Background & Aims
?on-Hispanic White populations are regularly over-prescribed opioids and other analgesics, which leads them to bear a greater burden of the opioid epidemic. At the same time, minoritized individuals and women are typically under-prescribed pain medication relative to clinical guidelines and experience poor pain management outcomes. While trying to understand the underlying mechanisms of this phenomenon, most studies focus on the patient demographics, often ignoring the demographics of the clinicians. To examine effects of clinician demographics and socioeconomic status (SES) on pain management decisions, we conducted a study through Zoom where medical trainees participated in simulated telemedicine appointments with mock shoulder injury patients of different demographics.
Methods
71 medical trainees (38 female, 33 male) from 26 different states attended a single 3.5-hour experimental session on Zoom. During the visit, they each interacted with 4 – 6 mock shoulder patients, collected their medical history, assessed their injury, conducted a medical exam, and made pain assessment and treatment decisions. All variables were added to a single Structural Equation Model (SEM) to test the contributions of clinician characteristics (gender, ethnicity, race, socioeconomic status (SES) of their neighborhood, demographic sensitivity stereotypes, opioid attitudes, medical experience) to their pain assessment and treatment decisions. The patients were assigned similar profiles, were trained by the researchers, and identified as one of the 3 demographic groups: non-Hispanic Black, non-Hispanic White, and Hispanic White. The clinician-patient dyad was gender-matched and the unit of analysis with a total of 405 dyadic interactions.
Results
Our results showed that the clinician’s demographics (SES and self-reported racial and ethnic identity) played a significant role in their decisions: Non-Hispanic clinicians prescribed more opioids than Hispanic clinicians, but White clinicians (Hispanic and non-Hispanic) prescribed more nonopioids than Black, Asian, or Biracial clinicians. At the same time, non-White clinicians assessed all groups of patients as more sensitive to pain, more probable to abuse opioids and rated patient pain higher in unpleasantness than White clinicians. Finally, the lower the SES of the clinician’s neighborhood, the more pain sensitivity they associated with typical people from all demographic groups and the more intense they would assess the pain of their patients.
Conclusions
Overall, our results show that clinicians identifying as non-Hispanic White or living in higher SES neighborhoods rate their patients’ pain and their patient’s demographic group’s sensitivity as lower but are more likely to prescribe opioid and nonopioid analgesics than clinicians from minoritized racial or ethnic groups and deprived neighborhoods. These results are of particular importance since most of the doctors in the U.S. identify as non-Hispanic White. Our findings underscore the importance of diversifying the physician workforce in the U.S. and provide empirical evidence that diversification may help reduce undertreatment of minoritized patients.
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