The intersection of race, gender, and primary care: results from the Women Physicians' Health Study.

The Women Physicians' Health Study is a nationally distributed mailed questionnaire survey of a random sample of 4501 female physicians. We examined differences in the professional characteristics and personal health habits of minority women physicians compared to other women physicians, with regard to the choice of primary care specialties, type or location of practice site, and career satisfaction. Most women physicians were self-described as non-Hispanic white (77.4%), with 13% Asians, and few blacks (4.3%) or Hispanics (5.2%). Blacks and Hispanics were more likely to choose primary care specialties (61.6% and 57.9%, respectively, vs. 49.3% of whites, p < 0.05). Black and Hispanic physicians were most likely to practice in urban areas (71.8% and 72.2%, respectively, p < 0.001). Minority physicians were most likely to report spending some time each week on clinical work for which they did not expect compensation. Black physicians were least likely to report high levels of work control and were least likely to be satisfied with their careers. While most physicians were compliant with the examined recommendations of the U.S. Preventive Services Task Force, we did find significant differences by ethnicity in compliance with clinical breast exams, mammograms, and pap smears. In conclusion, there continues to be fewer blacks and Hispanics in the U.S. physician workforce than in the general population. Minority women physicians are more likely to provide primary care services in communities that have been traditionally underserved and may also report higher rates of career dissatisfaction.

Prevalences and correlates of ethnic harassment in the U.S. Women Physicians' Health Study.

PURPOSE: To describe lifetime prevalences and correlates of ethnic harassment in U.S. women physicians. METHOD: The authors analyzed responses to questions about ethnic harassment that appeared in the Women Physicians' Health Study, a 1993-94, nationally distributed survey of 4,501 female physicians. RESULTS: Of the responding physicians, 62% of blacks reported having experienced ethnic harassment, twice the rate of Asians and "others," three times that of Hispanics, and ten times that of whites. Twenty-five percent of black physicians reported experiencing harassment in at least three phases of their careers (before medical school, during medical school, during training, in practice), compared with 6% of "others," 2% of Hispanics and Asians, and less than 0.5% of whites. U.S.-born and foreign-born doctors reported similar rates of harassment before and during medical school, while foreign-born doctors reported significantly more harassment during training and practice. Reports of harassment during medical school were higher for blacks under 50 than for those over 50 (38% vs 10%, p = .0101). In white physicians, harassment was significantly associated with religion. For certain ethnic groups, control of work environment, dissatisfaction with profession, and stress at work and home were associated with reported harassment. CONCLUSIONS: The prevalences of ethnic harassment at various stages of medical training and practice are high, and not decreasing. This has serious potential ramifications for the medical profession's goal of a diverse physician workforce.

The role of race/ethnicity and social class in minority health status.

Minority health is often considered as a unitary phenomenon; it is often assumed that the health status of minority groups in the United States is similar across groups and much worse than that for whites. Yet the reality is extraordinary diversity. Racial/ethnic groups differ greatly both among and within themselves with regard to health status and with regard to a large number of other indices. Mortality rates around the world generally show an inverse relationship with social class. While this generally holds true in the United States as well, once again we see a strong interaction with race/ethnicity. However, the mediating factors between race/ethnicity and social class, and health status are not well understood. Especially in the face of health care reform, a broad-based research agenda needs to be undertaken so that any restructuring of the health care delivery system is informed by empirical information.

The health status of minority populations in the United States.

There is increasing national recognition that while our nation's health care system is the most expensive in the world, the health care status of Americans overall ranks poorly compared with other Western, industrialized nations. In the United States we tend to look at minority-majority variations of health status, as well as the variations of many other indicators by race or ethnicity, because race and ethnicity are particularly important components of our society. In general, health status indicators of minority Americans are worse than those of whites. In some locales, death rates of minority Americans are comparable to those of Third World nations. At the same time, minority Americans make up a rapidly increasing proportion of the nation's population and work force. Our baseline national data on some minority groups, however, currently are inadequate to detect shifts in health status. Finally, the rapidly expanding problem of the acquired immunodeficiency syndrome among some minority populations provides both an imperative and an opportunity to learn how model prevention programs should be designed and executed.

Black men in the medical education pipeline: past, present, and future.

The authors discuss the decline in the numbers of black men enrolling in medical school over the last two decades and assess possible reasons for it, including the smaller numbers of men from nearly all races and ethnic groups now applying to medical school, the declining popularity of the undergraduate biology degree among men in general, the falling number of black students who go on to college, and, underlying all these, the pervasive effects of poverty on educational achievement, the dwindling employment opportunities for black men of limited education (brought on by dramatic changes in the American economy), and the rising indices of stress and alienation among black men. The authors review the larger social implications of the growing educational gap between black men and other segments of society, pose questions about some of the trends that have been mentioned, indicate lines for further research, and propose potential solutions to the problem of the deepening underrepresentation of black men in medical schools.

Patterns of cigarette smoking among Hispanics in the United States: results from HHANES 1982-84.

In the 1982-84 Hispanic Health and Nutrition Examination Survey, the prevalence of cigarette smoking was examined among Mexican Americans, Puerto Ricans, and Cuban Americans in the United States. Among 20-74 years olds, the age-adjusted smoking rates for Mexican American, Puerto Rican, and Cuban American men were high--42.5, 39.8, and 41.6 percent, respectively. Quite striking among Cuban American men was the high smoking rate among 20-34 year olds (50.1 percent), the highest smoking rate in the three Hispanic groups compared. The age-adjusted smoking rates for Mexican American, Puerto Rican, and Cuban American women were much lower than those for men-23.8, 30.3, and 24.4 percent, respectively. Both Puerto Rican and Cuban American men were more likely to be heavy smokers (52.3 and 64.1 percent, respectively, smoking a pack or more a day) as compared to the Mexican Americans (33.8 percent smoking a pack or more a day). The pattern was the same for women, with Mexican American women being lighter smokers (18.8 percent smoking a pack or more a day) as compared to heavy smoking among Puerto Rican and Cuban American women (35.1 and 48.6 percent, respectively, smoking a pack or more a day). Given the health hazards of smoking, future research and intervention are required for those groups with high exposure to cigarette smoking.

Minorities in medicine: past, present, and future.

Since 1970 the Association of American Medical Colleges (AAMC) has had two key policies about minorities in medicine: (1) special attention should be paid to minority groups underrepresented in medicine, and (2) minority groups should be represented in medicine in the same proportions as in the population as a whole. Despite strong gains in the 1970s in increasing the number of black trainees and graduates, the proportion of minorities in medicine now is declining in relation to the total population. The paper discusses this situation, changes in U.S. minority populations, factors that affected the attempt to achieve parity in medicine, the current status of minorities in medical training (including educational debt) and on medical faculties, and remedies for institutions' lack of success in achieving parity. Three successful programs are described, as are the broader social issues that underlie academic medicine's attempt to increase the proportion of minorities in medicine.

AIDS among blacks in the 1990s.

In the black community, many health indicators are going in the wrong direction. Black life expectancy is going down. Our middle class is growing but our poor are growing also. It is no longer even jarring to talk about black males as an endangered species. Black women are groaning under family responsibilities. Too many of our young people are better armed than the police and kill each other for "diss'in," ie, he was disrespecting me. It is appropriate that AIDS be responded to as a crisis, but we also have a weighty, preexisting set of long-standing and equally lethal health and social ills. The infrastructure we build in response to AIDS and the lessons we learn from this disease must be developed with this broader view in mind.

Perspectives on prevention and medical education for the 1990s.

Heart disease and stroke have been the first and third leading causes of death, respectively, in the United States for many years, and the importance of primary and secondary prevention in reducing morbidity and mortality from these two disease entities has been well established. Additional confirmatory information continues to accumulate, but it is accepted that hypertension, smoking, and serum lipids are important risk factors in coronary heart disease and stroke. Although this discussion deals primarily with cardiovascular disease, many of the issues related to prevention and medical education are generic and are equally relevant to the prevention of other diseases, including HIV infection. Moreover, the way in which medical education approaches preventive cardiology is likely to be similar to the way in which prevention issues are approached in general.