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African-American physicians were much more likely than white physicians to practice in HMOs in the 1990s

African-American physicians were 4.5 times more likely than white physicians to practice in HMOs in the 1990s. After controlling for greater debt among black physicians, the tendency of African-American physicians to locate in settings with more African-American patients (such as HMOs), and organizational hiring tendencies, African-American physicians were still 2.5 times more likely to practice in HMOs than white physicians. They were also one-third as likely to be academic physicians or physicians in large group practices, and two-thirds as likely to be hospital physicians as their white colleagues.

There are several reasons why more African-American physicians worked for HMOs in the 1990s, explain Forrest Briscoe, Ph.D., of Pennsylvania State University, and Thomas R. Konrad, Ph.D., of the University of North Carolina.

In many cases, HMOs were not the first choice for new physicians. HMOs were often considered less desirable practice locations, with lower remuneration and prestige. This led physicians with marginally better qualifications to avoid them, leaving those with poorer qualifications (a disproportionately larger number of African-American physicians) to accept employment in them with little choice. Similarly, HMOs provided a guaranteed steady income and did not require the capital expenditure typically required by partners in private practices. This was appealing to African-American physicians, who were usually more financially burdened after medical school than their white colleagues.

However, African-American physicians in this study weren't particularly happy with their HMO choice. For example, nearly one-fifth (19 percent) of them reported being turned down for another job compared with 11 percent of non-HMO African-American physicians. Five years later, the same African-American physicians from HMOs were 7.5 times more likely than non-HMO African-American physicians to leave their current practice, and twice as likely to express serious doubts about selecting a career in medicine.

These findings were based on analysis of data from the 1991 and 1996 Young Physicians Surveys of 3,705 U.S. physicians who completed residency between 1986 and 1989. The study was supported in part by the Agency for Healthcare Research and Quality (HS10861).

More details are in "HMO employment and African-American physicians," by Drs. Briscoe and Konrad, in the August 2006 Journal of the National Medical Association 98(8), pp. 1318-1325.

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