Racial and Gender Disparities in the Physician Assistant Profession.
Ontology highlight
ABSTRACT:
SUBMITTER: Smith DT
PROVIDER: S-EPMC4874816 | biostudies-other | 2016 Jun
REPOSITORIES: biostudies-other
Publications
Racial and Gender Disparities in the Physician Assistant Profession.
Smith Darron T DT Jacobson Cardell K CK
Health services research 20150914 3
<h4>Objective</h4>To examine whether racial, gender, and ethnic salary disparities exist in the physician assistant (PA) profession and what factors, if any, are associated with the differentials.<h4>Data sources/study setting</h4>We use a nationally representative survey of 15,105 PAs from the American Academy of Physician Assistants (AAPA).<h4>Study design</h4>We use bivariate and multivariate statistics to analyze pay differentials from the 2009 AAPA survey.<h4>Principle findings</h4>Women re ...[more]
Similar Datasets
Project description:Gout affects 8.3 million Americans according to NHANES 2007-2008, approximately 3.9 % of the US population. Gout has substantial effect on physical function, productivity, health-related quality of life (HRQOL), and health care costs. Uncontrolled gout is also associated with significant use of emergency care services. Women are less likely to have gout than men, but in the postmenopausal years the gender difference in disease incidence decreases. Compared with whites, racial and/or ethnic minorities, especially blacks, have higher prevalence of gout. Blacks are also less likely to receive quality gout care, leading to disproportionate morbidity. Women are less likely than men to receive allopurinol, and less likely to undergo joint aspirations for crystal analysis to establish diagnosis, but those on urate-lowering therapy are as likely as, or more likely than, men to undergo serum urate check within six months of initiation. Although a few studies provide the knowledge related to gender and race and/or ethnicity disparities for gout, several knowledge gaps exist in gout epidemiology and outcomes differences by gender and race and/or ethnicity. These should be investigated in future studies.
| S-EPMC3545402 | biostudies-literature
Project description:ImportanceDisparities in quality of care according to patient race and socioeconomic status persist in the US. Differential referral patterns to specialist physicians might be associated with observed disparities.ObjectiveTo examine whether differences exist between Black and White Medicare beneficiaries in the observed patterns of patient sharing between primary care physicians (PCPs) and physicians in the 6 specialties to which patients were most frequently referred.Design, setting, and participantsThis cross-sectional observational study of Black and White Medicare beneficiaries used claims data from 2009 to 2010 on 100% of traditional Medicare beneficiaries who were seen by PCPs and selected high-volume specialists in 12 health care markets with at least 10% of the population being Black. Statistical analyses were conducted from December 20, 2017, to September 30, 2020.ExposuresDifferences in patterns of patient sharing among Black and White patients.Main outcomes and measuresPrimary care physician and specialist degree (the number of other PCPs or specialists to whom each physician is connected) and strength (the number of shared patients per connection, overall, for Black patients and White patients and after equalizing the numbers of Black and White patients per PCP), as well as distance between PCP and patient and specialist zip code centroids.ResultsThe 12 selected markets ranged in size from Manhattan, New York (187 054 Black or White beneficiaries seen by at least 2 physicians within an episode of care; 9794 total physicians), to Tallahassee, Florida (44 644 Black or White beneficiaries seen by at least 2 physicians within an episode of care; 847 total physicians). The percentage of Black beneficiaries ranged from 11.5% (Huntsville, Alabama) to 46.8% (Chicago, Illinois). The mean PCP-specialist degree (number of specialists with whom a PCP shares patients) was lower for Black patients than for White patients. For instance, the mean PCP-cardiologist degree across all markets for White patients was 17.5 compared with 8.8 for Black patients. After sampling White patients to equalize the numbers of patients seen, the degree differences narrowed but were still not equivalent in many markets (eg, for all specialties in Baton Rouge, Louisiana: 4.5 for Black patients vs 5.7 for White patients). Specialist networks among White patients were much larger than those constructed based just on Black patients (eg, for cardiology across all markets: 135 for Black patients vs 330 for White patients), even after equalizing the numbers of patients seen per PCP (123 for Black patients vs 211 for White patients). The overall test for differences in referral patterns was statistically significant for all 6 specialties examined in 7 of the 12 markets and in 5 specialties for another 3.Conclusions and relevanceThis study suggests that differences exist in specialist referral patterns by race among Medicare beneficiaries. This is an observational study, and thus some differences might have resulted from patient-initiated visits to specialists.
| S-EPMC7835717 | biostudies-literature
Project description:ImportanceMen and women should earn equal pay for equal work. An examination of the magnitude of pay disparities could inform strategies for remediation.ObjectiveTo examine gender-based differences in pay within a large, comprehensive physician population practicing within a variety of payment systems.Design, setting, and participantsThis cross-sectional study used data from the Ontario Health Insurance Plan (OHIP) in the 2017 to 2018 fiscal year to estimate differences in gross payments between men and women physicians in Ontario, Canada. Pay gaps were calculated annually and daily. Regression analyses were used to control for observable practice characteristics that could account for individual differences in daily pay. In Canada's largest province, Ontario, medical services are predominantly provided by self-employed physicians who bill the province's single payer, OHIP. All physicians who submitted claims to OHIP were included. Data were analyzed from January 2020 to July 2021.ExposuresPhysician gender, obtained from the OHIP Corporate Provider Database. Gender is recorded as male or female.Main outcomes and measuresGross clinical payments were tabulated for individual physicians on a daily and annual basis in conjunction with each physician's practice characteristics, setting, and specialty.ResultsA total of 31 481 physicians were included in the study sample (12 604 [40.0%] women; 18 877 [60.0%] men; mean [SD] time since graduation, 23.3 [13.6] years), representing 99% of active physicians in Ontario. The unadjusted differences in clinical payments between male and female physicians were 32.8% (95% CI, 30.8%-34.6%) annually and 22.5% (95% CI, 21.2%-23.8%) daily. After accounting for practice characteristics, region, and specialty, the overall daily payment gap was 13.5% (95% CI, 12.3%-14.8%). The pay gap persisted with differing magnitudes when examined by specialty (ranging from 6.6% to 37.6%), practice setting (8.3% to 17.2%), payment model (13.4% to 22.8% for family medicine; 8.0% to 11.6% for other specialties), and rurality (8.0% to 16.5%).Conclusions and relevanceThis cross-sectional study examined differences in magnitude of annual and daily payment gaps and between unadjusted and adjusted gaps. Comparing the gaps for different specialties, geography, and payment systems illustrated the complexity of the issue by showing that the pay gap varied for physicians in different practice settings. As such, multiple directed interventions will be necessary to ensure that all physicians are paid equally for equal work, regardless of gender.
| S-EPMC8456385 | biostudies-literature
Project description:Recent work has emphasized the benefits of patient-physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn-physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.
| S-EPMC7474610 | biostudies-literature
Project description:There has been growing recognition of the popularity of medical crowdfunding and research documenting how crowdfunding arises from, and contributes to, social and health inequities. While many researchers have surmised that racism could well play a role in medical crowdfunding campaign outcomes, research on these dynamics has been limited. No research to date has examined these dynamics among the most successful medical crowdfunding campaigns, focusing instead on average users' experiences or specific patient subpopulations. This paper analyzes key characteristics and demographics of the 827 most successful medical crowdfunding campaigns captured at a point in time in 2020 on the popular site GoFundMe, creating the first demographic archetype of "viral" or highly successful campaigns. We hypothesized that this sample would skew towards whiter, younger populations, more heavily represent men, and reflect critical illnesses and accidents affecting these populations, in addition to having visually appealing, well-crafted storytelling. Analysis supported these hypotheses, showing significant levels of racial and gender disparities among campaigners. While white men had the greatest representation, Black and Asian users, and black women in particular, were highly underrepresented. Like other studies, we find evidence that racial and gender disparities persist in terms of campaign outcomes as well. Alongside this quantitative analysis, a targeted discourse analysis revealed campaign narratives and comments reinforced racist and sexist tropes of selective deservingness. These findings add to growing calls for more health research into the ways that social media technologies shape health inequities for historically marginalized and disenfranchised populations. In particular, we underscore how successful crowdfunding campaigns, as a both a means of raising funds for health and a broader site of public engagement, may deepen and normalize gendered and racialized inequities. In this way, crowdfunding can be seen as a significant technological amplifier of the fundamental social causes of health disparities.
| S-EPMC10916987 | biostudies-literature
Project description:ObjectiveTo assess racial and ethnic disparities in care for Medicare fee-for-service (FFS) beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs.Data sourcesWe used Medicare Data on Provider Practice and Specialty (MD-PPAS), Medicare Provider Enrollment, Chain, and Ownership System (PECOS), IRS Form 990, 100% Medicare FFS claims, and race/ethnicity estimated using the Medicare Bayesian Improved Surname Geocoding 2.0 algorithm.Study designUsing a sample of 16 007 POs providing primary care in 2015, we assessed racial/ethnic disparities on 12 measures derived from claims (2 cancer screenings; diabetic eye examinations; continuity of care; two medication adherence measures; three measures of follow-up visits after acute care; all-cause emergency department (ED) visits, all-cause readmissions, and ambulatory care-sensitive admissions). We decomposed these "total" disparities into within-PO and between-PO components using models with PO random effects. We then pair-matched 1853 of these POs that were affiliated with health systems to similar nonaffiliated POs. We examined differences in within-PO disparities by affiliation status by interacting each nonwhite race/ethnicity with an affiliation indicator.Data collection/extraction methodsMedicare Data on Provider Practice and Specialty identified POs billing Medicare; PECOS and IRS Form 990 identified health system affiliations. Beneficiaries age 18 and older were attributed to POs using a plurality visit rule.Principal findingsWe observed total disparities in 12 of 36 comparisons between white and nonwhite beneficiaries; nonwhites received worse care in 10. Within-PO disparities exceeded between-PO disparities and were substantively important (>=5 percentage points or>=0.2 standardized differences) in nine of the 12 comparisons. Among these 12, nonaffiliated POs had smaller disparities than affiliated POs in two comparisons (P < .05): 1.6 percentage points smaller black-white disparities in follow-up after ED visits and 0.6 percentage points smaller Hispanic-white disparities in breast cancer screening.ConclusionsWe find no evidence that system-affiliated POs have smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.
| S-EPMC7720702 | biostudies-literature
Project description:Purpose of the study"Life-space" is the spatial area through which a person experiences and interacts with the world. Life-space constriction, the shrinking of the spatial area that a person traverses, is associated with negative health outcomes in later life. Racial and gender disparities in mobility as indicated by life-space constriction are thought to contribute to broader disparities in health and functioning among older adults.Design and methodsData come from the 5-year follow-up of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study (N = 2,765; mean age = 73.6; 75.8% women; 73.7% White). Life-space constriction was defined as "not traveling beyond one's town." A series of logistic regression and Cox proportional hazard models were used to estimate risk for incident life-space constriction by race and gender.ResultsBlacks and women had greater likelihood of life-space constriction at baseline. Women were more likely to experience incident life-space constriction at follow-up relative to men (Hazard ratio [HR]: 1.89, 95% Confidence interval [CI]: 1.26-2.83). Blacks were associated with lower risk of life-space constriction over time (HR: 0.67, 95% CI: 0.45-0.99) relative to Whites.ImplicationsDisparities in life-space constriction by gender and race exist in later life. Understanding the processes underlying these mobility restrictions is important to developing intervention programs to enhance health and functioning for older adults.
| S-EPMC5181388 | biostudies-literature
Project description:OBJECTIVE:We examined race/gender effects on initial levels and trajectories of self-reported physical and mental health, as well as the moderating role of personality. We hypothesized that health disparities would remain stable or decrease over time, and that at-risk personality traits (e.g., neuroticism) would have a more robust negative impact on health for Black participants. METHOD:Analyses utilized 6 waves of data from a community sample of 1,577 Black and White adults (mean age 60 years), assessed every 6 months for 2.5 years. Using multigroup latent growth curve modeling, we examined initial levels and changes in health among White men, White women, Black men, and Black women. RESULTS:Black participants reported lower initial physical health than Whites. Women's physical health was stable over time, whereas men's declined. There were no disparities in mental health. Higher agreeableness was associated with higher initial levels of physical health only among Black men and White women. All other personality traits were associated with physical and mental health similarly across race and gender. CONCLUSIONS:Race and gender influence health trajectories. Most personality- health associations replicated across race and gender, except for agreeableness with physical health. An intersectional framework considering more than one aspect of social identity is crucial for understanding health disparities. Future studies may benefit from including large, diverse samples of participants and further examining the moderating effects of race and gender on personality associations with a variety of health outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
| S-EPMC6557706 | biostudies-literature
Project description:Background and objectivesTo examine racial/ethnic, nativity, and gender differences in the benefits of educational attainment on cognitive health life expectancies among older adults in the United States.Research design and methodsWe used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively healthy, cognitively impaired/no dementia, and dementia life expectancies by gender for older White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults with less than high school, high school, and some college or more.ResultsWhite respondents lived a greater percentage of their remaining lives cognitively healthy than their minority Black or Hispanic counterparts, regardless of level of education. Among respondents with some college or more, versus less than high school, Black and U.S.-born Hispanic women exhibited the greatest increase (both 37 percentage points higher) in the proportion of total life expectancy spent cognitively healthy; whereas White women had the smallest increase (17 percentage points higher). For men, the difference between respondents with some college or more, versus less than high school, was greatest for Black men (35 percentage points higher) and was lowest for U.S.-born Hispanic men (21 percentage points higher).Discussion and implicationsOur results provide evidence that the benefits of education on cognitive health life expectancies are largest for Black men and women and U.S.-born Hispanic women. The combination of extended longevity and rising prevalence of Alzheimer's disease points to the need for understanding why certain individuals spend an extended period of their lives with poor cognitive health.
| S-EPMC8023372 | biostudies-literature
Project description:BackgroundIn 2020, primary care practices adopted telemedicine as an alternative to in-person visits. Little is known about whether access to telemedicine was equitable, especially among older patients. Our objectives were to (1) examine older adults' use of telemedicine versus in-person primary care visits and (2) compare hospitalization for ambulatory care sensitive conditions (ACSCs) between the groups.MethodsIn this retrospective cross-sectional study of 17,103 patients aged ≥65 years seen at 32 clinics in the Mid-Atlantic, primary care patients were classified into two groups-telemedicine versus in person-based on the first visit between March and May 2020 and followed up for 14 days. Using multivariable logistic regression, we measured the odds of being seen via telemedicine versus in person as a function of patient demographics, comorbidities, and week of study period. We then measured the odds of ACSC hospitalization by visit modality.ResultsMean age was 75.1 years (SD, 7.5), 60.6% of patients were female, 64.6% white, 28.1% black, and 2.0% Hispanic. Overall, 60.3% of patients accessed primary care via telemedicine. Black (vs. white) patients had higher odds of using telemedicine (adjusted odds ratio [aOR], 1.30; 95% CI, 1.14-1.47) and Hispanic (vs. not Hispanic) patients had lower odds (aOR, 0.63; 95% CI, 0.42-0.92). Compared with the in-person group, patients in the telemedicine group had lower odds of ACSC hospitalization (aOR, 0.78; 95% CI, 0.61-1.00). Among patients who used telemedicine, black patients had 1.43 higher odds of ACSC hospitalization (95% CI, 1.02-2.01) compared with white patients. Patients aged 85 or older seen via telemedicine had higher odds of an ACSC hospitalization (aOR, 1.60; 95% CI, 1.03-2.47) compared with patients aged 65-74.ConclusionsThese findings support the use of telemedicine for primary care access for older adults. However, the observed disparities highlight the need to improve care quality and equity regardless of visit modality.
| S-EPMC8497419 | biostudies-literature