racial-ethnic stereotyping
Social categorization and racial-ethnic stereotyping likely influence physician behavior and decision making. However, because these are unconscious processes, physicians may be unaware of them and may underestimate their own contributions to racial-ethnic disparities. Understandably, physicians may be reluctant to explore their unconscious biases; it would be difficult for most physicians, who have dedicated their careers to helping others, to confront their own contributions to racial-ethnic inequality ( 10 ). Nonetheless, attempts to eliminate disparities will not be successful as long as health care providers believe that the sources of disparities are entirely external to themselves. Physicians must become aware of their own unconscious biases in order to change the behaviors that contribute to racial-ethnic inequalities.
We hypothesized that there are several prerequisites for changing physician behavior: physicians must be aware that racial-ethnic disparities exist, physicians must believe that they may contribute to disparities, and physicians must be motivated to change their behavior. The purpose of this study was to evaluate the extent to which psychiatrists have achieved these prerequisites and to identify factors that are associated with achievement of each.
Methods
Study sample
Data were collected through an online survey of American Psychiatric Association (APA) members conducted from April 2006 to August 2006. The survey was also distributed at the APA’s Institute on Psychiatric Services in October 2006. For the online portion of the study, names and addresses of 2,000 randomly selected member psychiatrists were purchased from the APA. A letter of introduction and unique access code were mailed to each; a printed survey was available. A maximum of three contact attempts were made. Of the 2,000 individuals identified, a correct address could not be obtained for 24 and seven were retired or deceased. Of the final sample of 1,969 eligible members, 186 psychiatrists (9%) completed the survey online.
Surveys were also distributed from an exhibit hall booth at the 58th Institute on Psychiatric Services, a national professional conference. Respondents were compensated with a $5 specialty coffee gift card. Of the 190 psychiatrists who completed the survey at the conference, two had previously participated, and only their responses to the online survey were used. The final sample for this study was 374 individuals.
The University of Rochester Research Subjects Review Board reviewed this study and determined that it was exempt from institutional review board review.
Survey
Content of our survey was informed by a survey developed by the Kaiser Family Foundation ( 15 ) that was subsequently modified by Lurie and colleagues ( 16 ) for use with cardiologists. The survey included questions about familiarity with racial disparities research, perceived awareness of psychiatrists about racial disparities, and changes in awareness over the past decade. To measure perceived determinants of quality of care, physicians rated the extent to which 12 patient factors (including race) affect quality of psychiatric care, both in general and in their own practice setting. A “difference” variable was calculated by subtracting the perceived influence of race in the participant’s practice from the perceived influence of race in general. Finally, respondents were asked whether they had participated in the past year in any program designed to reduce racial disparities in health care or whether they would be interested in participating in such a program; they were also asked whether they believed such programs were likely to reduce health disparities. Most items were measured on 5-point Likert scales. Key terms, such as quality of care, were defined.
