Abstract
Healthcare treatment differences persist for African Americans even after controlling for socioeconomic status (van Ryn and Burke 2000). Although blacks represent a sizable percentage of the middle class, most disparities research does not address class heterogeneity. Furthermore, research indicates patient–provider race concordance may mitigate racial disparities in health care (Laveist and Neru-jeter in J Health Soc Behav 43(3):296–306, 2002; IOM in Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press, Washington, 2002). This study explores race and gender preference for black middle-class women in healthcare settings. The study uses in-depth interviews and focus groups to explore the experiences of thirty African American women between 38 and 67 in a large urban area. The majority of respondents expressed a strong preference for a female OB/GYN (of any race) while 9 preferred a female primary care provider (of any race). Although the women did not express an explicit race preference, they had a strong affinity for black female providers. Importantly, respondents complicated the idea of provider-level race preference by noting that other site-level factors like wait times and the site’s racial composition affected their racial preferences. Although increasing racial diversity among providers is generally positive, respondents suggest that alone will not ameliorate racial disparities. The complexities of the healthcare encounter, including time pressure, clinical uncertainty, and the patient’s desire for expertise regardless of race or gender, all impinge on respondents’ race preferences. Lastly, women noted that site-level factors may be conflated with the race of provider such that having a black provider does not necessarily lead to better care or protect women from discrimination or bias.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
The focus group respondent’s great-grandfather had been killed as a result of being in the Tuskegee Syphilis Experiment. Her family was deeply traumatized by the experience and would not allow anyone in the family to be treated by a non-black provider.
I am using the term racialized to connote an emphasis on race or racial considerations in stratifying people, allocating societal resources and determining policies, and interpreting events. This does not mean that describing people as white, black, Indian, or Latino is “racializing.” Rather, these are the descriptions of people that acknowledge diversity of language, culture, skin color, etc., without necessarily placing a valence or hierarchy on one group over another. With regard to the women in this study, to note that they are more nuanced and less racialized than the race concordance hypothesis would lead us to believe, simply means that race is not the superordinate factor in determining their interpretation of the healthcare encounter.
Ellen strongly endorsed the importance of developing a personal connection with her provider and emphasized the importance of getting the provider to see you as an individual and not just another number. To be seen as an individual, and to treat others as such, seems to be part of her worldview.
Sojourner Truth posed this rhetorical question during a speech she delivered before the 1,851 Women’s Convention in which she questioned why black women were not afforded the same protections and luxuries as white women. It is included here to highlight the frequent omission of gender as a salient identity for minority women, particularly in health disparities research in which race/ethnicity is foregrounded.
However, some studies have found physicians spend more time and engage in more patient-centered communication styles, in racially concordant pairs. Studies that have audio-recorded race-concordant and race-discordant medical visits of black and white patients yield convergent evidence. Cooper et al. (2003) demonstrated that race-concordant visits were significantly longer and were characterized by greater patient-positive affect compared to race-discordant interactions.
References
American Medical Association. (2007). Physicians in the United States and possessions by selected characteristics 2007. Available from http://www.ama-assn.org/ama/pub/category/2676.html.
Auerbach, C., & Silverstein, L. B. (2003). Qualitative data: An introduction to coding and analysis (1st ed.). New York, NY: New York University.
Bridges, K. M. (2011). Reproducing race: An ethnography of pregnancy as a site of racialization. Berkeley, CA: University of California Press.
Casciotti, D. M., & Klassen, A. C. (2011). Factors associated with female provider preference among African American women, and implications for breast cancer screening. Health Care for Women International, 32(7), 581–598.
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative Analysis. London: Sage Publications.
Chen, F. M., Fryer, G. E., Phillips, R. L., Wilson, E., & Pathman, D. E. (2005). Patients’ beliefs about racism, preferences for physician race, and satisfaction with care. The Annals of Family Medicine, 3(2), 138–143.
Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. New York: Rutledge.
Cooper, L. A., Roter, D. L., Johnson, R. L., Ford, D. E., Steinwachs, D. M., & Powe, N. R. (2003). Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine, 139(11), 907–915.
Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five approaches (1st ed.). Thousand Oaks, CA: Sage Publications, Inc.
Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.
Dale, H. E., Polivka, B. J., Chaudry, R. V., & Simmonds, G. C. (2010). What young African American women want in a health care provider. Qualitative Health Research, 20(11), 1484–1490.
Hooks, B. (2000). Feminist theory: From margin to center. London: Pluto Press.
Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.
Johnson, R., Saha, S., Arbelaez, J., Beach, M., & Cooper, L. (2004). Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. Journal of General Internal Medicine, 19, 101–110.
Keppel, G. (2007). Ten largest racial and ethnic health disparities in the United States based on healthy people 2010 objectives. American Journal of Epidemiology, 166, 97–103.
Laveist, T., & Nuru-jeter, A. (2002). Is doctor–patient race concordance associated with greater satisfaction with care? Journal of Health and Social Behavior, 43(3), 296–306.
Malat, J., & Hamilton, M. A. (2006). Preference for same-race health care providers and perceptions of interpersonal discrimination in health care. Journal of Health and Social Behavior, 47(2), 173–187.
Meghani, S., et al. (2009). Patient-provider race-concordance: Does it matter in improving minority patients’ health outcomes? Ethnicity and Health, 14(1), 107–130.
Padgett, D. K. (2008). Qualitative methods in social work research (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.
Patillo, Mary. (2005). Black middle-class neighborhoods. Annual Review of Sociology, 31, 305–329.
Penner, L. A., Albrecht, T. L., Coleman, D. K., & Norton, W. E. (2007). Interpersonal perspectives on black–white health disparities: Social policy implications. Social Issues and Policy Review, 1(1), 63–98.
Ridgeway, C. L. (2009). Framed before we know it: How gender shapes social relations. Gender ad Society, 23, 145–160.
Samuels, G., & Ross-Sheriff, F. (2008). Identity, oppression, and power: Feminisms and intersectionality theory. Affilia: Journal of Women & Social Work, 23(1), 5–9.
Strauss, A. C., & Corbin, J. M. (1990). Basics of qualitative research: Grounded theory procedures and techniques (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.
Strolovitch, D. Z. (2007). Affirmative advocacy: Race, class, and gender in interest group politics. Chicago: University of Chicago Press.
Van Ryn, M., & Burke, J. (2000). The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science and Medicine, 50(6), 813–828.
Williams, D. R., & Collins, C. (1995). US socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21, 349–386.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sacks, T.K. Race and Gender Concordance: Strategy to Reduce Healthcare Disparities or Red Herring? Evidence from a Qualitative Study. Race Soc Probl 5, 88–99 (2013). https://doi.org/10.1007/s12552-013-9093-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12552-013-9093-y