Abstract
Background
Patient and provider race and gender concordance (patient and physician identify as the same race/ethnicity or gender) may impact patient experience and satisfaction.
Objective
We sought to examine how patient and physician racial and gender concordance effect patient satisfaction with outpatient clinical encounters. Furthermore, we examined factors that changed satisfaction among concordant and discordant dyads.
Design
Consumer Assessment of Healthcare Provider and Systems (CAHPS) Patient Satisfaction Survey Scores were collected from outpatient clinical encounters between January 2017 and January 2019 at the University of California, San Francisco.
Participants
Patients who were seen in the eligible time period, who voluntarily provided physician satisfaction scores. Providers with fewer than 30 reviews and encounters with missing data were excluded.
Main Measures
Primary outcome was rate of top satisfaction score. The provider score (1–10 scale) was dichotomized as “top score (9-10)” and “low scores (<9).”
Key Results
A total of 77,543 evaluations met inclusion criteria. Most patients identified as White (73.5%) and female (55.4%) with a median age of 60 (IQR 45, 70). Compared to White patients, Asian patients were less likely to give a top score even when controlling for racial concordance (OR: 0.67; CI 0.63–0.714). Telehealth was associated with increased odds of a top score relative to in-person visits (OR 1.25; CI 1.07–1.48). The odds of a top score decreased by 11% in racially discordant dyads.
Conclusions
Racial concordance, particularly among older, White, male patients, is a nonmodifiable predictor of patient satisfaction. Physicians of color are at a disadvantage, as they receive lower patient satisfaction scores, even in race concordant pairs, with Asian physicians seeing Asian patients receiving the lowest scores. Patient satisfaction data is likely an inappropriate means of determining physician incentives as such may perpetuate racial and gender disadvantages.
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Data Availability
Data will not be made available.
Code Availability
Code can be made available without associated data.
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Acknowledgements
We gratefully acknowledge the assistance of Nizar Hakam, Behnam Nabavizadeh, Natalie Rios, and Michael Sadighian particularly for their roles in reviewing provider profiles. All represent the UCSF Department of Urology and were otherwise uncompensated for their work.
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NS: data analysis/interpretation and manuscript drafting and editing. NH: data analysis/interpretation and manuscript editing. JH: project design and data collection and analysis. AF: project design, data analysis, and manuscript editing. DD: project design and manuscript editing. NP: project design and manuscript editing. DS: project design, data analysis, manuscript editing, and supervision. BB: project design, data analysis, manuscript editing, and supervision.
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Appendix
Appendix
Ratings by patient/physician racial pairing. Density of patient satisfaction scores (0–10) based on patient and physician race/ethnicity
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Shaw, N.M., Hills, N., Holler, J. et al. The Impact of Patient–Physician Racial and Gender Concordance on Patient Satisfaction with Outpatient Clinic Visits. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01676-5
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DOI: https://doi.org/10.1007/s40615-023-01676-5