Racial And Ethnic Bias Impact Perceptions Of Surgeon Performance
*Thuy B Tran, *Mustafa Raoof, *Loretta Erhunmwunsee, *Veronica Jones, *Namgyal Kyulo, *Mohammad Z Shaikh, *Laleh G Melstrom, Yuman Fong, *Susanne G Warner
City of Hope National Medical Center, Duarte, CA
OBJECTIVE: Patient satisfaction is increasingly used as a surrogate for physician performance. How patient and surgeon race and ethnicity affect perceptions of surgeon communication and care is sparsely explored.
METHODS: Press Ganey patient satisfaction surveys collected from January 2019 to September 2020 were studied. Multivariate logistic regressions identified factors associated with favorable surgeon performance related to patient and surgeon demographics.
RESULTS: A total of 4,732 unique outpatient satisfaction survey responses were analyzed. The majority of patients were White (75%), followed by Asian (12%), Black (6.2%), and Hispanic (5.6%). Underrepresented minorities accounted for 8.9% of the 79 surgeons evaluated, and 34% were female. Female surgeons were more likely to achieve the highest overall ratings for effective communication, while Asian surgeons received lower scores. Compared to other groups, Hispanic patients were most likely to perceive that surgeons show less respect for patient concerns (13.9% vs. 9.3%, P=0.004) and inadequate time spent explaining health concerns (12.6% vs. 9.2%, P<0.001). Black, Hispanic, and Asian patients were more likely to report unfavorable experiences than their White counterparts (P<0.001). After adjusting for confounding factors, Asian surgeons had 20% lower odds of receiving favorable scores for communication (OR 0.80, 95% 0.73-0.98, P=0.031). All surgeon communication scores were higher during the coronavirus pandemic when tele-video visits were implemented (P<0.001).
CONCLUSIONS: Both patient and surgeon race drive negative perceptions of patient-physician communication. As underrepresented minorities report more negative experiences, further studies should focus on effects of cultural awareness and anti-racist bias training on underrepresented patient satisfaction.
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