May 2000 • Volume 6 • Number 5
Study promotes affirmative action
Minority generalists often care for low-income AmericansBY JANE STOEVER
Minority physicians in primary care often serve low-income patients -- whether or not the patients are members of minority groups.
It's a matter of choice. And roots. Minority physicians often opt to practice in areas with low-income populations.
Michael Ramos, M.D., enjoys a well-baby visit with proud mom Angelia Simmons and daughter Roxanne."A lot of us, growing up, didn't have anything anyway, money-wise," says family physician Michael Ramos, M.D., of Pueblo, Colo. About 55 percent of his patients are Hispanic, about 40 percent are Anglo and a few are African-Americans. About half of his patients are on Medicaid, and 5-10 percent are uninsured.
"I do a lot of OB, see a lot of kids," says Ramos. "I like it."
Many of his patients work at a steel mill or in stores. "Everybody's pretty much the working poor here," says Ramos.
North of Denver, family physician Diego Osuna, M.D., practices in a community health center in Commerce City, Colo., an industrial area. The center serves local residents and migrant farm workers. About 25 percent of the center's patients are on Medicaid, and some 70 percent are uninsured.
"We're filling a great need," says Osuna.
The practice locations of Ramos and Osuna reflect findings from a study completed recently by the AAFP Center for Policy Studies in Family Practice and Primary Care in Washington, D.C.
The study, which surveyed all Colorado physicians, found that Hispanic primary care physicians practiced in areas with more poor people than the areas where Anglo primary care physicians worked (see chart).
"These findings argue for a special provision to admit ethnic minorities to undergraduate and graduate medical education programs," says the study report.
In conclusion, the report says, "We now have decades of experience with the failure of nonminority physicians to serve underrepresented minorities in rural and urban areas. These data suggest that attention to -- not avoidance of -- affirmative action may offer a better chance to serve the underserved in the future."
The AAFP has no policy on affirmative action in medical education.
Osuna says recruitment of prospective physicians likely to serve the uninsured is an important response but is only one response to the growing numbers of the uninsured. He adds, "As a society, we need to look at all the ways we can address the problem of unequal access to health care."
Percentages of population by ethnic composition
and poverty status in ZIP code areas where
Colorado primary care physicians practice
Population Served by
Anglo
physiciansServed by
Hispanic
physiciansHispanics 12.0% 22.1% Below poverty level 12.6% 16.9% Anglos 9.7% 11.7% Hispanics 20.2% 24.7% The study's principal investigator, Edward Fryer Jr., Ph.D., says that while the study was limited to Colorado, the large number of survey respondents (5,992), including a sizable minority group (135 Hispanic physicians), suggests the results may apply to other states. In addition, more African-American than Anglo physicians in the study practiced in low-income areas, but there were too few African-American physician respondents (only 64) for them to be considered statistically significant in the study.
Family medicine was popular among Hispanics in the study: 56.3 percent of the Hispanic generalists were family physicians, and 30.3 percent of all Hispanics in the study were family physicians. The Colorado Area Health Education Center Program in Denver initiated the study, which was completed by the AAFP policy center last year.
For more information, call Fryer at the policy center, (877) 349-0461.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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