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The Service Patterns of a Racially, Ethnically, and Linguistically Diverse Housestaff

Murray-García, Jann L. MD, MPH; García, Jorge A. MD, MS; Schembri, Michael E.; Guerra, Lisa M. MD, MS

Educating Physicians: Research Reports

Purpose: To explore whether racial and ethnic concordance in the service patterns of residents is as disproportionate as it is among practicing physicians, and to examine the effect of residents' second-language proficiencies on these patterns.

Method: The authors conducted a cross-sectional study of billing data from 13,681 patient visits to resident continuity clinics at a Northern California pediatric medical center between May 1998 and October 1999. For each racial or ethnic group of patients, the proportion of patient visits to race-concordant residents was compared with the proportion of visits to all residents of other races or ethnicities. Multivariate logistic regression analyses (adjusted for confounders and residents' second-language proficiency) were used to measure the concordance of race or ethnicity in patient—resident pairs.

Results: For all visits made to African-American, Asian, and Latino residents, the percentage of race-concordant visits exceeded the percentage of race-discordant visits for each patient group. In adjusted regression models, African-American, Asian, and Latino patients were more likely to visit residents of the same race or ethnicity. White patients were not more or less likely to visit white residents. When adjusted for residents' second-language proficiencies, Latino patients remained more likely to visit Latino residents and Asian patients remained more likely to see Asian residents. In analyses restricted to residents reporting fluency in Spanish, Latino patients were more likely to visit Latino residents.

Conclusion: African-American, Asian, and Latino pediatric residents disproportionately served more patients from their own racial or ethnic backgrounds. This service pattern was not completely explained by physicians' second-language proficiencies. A resident's race or ethnicity may reflect a unique set of skills that is highly valued by patients or health care systems.

Dr. Murray-García is a pediatrician and health policy consultant, Davis, California. Dr. García is assistant professor of medicine, Division of General Medicine, University of California, Davis Medical Center, Drs. Murray-García and García are members of the Center for Health Services Research in Primary Care, University of California, Davis School of Medicine; Mr. Schembri is a programmer analyst, Department of Family and Community Medicine, University of California, San Francisco School of Medicine (formerly of the Center for Health Services Research in Primary Care, University of California, Davis School of Medicine); Dr. Guerra is assistant professor, clinical pediatrics, Department of Pediatrics, University of Southern California School of Medicine (formerly of the Department of Pediatrics, University of California, Davis School of Medicine, and the Center for Health Services Research in Primary Care).

Correspondence and requests for reprints should be addressed to Jorge A. García, MD, MS, Division of General Medicine, University of California, Davis Medical Center, PSSB, 4150 V Street, Suite 2400, Sacramento, CA 95817-1498; e-mail: <jzgarcia@ucdavis.edu>.

The authors thank Dr. Melanie Tervalon for her helpful review of the manuscript, and Ms. Helena Teixeira for her assistance in preparing the manuscript. They also thank CHO personnel, Dr. Nancy Hilton, Dr. Theodore Chaconas, Dr. Patricia Chase, Ms. Colleen Cervi, Ms. Midge Maritzen, Ms. Marilyn Richard, and Mr. Garland Parker, for their invaluable assistance during the course of the study. Drs. García and Guerra were supported in part by funds from the University of California, Davis School of Medicine Hispanic Center of Excellence Faculty Development Program (HRSA-BHPr 4 D34 MB 02059-06).

© 2001 Association of American Medical Colleges