Managed Care ‘Strangling’ Black Doctors, Kansas City Star Columnist Writes

Managed care's "rechanneling of dollars" has "slowly strangle[d]" black physicians' private practices, redirecting patients to white doctors with larger and perhaps more "cost-effective" practices and, thereby hurting the physicians who "had been the backbone of the black middle class," Kansas City Star columnist Lewis Diuguid writes. He quotes health care consultant Delia Young, who says, "Managed care has devastated the entire provider spectrum of health care. But anything that's a blow to the larger community is always going to be 10 times as tenacious to our fragile community." Thirty years ago, most black doctors were in private practice, and treated 95% of the black population. Today, however, two-thirds of black physicians are salaried employees and 67% of black patients see white doctors, a transition that has been "costly to the black community in the loss of businesses, jobs and doctors," Diuguid writes. Black physician practices, often smaller and hence viewed as less cost-efficient, have been largely excluded from managed care provider lists, with many of their patients subsequently rerouted to larger white physician groups, several black Kansas City physicians say. Diuguid writes that sometimes the exclusion of black physicians from managed care contracts is also "tied to the bias that they aren't as good in caring for patients or in generating revenue as white doctors are." The trend has significant social consequences, Diuguid says, creating access problems for urban patients whose new doctors reside in suburban areas and leaving black doctors with sicker patients who "have fewer means to pay." This "silent assault" on black physician practices also raises the issue of whether blacks receive "culturally competent care," or adequate care at all: Diuguid writes that a May study in the Journal of the American Medical Association found that black patients, along with those who lived in rural areas or had low incomes, did not receive regular mammograms for breast cancer survivors and yearly vision tests for patients with diabetes. Further, a Johns Hopkins study last year found that minority patients encountered more difficulty in scheduling physician appointments, waited longer to see doctors and were less likely to be referred to specialists. Diuguid concludes, "The system is strangling the black community, its physicians and residents. Managed care must be fixed if that choke hold is to end so true healing can take place" (Diuguid, Kansas City Star, 12/5).