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Racial inequality even affects how long we wait for the doctor

(David McNew/Getty Images)

To medicine's long list of racial disparities, add this: Minorities wait much longer to see the doctor.

For years, grim statistics have revealed the rampant and widespread disparities in the health of Americans of different races. Black Americans are more likely to be obese than white Americans. Minorities are more likely to have diabetes than whites. Black women are more likely to have heart failure, coronary heart disease, hypertension and strokes than white women. Black Americans experience a higher incidence of cancer and are more likely to die from cancers that we know how to effectively treat.

These jarring inequities have drawn attention to differences in access to high-quality care. A brief study published Monday in JAMA Internal Medicine highlights one possible underlying factor: the total time it takes for people to see a health-care professional. That burden was 25 percent longer for minorities and unemployed people. And it wasn't because they were spending more time with the doctor, as the graph below shows:

Instead, the differences appeared as part of the "clinic time" — defined as the time spent waiting for or receiving care. White Americans spent 80 minutes waiting for or receiving care. Black Americans, on the other hand, spent 99 minutes receiving care, on average, and Hispanic patients spent 105 minutes.

Since the face-to-face time with a doctor was nearly identical across racial and ethnic groups, at about 20 minutes, the data suggest that minorities are spending more time interacting with the medical system in other ways: by waiting, or by engaging with the administrative parts of medicine. Black and Hispanic people also spent nearly 10 minutes longer traveling to their appointments, which added to the time cost of going to the doctor.

The authors and an accompanying editorial acknowledge that some of the difference may be accounted for because people are seeking care in different kinds of clinics.

"It does not change the underlying implications that disparities in timeliness to obtaining care exist for more vulnerable patient populations," the editors of the journal wrote."This study characterizes a problem we all know to exist."

Over the years, there has been growing interest in examining what factors may play into the striking differences in the health of white people and minorities. These include the "social determinants of health" — lifestyle factors as basic as where a person is born and who his or her parents are and how wealthy the family is. But they also include potential bias from the health-care system, where, for example, there are notoriously few black doctors.

Alexander Green, associate director of the disparities solution center at Massachusetts General Hospital, said that the data isn't always clear about how bias manifests. Years ago, he administered a test of unconscious racial bias to physicians. Those who harbored unconscious biases that black people were less cooperative with medical procedures were less likely to recommend aggressive treatment when reviewing the chart of a patient suffering chest pains with a photo of a black face — rather than a white face.

While the types of clinics where the patients are being seen are likely to play a role in the longer wait times, Green said it's possible that unconscious bias plays a subtle role, too.

"It could be bias, conscious or unconscious, on the part of providers, or other staff that work at the site where they're receiving care," Green said. "Wait times are something very subjective, in that it could be any number of reasons it might seem justified in the mind of a provider or a staff member to have this person waiting a little bit longer: 'I know this person better and I'll squeeze them in first,' or being concerned the visit is going to take longer."