Disparities/Minority Health

Pediatricians show less implicit race bias than others

Although racial and ethnic disparities in care exist in pediatrics, pediatricians are less likely to harbor attitudes that favor white Americans than other physicians and individuals, suggests a new study. Implicit attitudes and stereotypes are by nature outside of personal awareness, and may unknowingly influence quality of care. However, the University of Washington researchers found no link between pediatricians' implicit racial attitudes and stereotypes and quality of pediatric care, and they call for more studies to examine the complex relationship between implicit attitudes and stereotypes and medical care.

Researchers surveyed academic pediatricians about their implicit and explicit racial attitudes and stereotypes using the Implicit Association Test (IAT). The IAT asks test takers to quickly sort and categorize two pairs of images and words, and it assumes that the test taker will more quickly sort concepts that are more readily associated mentally than concepts that are more weakly associated. To measure quality of care, they asked the pediatricians how they would treat patients using four pediatric case vignettes (each were given two black patients and two white patients) to determine if there were racial differences in treatment recommendations for pain control, management of urinary tract infection, attention deficit hyperactivity disorder, and asthma control. Most (82 percent) of the surveyed pediatricians were white, and 93 percent were American-born.

The majority of pediatricians reported no difference in feelings toward racial groups. However, when asked about patients in their own practices, the pediatricians reported attitudes that strongly associated whites (but not blacks) with the concept of "compliant patient," and unexpectedly associated blacks with "preferred medical care."

The pediatricians' Race Attitude IAT results revealed a much smaller implicit preference for whites relative to blacks than found with other physicians and the over one million individuals who have taken the Race Attitude IAT. On the Race and Compliant Patient, researchers found a moderate "perceived compliance and race" stereotype. The researchers did not find a strong relationship between difference in treatment recommendations by patient race (quality of care) and implicit measures.

The study was supported in part by the Agency for Healthcare Research and Quality (HS15760). More details are in "Physician implicit attitudes and stereotypes about race and quality of medical care," by Janice A. Sabin, Ph.D., M.S.W., Frederick P. Rivara, M.D., M.P.H., and Anthony G. Greenwald, Ph.D., in the July 2008 Medical Care 46(7), pp. 678-685.

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