Skip to main content
SpringerLink
Log in

Perspectives of Orthopedic Surgeons on Racial/Ethnic Disparities in Care

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objectives

Racial/ethnic disparities in healthcare, including orthopedics, have been extensively documented. However, the level of knowledge among orthopedic surgeons regarding racial/ethnic disparities is unknown. The purpose of this study is to determine the views of orthopedic surgeons on (1) the extent of racial/ethnic disparities in orthopedic care, (2) patient and system factors that may contribute, and (3) the potential role of orthopedic surgeons in the reduction of disparities.

Methods

Three hundred five members of the American Orthopaedic Association completed a survey to assess their knowledge of racial/ethnic disparities and their perceptions about the underlying causes.

Results

Twelve percent of respondents believe that patients often receive different care based on race/ethnicity in healthcare in general, while 9 % believe that differences exist in orthopedic care in general, 3 % believe that differences exist within their hospitals/clinics, and 1 % reported differences in their own practices. Despite this, 68 % acknowledge that there is evidence of disparities in orthopedic care. Fifty-one percent believe that a lack of insurance significantly contributes to disparities. Thirty-five percent believe that diversification of the orthopedic workforce would be a “very effective” strategy in addressing disparities, while 25 % percent believe that research would be “very effective” and 24 % believe that surgeon education would be “very effective.”

Conclusion

Awareness regarding racial/ethnic disparities in musculoskeletal care is low among orthopedic surgeons. Additionally, respondents were more likely to acknowledge disparities within the practices of others than their own. Increased diversity, research, and education may help improve knowledge of this problem.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press, 2003.

  2. Centers for Disease Control and Prevention, “Healthy People.” www.cdc.gov/nchs/healthy_people/index.htm.

  3. Jones A, Kwoh CK, Kelley ME, Ibrahim SA. Racial disparity in knee arthroplasty utilization in the veterans health administration. Arthritis Rheum. 2005;53(6):979–81.

    Article  PubMed  Google Scholar 

  4. Skinner J, Weinstein JN, Sporer SM, Wennberg JE. Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med. 2003;349:1350–9.

    Article  CAS  PubMed  Google Scholar 

  5. Nwachukwu BU, Kenny AD, Losina E, et al. Complications for racial and ethnic minority groups after total hip and knee replacement: a review of the literature. J Bone Joint Surg Am. 2010;92:338–45.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ibrahim SA, Stone RA, Han X, et al. Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty. Arthritis Rheum. 2005;52(10):3143–51.

    Article  PubMed  Google Scholar 

  7. Adelani MA, Archer KR, Song Y, Holt GE. Immediate complications following hip and knee arthroplasty: does race matter? J Arthroplasty. 2013;28(5):732–5.

    Article  PubMed  Google Scholar 

  8. Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E. Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am. 2005;87(6):1222–8.

    PubMed  Google Scholar 

  9. Paxton EW, Inacio MC, Singh JA, Love R, Bini SA, Namba RS. Are there modifiable risk factors for hospital readmission after total hip arthroplasty in a US healthcare system? Clin Orthop Relat Res. 2015;473(11):3446–55.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dailey EA, Cizik A, Kasten J, Chapman JR, Lee MJ. Risk factors for readmission of orthopaedic surgical patients. J Bone Joint Surg Am. 2013;95(11):1012–9.

    Article  PubMed  Google Scholar 

  11. Mikuls TR, Saag KG, George V, Mudano AS, Banerjee S. Racial disparities in the receipt of osteoporosis related healthcare among community-dwelling older women with arthritis and previous fracture. J Rheumatol. 2005;32:870–5.

    PubMed  Google Scholar 

  12. Miller RG, Ashar BH, Cohen J, et al. Disparities in osteoporosis screening between at-risk African-American and white women. J Gen Intern Med. 2005;20:847–51.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Furstenberg AL, Mezey MD. Differences in outcome between black and white elderly hip fracture patients. J Chronic Dis. 1987;40(10):931–8.

    Article  CAS  PubMed  Google Scholar 

  14. Jacobsen SJ, Goldberg J, Miles TP, et al. Race and sex differences in mortality following fracture of the hip. Am J Public Health. 1992;82:1147–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.

    Article  CAS  PubMed  Google Scholar 

  16. Epstein A, Weissman J, Schneider E, et al. Race and gender disparities in rates of cardiac revascularization: do they reflect appropriate use of procedures or problems in quality of care? Med Care. 2003;41:1240–55.

    Article  PubMed  Google Scholar 

  17. Lurie N, Fremont A, Jain AK, et al. Racial and ethnic disparities in care: the perspectives of cardiologists. Circulation. 2005;111:1264–9.

    Article  PubMed  Google Scholar 

  18. Taylor SL, Fremont A, Jain AK, et al. Racial and ethnic disparities in care: the perspectives of cardiovascular surgeons. Ann Thorac Surg. 2006;81:531–6.

    Article  PubMed  Google Scholar 

  19. Sullivan LW, Mittman IS. The need for greater racial and ethnic diversity in orthopaedic surgery. Clin Orthop Relat Res. 2011;469:1809–12.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mallinger JB, Lamberti JS. Psychiatrists’ attitudes toward and awareness about racial disparities in mental health care. Psychiatr Serv. 2010;61:173–9.

    Article  PubMed  Google Scholar 

  21. Oliver MN, Wells KM, Joy-Gaba JA, Hawkins CB, Nosek BA. Do physicians’ implicit views of African Americans affect clinical decision making? J Am Board Fam Med. 2014;27(2):177–88.

    Article  PubMed  Google Scholar 

  22. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504–10.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Abdus S, Mistry KB, Selden TM. Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act. Am J Public Health 2015; Oct 8: e1-e8.

  25. Hayes SL, Riley P, Radley DC, McCarthy D. Closing the gap: past performance of health insurance in reducing racial and ethnic disparities in access to care could be an indication of future results. Issue Brief (Commonw Fund). 2015;5:1–11.

    CAS  Google Scholar 

  26. Losina E, Wright EA, Kessler CL, Barrett JA, Fossel AH, Creel AH, et al. Neighborhoods matter: use of hospitals with worse outcomes following total knee replacement by patients from vulnerable populations. Arch Intern Med. 2007;167:182–7.

    Article  PubMed  Google Scholar 

  27. Grava-Gubins I, Scott S. Effects of various methodologic strategies: survey response rates among Canadian physicians and physicians-in-training. Can Fam Physician. 2008;54(10):1424–30.

    PubMed  PubMed Central  Google Scholar 

  28. Reinisch JF, Yu DC, Li WY. Getting a Valid Survey Response from 662 Plastic Surgeons in the 21st Century. Ann Plast Surg 2015; e-publication ahead of print.

  29. Cunningham CT, Quan H, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015;15:32.

    Article  PubMed  PubMed Central  Google Scholar 

  30. American Orthopaedic Association, www.aoassn.org.

Download references

Acknowledgments

We thank the University of Chicago Survey Lab, American Academy of Orthopaedic Surgeons Diversity Advisory Board, and Myria Stanley of the American Orthopaedic Association for their assistance with this project.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO, 63110, USA

    Muyibat A. Adelani

  2. Center for Musculoskeletal Care at Yale School of Medicine and Yale-New Haven Health, New Haven, CT, USA

    Mary I. O’Connor

  3. Orthopaedics and Rehabilitation, Yale School of Medicine, 1450 Chapel Street, Selena Lewis 4, New Haven, CT, 06511, USA

    Mary I. O’Connor

Authors
  1. Muyibat A. Adelani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary I. O’Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muyibat A. Adelani.

Ethics declarations

Funding

There was no funding for this study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study, implied by their completion of the survey.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adelani, M.A., O’Connor, M.I. Perspectives of Orthopedic Surgeons on Racial/Ethnic Disparities in Care. J. Racial and Ethnic Health Disparities 4, 758–762 (2017). https://doi.org/10.1007/s40615-016-0279-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-016-0279-z

Keywords

Search

Navigation