Black patients more likely to perceive racial bias from orthopaedic surgeons, finds study

Black patients report more difficulties relating to their orthopaedic surgeon and are more likely to perceive bias from their surgeon, as compared with White patients, reports a study in the Journal of Bone and Joint Surgery.

"Black patients were six times more likely to report difficulty relating to their surgeon and 14 times more likely to report perceived racial bias compared with their White counterparts," according to the survey study by Marsalis Brown, MD, of University Hospitals—Cleveland Medical Center, and colleagues. The research also shows race- and gender-related differences in patient preferences for orthopaedic surgeons with specific characteristics.

Survey shows racial differences in patient experiences

The study evaluated patients' experiences, perceptions, and preferences related to diversity in orthopaedic surgery. The survey included 349 patients seen at orthopaedic clinics within the authors' health system. About 80% of respondents were White and 18% were Black; only about three percent were Hispanic.

The results showed differences in patient experiences between racial groups. Black patients were more likely to report difficulties relating to their orthopaedic surgeon, as compared with White patients: 11.48% versus 2.29%. Black patients were also much more likely to perceive racial bias from their surgeon: 5.17% versus 0.37%.

Patients perceived low levels of diversity within orthopaedic surgery (average rating of 2.5 out of 10) with only a small difference between Black and White patients (2.10 versus 2.57). Black patients ranked race as a more important factor to consider when selecting a surgeon: average rating 3.49 compared with 1.45 for White patients.

Women report more difficulty relating to their orthopaedic surgeon

Women were about five times more likely to report difficulty relating to their surgeon. Although male and female patients had similar perceptions of diversity in orthopaedic surgery, women placed more importance on their surgeon's gender.

The study also found some differences according to patient income and education, with more-educated patients perceiving lower diversity among surgeons. That perception is consistent with the slow rate of change in representation of racial and ethnic minorities and women in orthopaedic surgery, which lags behind other surgical specialties.

The findings are especially important in light of recent studies, which have shown that diversity leads to higher patient satisfaction, greater adherence to recommended treatment, and improvement in the patient-physician relationship.

"Despite the ongoing education reforms to encourage increased diversity during trainee selection, the impact of such efforts is yet to manifest as changes in patient perceptions in current practice settings," Dr. Brown and co-authors write. They discuss the critical need for reforms early in medical education, including early exposure to orthopaedic surgery, improving access to mentors, and steps to improve retention through each educational level.