considerate care to a complicated patient," said Drake. "Yet a relative who gets the patient satisfaction form in the mail who might be pissed off at, say, the hospital parking fees — or maybe doesn't like the color of the doctor's skin — will determine how well the doctor gets paid, or even if he keeps his job."

The government should not have passed such a program, she said, and it creates a financial threat that is causing unethical hospital administrators to pressure their doctors to bump satisfaction scores.

The policy could also hinder hiring policies, said Drake, because hospitals serving minority populations will likely hire black doctors to keep their patient approval scores high.

"You could even say that law increases the Bojangles effect — forcing physicians to smile obsequiously while writing orders they don't believe in for patients they'll increasingly grow to resent," she concluded.

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