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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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“These culturally sensitive PREM tools will lead to patient centred treatment approaches, improved clinical efficacy and quality of care [7].”
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“Regarding a lack of physician-patient racial concordance, Takeshita et al. found that Black patients who were treated by White or Asian surgeons were less likely to rate them favorably compared to those who saw Black surgeons [17].”
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“Previous studies demonstrate increased trust [49], comfort [50], and satisfaction [51] among patients who receive care from racially and ethnically concordant providers, a sentiment echoed by our participants.”
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“Racial and gender concordance between clinicians and patients was also prioritized to foster trust [48] and enhance engagement [49], particularly for minoritized patients who may have experienced medical discrimination.”
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“Studies across a range of medical disciplines have revealed that racial/ethnic concordance 36 , shared social characteristics 37 , and perceived personal similarity (partly influenced by physicians’ use of patient-centered communication) 38 are associated with positive patient experiences and care…”
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“Obesity disproportionately affects people from minority racial and ethnic groups in the United States [11], and patient-physician racial/ethnic concordance has been associated with improved patient experience ratings [12].”
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“In addition, Black patients are more satisfied with their care when they have Black physicians [4].”
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“34 Race concordance between physicians and patients has been associated with enhanced doctor-patient communication, 35 improved patient ratings of their experiences, 36 and increased adherence to physicians’ recommendations.”
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“45,48,54,55 Patient-level covariates included demographic (age, sex, race/ethnicity) and socioeconomic (health insurance, family income, education level, marital status) variables, as well as perceived general health status, two proxy measures for acculturation (US vs. foreign-born 56 and interview…”
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“The findings are also consistent with prior findings that racial and ethnic concordance results in higher patient satisfaction and perception of empathy [18, 19].”
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“38 Racial identity has been shown to influence the effectiveness of CHW interventions with Black adults.”
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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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