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Clinics Where Minority and Nonminority Patients Receive Primary Care

Anita B. Varkey, MD; Linda Baier Manwell, MS; Eric S. Williams, PhD; Said A. Ibrahim, MD, MPH; Roger L. Brown, PhD; James A. Bobula, PhD; Barbara A. Horner-Ibler, MD, MASW; Mark D. Schwartz, MD; Thomas R. Konrad, PhD; Jacqueline C. Wiltshire, PhD; Mark Linzer, MD; for the MEMO Investigators

Arch Intern Med. 2009;169(3):243-250.

Background  Few studies have examined the influence of physician workplace conditions on health care disparities. We compared 96 primary care clinics in New York, New York, and in the upper Midwest serving various proportions of minority patients to determine differences in workplace organizational characteristics.

Methods  Cross-sectional data are from surveys of 96 clinic managers, 388 primary care physicians, and 1701 of their adult patients with hypertension, diabetes mellitus, or congestive heart failure participating in the Minimizing Error, Maximizing Outcome (MEMO) study. Data from 27 clinics with at least 30% minority patients were contrasted with data from 69 clinics with less than 30% minority patients.

Results  Compared with clinics serving less than 30% minority patients, clinics serving at least 30% minority patients have less access to medical supplies (2.7 vs 3.4, P < .001), referral specialists (3.0 vs 3.5, P < .005) on a scale of 1 (none) to 4 (great), and examination rooms per physician (2.2 vs 2.7, P =.002) . Their patients are more frequently depressed (22.8% vs 12.1%), are more often covered by Medicaid (30.2% vs 11.4%), and report lower health literacy (3.7 vs 4.4) on a scale of 1 (low) to 5 (high) (P < .001 for all). Physicians from clinics serving higher proportions of minority populations perceive their patients as frequently speaking little or no English (27.1% vs 3.4%, P =.004), having more chronic pain (24.1% vs 12.9%, P < .001) and substance abuse problems (15.1% vs 10.1%, P =.005), and being more medically complex (53.1% vs 39.9%) and psychosocially complex (44.9% vs 28.2%) (P < .001 for both). In regression analyses, clinics with at least 30% minority patients are more likely to have chaotic work environments (odds ratio, 4.0; P =.003) and to have fewer physicians reporting high work control (0.2; P =.003) or high job satisfaction (0.4; P =.01).

Conclusion  Clinics serving higher proportions of minority patients have more challenging workplace and organizational characteristics.

Author Affiliations: Department of Medicine, John H. Stroger Jr Hospital of Cook County and Rush University Medical Center, and Loyola University Medical Center, Chicago, Illinois (Dr Varkey); Departments of Family Medicine (Ms Baier Manwell and Dr Bobula) and Medicine (Dr Linzer) and Center for Women's Health Research (Dr Wiltshire), School of Medicine and Public Health, and School of Nursing (Dr Brown), University of Wisconsin–Madison, and Department of Medicine, Medical College of Wisconsin, Milwaukee (Dr Horner-Ibler); Department of Management and Marketing, Culverhouse College of Commerce and Business Administration, University of Alabama, Tuscaloosa (Dr Williams); Veterans Affairs Pittsburgh Health Care System and Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Ibrahim); Department of Medicine, New York University Medical School and Veterans Affairs New York Harbor Health Care System, New York (Dr Schwartz); and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Dr Konrad).

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