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Physician Implicit Attitudes and Stereotypes About Race and Quality of Medical Care

Sabin, Janice A. PhD, MSW*; Rivara, Frederick P. MD, MPH†‡; Greenwald, Anthony G. PhD§

doi: 10.1097/MLR.0b013e3181653d58
Original Article

Background: Recent reports speculate that provider implicit attitudes about race may contribute to racial/ethnic health care disparities.

Objectives: We hypothesized that implicit racial bias exists among pediatricians, implicit and explicit measures would differ and implicit measures may be related to quality of care.

Research Design: A single-session, Web survey of academic pediatricians in an urban university measured implicit racial attitudes and stereotypes using a measure of implicit social cognition, the Implicit Association Test (IAT). Explicit (overt) attitudes were measured by self-report. Case vignettes were used to assess quality of care.

Results: We found an implicit preference for European Americans relative to African Americans, which was weaker than implicit measures for others in society (mean IAT score = 0.18; P = 0.01; Cohen's d = 0.41). Physicians held an implicit association between European Americans relative to African Americans and the concept of “compliant patient” (mean IAT score = 0.25; P = 0.001; Cohen's d = 0.60) and for African Americans relative to European Americans and the concept of “preferred medical care” (mean IAT score =−0.21; P = 0.001; Cohen's d = 0.64). Medical care differed by patient race in 1 of 4 case vignettes. No significant relationship was found between implicit and explicit measures, or implicit measures and treatment recommendations.

Conclusions: Pediatricians held less implicit race bias compared with other MDs and others in society. Among pediatricians we found evidence of a moderate implicit “perceived patient compliance and race” stereotype. Further research is needed to explore whether physician implicit attitudes and stereotypes about race predict quality of care.

From the *University of Washington, School of Social Work, Seattle, Washington; †Department of Pediatrics, University of Washington; Seattle, Washington; ‡Child Health Institute, Seattle, Washington; and §Department of Psychology, University of Washington, Seattle, Washington.

Supported by the Agency for Healthcare Research and Quality grant award 1-R36HS1576-01, National Institute of Mental Health training grant award T32MH20010, and University of Washington Magnuson Health Scholars Award (2005).

This research was presented in an oral presentation at the American Public Health Association annual meeting, Medical Care Section, November 2007, Washington, DC.

Reprints: Janice A. Sabin, PhD, MSW, University of Washington, School of Social Work, 4101 15th Ave., NE, Box 354900, Seattle, WA 98105-6299. E-mail: sabinja@u.washington.edu.

© 2008 Lippincott Williams & Wilkins, Inc.