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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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“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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Self-citationMorris, O. J., Wiese, A., Pinciotti, C., Pacheco, R., Mallen, M. C. M., Schweissing, E. J., Soileau, K. J., Crowley, J. J., & Storch, E. A. (2024) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2024.88.2.148 · Cited by 9
Intersectionality and Social Drivers of Health in Cardiovascular Care
Hurwitz, M., Bonomo, J., Spitz, J. A., & Sharma, G. V. (2024) · Methodist DeBakey Cardiovascular Journal · doi:10.14797/mdcvj.1436 · Cited by 12
Singh, J. S., Brasher, S. N., Sarrett, J. C., Barger, B. D., Guerra, K. A. S., Dilly, L. J., Rubin, I. L., Stapel‐Wax, J. L., Benevides, T. W., & Fernàndez‐Carriba, S. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-024-02280-x · Cited by 12
“Emerging evidence suggests a positive effect of patient-provider race/ethnicity concordance in patient experiences [175, 176] and the value a responsive clinician can have on families’ ASD diagnostic experience, including Spanish-speaking immigrant families [177].”
Investigator racial diversity and clinical trial participation
Alsan, M. M., Campbell, R., Leister, L., & Ojo, A. (2025) · Journal of Health Economics · doi:10.1016/j.jhealeco.2025.102968 · Cited by 10
Oguro, N., Yajima, N., Miyawaki, Y., Yoshimi, R., Shimojima, Y., Sada, K., Hayashi, K., Shidahara, K., Sakurai, N., Hidekawa, C., et al. (2022) · The Journal of Rheumatology · doi:10.3899/jrheum.220678 · Cited by 10
Corbett, M., Allen, A., Bobo, N., Foggs, M. B., Fonacier, L. S., Gupta, R. S., Kowalsky, R. H., Martinez, E. M., Begolka, W. S., Zachary, C. Y., et al. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.12.017 · Cited by 10
Cultural Competence in the Care of LGBTQ+ Patients: A Primer for Breast/Chest Centers
Mehta, T. S., Thompson, J., Applegate, J. M., & Wahab, R. A. (2023) · Journal of Breast Imaging · doi:10.1093/jbi/wbad012 · Cited by 10
Robinson, S. G., Mandel, A. L., Nicosia, J., Siegel, J., & Jahromi, A. H. (2023) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000005009 · Cited by 10
Pugazenthi, S., Johnson, G. W., Lee, H., & Strahle, J. M. (2023) · Journal of neurosurgery · doi:10.3171/2023.3.jns23288 · Cited by 10
When I Don't see me, Am I seen? Race and student perception of the surgery clerkship
Zmijewski, P. V., Aleman, C., McLeod, C., Gillis, A., Sidani, M. A., Lynch, K. A., Parker, C. C., Lancaster, R. B., Lindeman, B. M., Chen, H., et al. (2023) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2023.12.005 · Cited by 10
Jolles, D. R., Montgomery, T. M., Breman, R. B., George, E., Craddock, J., Sanders, S., Niemcyzk, N., Stapleton, S. R., Bauer, K., & Wright, J. (2022) · The Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0000000000000647 · Cited by 11
Lee, D. N., Hutchens, M. J., George, T. J., Wilson-Howard, D. S., Cooks, E., & Krieger, J. L. R. (2022) · Medical Education Online · doi:10.1080/10872981.2022.2107470 · Cited by 12
Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality
Wheless, M. C., Lee, J. J., Domenico, H. J., Martin, B. J., Bennett, M. L., Martin, S. F., Berlin, J. D., Green, J. K., & Agarwal, R. (2023) · JCO Oncology Practice · doi:10.1200/op.23.00095 · Cited by 9
Reducing Racial Disparities in Maternal Healthcare: A Midwifery Focus
LoGiudice, J. A. (2022) · SAGE Open Nursing · doi:10.1177/23779608221138430 · Cited by 9
“Specifically, a study of 117,589 Press Ganey survey scores found that racial/ethnic concordance between a patient and their provider greatly improved the patient experience (Takeshita et al., 2020).”
BackgroundWilliams, V. M., Franco, I. “., Tye, K. E., Jagsi, R., Sim, A. J., Oladeru, O. T., Rivera, A., Toumbou, K., Suneja, G., Deville, C., et al. (2022) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2022.11.038 · Cited by 9
Germino, E., Saripalli, A. L., Taparra, K., Rattani, A., Pointer, K. B., Singh, S. A., Musunuru, H. B., Shukla, U., Vidal, G., Pereira, I. J., et al. (2023) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2023.02.003 · Cited by 9
The Effects of Holistic Admissions on Diversity in Nursing: A Literature Review
Manske, A., Johnson, T., & Brown, M. (2023) · Journal of Nursing Education · doi:10.3928/01484834-20230815-08 · Cited by 9
Race differences in patient trust and distrust from audio-recorded cardiology encounters
Hantzmon, S. V., Davenport, C. A., Gupta, M. N. D., Adekunle, T. A., Gaither, S. E., Olsen, M. K., Pinheiro, S. O., Johnson, K. S., Mahoney, H. R., Falls, A., et al. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.108083 · Cited by 9
Physician Workforce Diversity Is Still Necessary and Achievable if It Is Intentionally Prioritized
Vereen, R. J., & Wolf, M. F. (2024) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-024-01953-x · Cited by 9
“Patients detail higher experience ratings when they experience racial, ethnic, gender, and language concordance with their providers [4, 27, 28].”
McNeill, I. T., Carrasquilla, A., Asfaw, Z. K., Barthélemy, E. J., Mehr, A., Townsend, K. D., Joseph, A., Bederson, J. B., Butts, G. C., & Germano, I. M. (2022) · Journal of neurosurgery · doi:10.3171/2022.5.jns22196 · Cited by 9
Improving health equity through clinical innovation
Alfred, M. C., & Tully, K. P. (2022) · BMJ Quality & Safety · doi:10.1136/bmjqs-2021-014540 · Cited by 9
Diversity and Professional Advancement in Medical Physics
Rankin, J., Whelan, B., Pollard‐Larkin, J., Paradis, K. C., Scarpelli, M., Sun, C., Mehta, C. C., Farahani, K., & Castillo, R. (2022) · Advances in Radiation Oncology · doi:10.1016/j.adro.2022.101057 · Cited by 9
Ajayi, P. T., Murdock, C. J., Destine, H., Trenchfield, D. R., Aiyer, A. A., & Oni, J. K. (2023) · The Journal of Arthroplasty · doi:10.1016/j.arth.2023.05.048 · Cited by 9
Efforts in Undergraduate Medical Education to Improve Socioeconomic Status Diversity
Velasquez, D. E., Shrestha, A., & Matias, W. R. (2024) · Academic Medicine · doi:10.1097/acm.0000000000005942 · Cited by 8
Uncovering the Hidden Curriculum in Health Professions Education
Wolford, L. L., Lugo‐Neris, M. J., Liu, C. W., Nieves, L. E., Rodriguez, C. L., Patel, S. S., Lee, S. J., & Naidoo, K. (2025) · Education Sciences · doi:10.3390/educsci15070791 · Cited by 10
“Shared backgrounds have been linked to more patient-centered care (Cooper et al., 2003; Shen et al., 2018), better clinical outcomes (Takeshita et al., 2020), lower healthcare costs (Jetty et al., 2022), increased follow-through on clinical recommendations (Jetty et al., 2022; Traylor et al.,…”
Paguio, J. A., Golbin, J. M., Yao, J. S., Eala, M. A. B., Dee, E. C., & Yu, M. G. (2021) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2021.100158 · Cited by 8
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) · Gastroenterology · doi:10.1053/j.gastro.2022.06.059 · Cited by 8
Examining disparities in regional anaesthesia and pain medicine
Umeh, U. O. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.02.015 · Cited by 8
Metlock, F., Addison, S., McKoy, A., Yang, Y., Hope, A., Joseph, J. J., Zhang, J., Williams, A., Gray, D. M., Gregory, J. R., et al. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21040449 · Cited by 8
“The available evidence either supporting or refuting the effectiveness of concordance between the research team and participants is scant [45], yet this observation aligns with the existing literature on provider–patient communication during clinical encounters [46].”
ResultSanten, S. A., Gonzalez‐Flores, A., Coe, C. L., Partin, M. T., Brenner, J. M., Nalin, P. M., Macerollo, A. A., Cangiarella, J., Saavedra, A., & Leong, S. L. (2024) · Medical Science Educator · doi:10.1007/s40670-024-02043-7 · Cited by 8
“Patients of diverse backgrounds are better served with better outcomes when treated by physicians who are congruent with their background, making the case for increasing the diversity of the workforce [24].”
BackgroundA Report of Salaries of Academic Cardiothoracic Surgeons Based on Race and Ethnicity
Enofe, N., Tompkins, A. K., Cooke, D. T., Freeman, K. A., DiMaio, J. M., Merrill, W. H., Erkmen, C. P., Pereira, S., Erkmen, C. P., Backhus, L. M., et al. (2024) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2024.03.044 · Cited by 8
Muirhead, L., Harris, B. G., Kimble, L. P., Giordano, N. A., & McCauley, L. (2024) · Nursing Outlook · doi:10.1016/j.outlook.2024.102313 · Cited by 8
Metadata
- 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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