Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings
Open accessAbstract
Importance: The Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings. Objective: To evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance. Design, Setting, and Participants: A cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019. Exposures: Patient-physician racial/ethnic and gender concordance. Main Outcomes and Measures: The primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance. Results: In total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90). Conclusions and Relevance: In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.
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Previous studies on patient-clinician racial/ethnic or gender concordance have shown mixed or inconclusive results.
“Findings from these studies are varied: some suggest that patient-clinician racial/ethnic or gender concordance offers benefits [7-11], while others do not [12-14]. Moreover, a recent systematic review studying the association between racial, gender, and multifactorial concordance reported inconclusive results on patient outcomes, advocating for further research [15].”
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Clark, L. A., Shergina, E., Machado, N. M., Scheuermann, T. S., Sultana, N., Polineni, D., Shih, G. H., Simari, R. D., Wick, J., & Richter, K. P. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.46018 · Cited by 30 · see citing works
Superhuman, but never enough: Black women in medicine
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Racial and Ethnic Bias in Medical School Clinical Grading: A Review
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Racial Disparities in Barriers to Care for Patients With Diabetic Retinopathy in a Nationwide Cohort
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Factors and barriers that influence the matriculation of underrepresented students in medicine
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Paving the Way for Health Equity in Cardiology
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“Researchers found that delivery of health care between racially/ethnically concordant patientphysician dyads was associated with greater patient satisfaction (11).”
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Associations of Race, Ethnicity, and Social Determinants of Health With Colorectal Cancer Screening
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Surgical Care for Racial and Ethnic Minorities and Interventions to Address Inequities
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Inequities in Therapy for Infantile Spasms: A Call to Action
Baumer, F. M., Mytinger, J. R., Neville, K. L., Abath, C. B., Gutierrez, C., Numis, A. L., Harini, C., He, Z., Hussain, S. A., Berg, A. T., et al. (2022) · Annals of Neurology · doi:10.1002/ana.26363 · Cited by 27 · see citing works
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“4,5 6-8 Some evidence also suggests that perceptions of discrimination compel racially minoritized patients to seek care from clinicians with concordant racial identities.”
Is patients' trust in clinicians related to patient-clinician racial/ethnic or gender concordance?
Greene, J., Silver, D., Verrier, E., & Long, S. K. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.107750 · Cited by 26 · see citing works
Racial disparities in opioid administration and prescribing in the emergency department for pain
Kang, H., Zhang, P., Lee, S., Shen, S., & Dunham, E. (2022) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2022.02.043 · Cited by 26 · see citing works
Addressing Equity, Diversity, and Inclusion of Black Physicians in the Oncology Workforce
Winkfield, K. M., Levit, L. A., Tibbits, M., Melnick, E., Schenkel, C., Kirkwood, M. K., Green, S., & Pierce, L. J. (2021) · JCO Oncology Practice · doi:10.1200/op.21.00079 · Cited by 26 · see citing works
Glover, A., Holman, C., & Boise, P. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06491-2 · Cited by 25 · see citing works
“Racial con-cordance—having a shared racial identity between the patient and provider—has been associated with improved patient experiences [26, 27] and clinical care outcomes [28].”
BackgroundCultural Humility: Retraining and Retooling Nurses to Provide Equitable Cancer Care
Nolan, T. S., Alston, A. D., Choto, R., & Moss, K. O. (2021) · Clinical journal of oncology nursing · doi:10.1188/21.cjon.s1.3-9 · Cited by 28 · see citing works
Gott, M., Wiles, J. L., Mason, K. R., & Moeke‐Maxwell, T. (2022) · Palliative Medicine · doi:10.1177/02692163221138621 · Cited by 25 · see citing works
Lam, J. T. H., Coret, M., Khalil, C., Butler, K. J. D., Giroux, R., & Martimianakis, M. A. (2024) · Medical Education · doi:10.1111/medu.15425 · Cited by 26 · see citing works
Representation of American Indian and Alaska Native Individuals in Academic Medical Training
Forrest, L. L., Leitner, B. P., Guzmán, C. E. V., Brodt, E., & Odonkor, C. A. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.43398 · Cited by 24 · see citing works
Chan, A., McDermott, J. J., IV, Lee, T. C., Ye, G. Y., Shahrvini, B., Saseendrakumar, B. R., & Baxter, S. L. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269231 · Cited by 24 · see citing works
“Race discordance between patients and physicians is associated with lower patient satisfaction rating and lower rates of adherence to prescribed medications and medical interventions [23].”
BackgroundPatient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis
Reyes, A. M., Royan, R., Feinglass, J. M., Thomas, A., & Stey, A. M. (2023) · JAMA Surgery · doi:10.1001/jamasurg.2022.7055 · Cited by 23 · see citing works
Sex and Racial Disparities in Peripheral Artery Disease
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Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools
Boatright, D. B., Nguyen, M. T., Hill, K. A., Berg, D. N., Castillo-Page, L., Anderson, N., Agbelese, V., Venkataraman, S., Saha, S., Schoenbaum, S. C., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.0001 · Cited by 21 · see citing works
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Pineda, E., Benavente, R. V., Gimmen, M. Y., DeVille, N. V., & Taparra, K. (2023) · Cancers · doi:10.3390/cancers15051392 · Cited by 22 · see citing works
“for cultural connection and understanding between Micronesian patients and their physicians, which may strengthen the physician–patient relationship and improve healthcare delivery [124].”
BackgroundStructural Sexism and Cancer Care: The Effects on the Patient and Oncologist
Keenan, B. P., Barr, E., Gleeson, E., Greenberg, C. C., & Temkin, S. M. (2023) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_391516 · Cited by 22 · see citing works
Chary, A. N., Hernandez, N., Rivera, A. P., Santangelo, I., Ritchie, C. S., Ouchi, K., Liu, S. W., Naik, A. D., & Kennedy, M. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18897 · Cited by 22 · see citing works
“Although there is mixed evidence about impacts of racial/ethnic and gender concordance between patients and physicians on patient experience, outcomes, and communication, 37 – 39 language-concordant care consistently improves outcomes.”
BackgroundEstimating the Specialist Surgical Workforce Density in South Africa
Tiwari, R., Chikte, U. M. E., & Chu, K. (2021) · Annals of Global Health · doi:10.5334/aogh.3480 · Cited by 21 · see citing works
“Ethnic concordance between patients and their physicians has also been shown to improve patient satisfaction [25].”
BackgroundThree decades of demographic trends among academic emergency physicians
Manchanda, E. C. C., Ling, A. Y., Bottcher, J. L., Marsh, R. H., Brown, D., Bennett, C., & Yiadom, M. Y. A. B. (2022) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.12781 · Cited by 21 · see citing works
“The Forgotten Minority”: Perpetuation of Ableism in Medical Education
Haywood, C., Lagu, T. C., Salinger, M. R., López-Rosado, R., DeJong, C., & Iezzoni, L. I. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-024-09308-2 · Cited by 20 · see citing works
“43 There is a strong precedent for benefits of diversifying the workforce, 44,45 and yet, our findings added to growing recognition that PWD are discriminated against in the application and admissions process for medical school.”
Health Care Disparities and the Future of Pancreatic Cancer Care
Papageorge, M. V., Evans, D. B., & Tseng, J. F. (2021) · Surgical Oncology Clinics of North America · doi:10.1016/j.soc.2021.06.012 · Cited by 20 · see citing works
Crable, E. L., Drainoni, M., Jones, D. K., Walley, A. Y., & Milton, J. N. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108632 · Cited by 20 · see citing works
Experiences of race- and gender-based discrimination among Black female physicians
Chilakala, A., Camacho‐Rivera, M., & Frye, V. A. (2022) · Journal of the National Medical Association · doi:10.1016/j.jnma.2021.12.008 · Cited by 20 · see citing works
Gutierrez-Wu, J. C., Lawrence, C., Jamison, S., Wright, S. T., Steiner, M. J., & Orr, C. J. (2022) · Journal of the National Medical Association · doi:10.1016/j.jnma.2022.01.012 · Cited by 20 · see citing works
Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand
Rahal, H. K., Tabibian, J. H., Issaka, R. B., Quezada, S. M., Gray, D. M., Balzora, S., Yang, L., Badiee, J., & May, F. P. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001984 · Cited by 20 · see citing works
Hynson, E., Bloomer, J., Samson, Z., Price, K., Tran, D., & Muench, U. (2022) · Policy Politics & Nursing Practice · doi:10.1177/15271544221118319 · Cited by 20 · see citing works
“Evidence suggests that race concordance between providers and patients can help increase access to care, improve patient outcomes, and increase patient satisfaction (Alsan et al., 2019; LaVeist & Nuru-Jeter, 2002; Takeshita et al., 2020).”
BackgroundCanavan, M., Wang, X., Ascha, M. S., Miksad, R. A., Showalter, T. N., Calip, G. S., Gross, C. P., & Adelson, K. B. (2023) · Journal of Clinical Oncology · doi:10.1200/jco.22.02180 · Cited by 20 · see citing works
Increasing URiM Family Medicine Residents at University of Utah Health
Stoesser, K. L., Frame, K. A., Sanyer, O. N., Leiser, J. P., Moreno, L. E., Bosch, C., Jones, J. L., Morales, J., Rodríguez, S. R., Wilson, J., et al. (2021) · PRiMER · doi:10.22454/primer.2021.279738 · Cited by 20 · see citing works
“Our leaders sought a way to increase URiM resident recruitment with (1) a more comprehensive review of applications, (2) deemphasis of traditional academic achievement markers, (3) inclusion of a resiliency scale, and (4) increasing the relative weight of this scale, summarized in Table 5.”
MethodHow to Create a Diversity, Equity, and Inclusion Curriculum: More Than Checking a Box
Henry, T. L., Rollin, F. G., & Olakunle, O. E. (2024) · The Annals of Family Medicine · doi:10.1370/afm.3078 · Cited by 21 · see citing works
“20-22 To most effectively promote an understanding of how racism affects the current health care system and patient outcomes, it is imperative to integrate a DEI and antiracism curriculum throughout the 4 years of medical education.”
BackgroundPatient-physician sex concordance and outcomes in cardiovascular disease: a systematic review.
Harik, L., Yamamoto, K., Kimura, T., Rong, L. Q., Vogel, B., Mehran, R., Bairey-Merz, C., & Gaudino, M. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae121 · Cited by 19 · see citing works
An Analysis of Underrepresented in Medicine Away Rotation Scholarships in Surgical Specialties
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Practical Strategies for Underrepresented Minority Recruitment in General Surgery Residency
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Health and Well-Being of Intensive Care Unit Physicians
Klick, J. C., Syed, M., Leong, R. L., Miranda, H. G., & Cotter, E. K. H. (2023) · Anesthesiology Clinics · doi:10.1016/j.anclin.2022.10.009 · Cited by 19 · see citing works
“The lack of diversity can significantly impact culturally mindful delivery of health care.(44) The Association of American Medical Colleges collects data on diversity, and their report from 2019 shows that women comprise 35.”
Patient Preferences and Perceptions of Provider Diversity in Orthopaedic Surgery
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“Conversely, patients have tended to report higher satisfaction ratings in patient-physician dyads where there was racial and gender concordance 11,12 .”
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The Value of Diversity, Equity, and Inclusion in Otolaryngology
Francis, C. L., Cabrera‐Muffly, C., Shuman, A. G., & Brown, D. J. (2021) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2021.07.017 · Cited by 19 · see citing works
Bialosky, J. E., Cleland, J. A., Mintken, P. E., Beneciuk, J. M., & Bishop, M. D. (2021) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2021.1989754 · Cited by 18 · see citing works
“for those individuals who have a preference for provider race or ethnicity increases the likelihood of satisfaction with care [28,47].”
BackgroundAssociation of applicant demographic factors with medical school acceptance
Perez, M. A., Williams, C., Henderson, K., McGregor, R., Vapiwala, N., Shea, J. A., & Dine, C. J. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04897-8 · Cited by 17 · see citing works
“Moreover, research has demonstrated that medical student and physician diversity is associated with improved educational experiences as well as patient outcomes [11– 14].”
BackgroundGagnon, K. W., Quinn, K. G., Walsh, J. L., Amirkhanian, Y. A., & Kelly, J. A. (2025) · BMC Family Practice · doi:10.1186/s12875-025-02900-3 · Cited by 17 · see citing works
“Previous research has shown that representative healthcare providers improves patient care and health outcomes, in part because of shared lived experience described by participants in our study [38, 39].”
Racial Disparities in the Utilization of Shoulder Arthroplasty in the United States
Farley, K. X., Dawes, A. M., Wilson, J. M., Toston, R. J., Hurt, J. T., Gottschalk, M. B., Navarro, R. A., & Wagner, E. R. (2022) · JBJS Open Access · doi:10.2106/jbjs.oa.21.00144 · Cited by 17 · see citing works
Promoting diversity in neurosurgery through a virtual symposium
Charles, A. J., Seas, A., Corley, J. A., Duvall, J. B., Owolo, E. S., Abu-Bonsrah, N. A., Elsamadicy, A. A., Simpson, V. M., Sanusi, O. R., Holly, L. T., et al. (2023) · Journal of neurosurgery · doi:10.3171/2023.1.jns221743 · Cited by 18 · see citing works
Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care
Hascher, K., Jaiswal, J., LoSchiavo, C. E., Ezell, J. M., Duffalo, D., Greene, R. E., Cox, A. B., Burton, W. M., Griffin, M., John, T., et al. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-08635-8 · Cited by 19 · see citing works
“23,83 88 As there is limited knowledge specific to the role of sexual orientation concordance, future research should explore this with attention to the context of PCC. Providers must be competent in the knowledge and clinical skills required to care for SMM so that patients who identify as SMM can…”
BackgroundYouth preferences for healthcare providers and healthcare interactions: a qualitative study
Waselewski, M. E., Amaro, X., Huerto, R., Berger, J., da Silva, M. S., Siroky, K., Torres, A., & Chang, T. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02300-z · Cited by 17 · see citing works
“Patients may experience improved adherence, more timely healthcare delivery, greater shared decision-making, better communication, and higher satisfaction when seen by racially concordant providers [5, 9–17].”
BackgroundExploring Biologic Treatment Hesitancy Among Black and Indigenous Populations in Canada: a Review
Akuffo‐Addo, E., Udounwa, T., Chan, J., & Cauchi, L. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01282-x · Cited by 17 · see citing works
- Authors
- Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L.
- Affiliations
- University of Pennsylvania (US)
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Corresponding author
- Takeshita, Junko
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2020-11-09
- Volume
- 3
- Issue
- 11
- Pages
- e2024583
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC7653497
- OpenAlex
- W3099608639
- Cited by
- 697
- References
- 41
- Citations by year
- 2026: 81 · 2025: 152 · 2024: 159 · 2023: 140 · 2022: 111 · 2021: 51 · 2020: 1
- FWCI
- 79.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- University of Pennsylvania
- National Institutes of Health
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR068433)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- gender concordance, physician-patient relationship, patient experience, racial disparities, Black patients, Asian patients, physician gender, outpatient care, patient satisfaction, health care delivery improvement, Philadelphia
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Delivery of Health Care, Ethnicity, Female, Gender Identity, Humans, Male, Middle Aged, Pennsylvania, Physician-Patient Relations, Physicians, Quality of Health Care, Surveys and Questionnaires, Universities, Patient Satisfaction, Patient Outcome Assessment
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