HMO employment and African-American physicians.

Full Abstract

OBJECTIVES:
To assess the level and determinants of African-American physicians' employment in health maintenance organizations (HMOs), particularly early in their careers.

METHODS:
We analyzed data from the 1991 and 1996 Young Physicians Surveys to assess racial differences in the likelihood of HMO employment (n = 3,705). Using multinomial logistic regression, we evaluated four explanations for an observed relationship between African-American physicians and HMO employment:
human capital stratification among organizations, race-based affinity between physicians and patients, financial constraints due to debt burden, and different organizational hiring practices. Using binomial logistic regression, we also evaluated differences in the odds of being turned down for a prior practice position, of subsequently leaving the current practice organization and of later having career doubts.

RESULTS:
Without any controls, African-American physicians were 4.52 times more likely to practice in HMOs than Caucasian physicians. After controlling for human capital stratification, racial concordance and financial constraints, African-American physicians remained 2.48 times more likely to practice in HMOs than Caucasian physicians. In addition, 19.2% of African-American physicians in HMOs reported being turned down for another job, far more than any other racial/ethnic group in the HMO setting and any racial/ethnic group, including African-American physicians in the non-HMO setting (including all other practice locations). Five years later, those same African-American physicians from HMOs also reported significantly more turnover (7.50 times more likely than non-HMO African-American physicians to leave their current practice) and doubt about their careers (2.17 times more likely than non-HMO African-American physicians to express serious career doubts).

CONCLUSIONS:
African-American physicians were disproportionately hired into HMO settings, impacting their subsequent careers.

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Author information

Author/s: Briscoe, Forrest (F); Konrad, Thomas R (TR);

Affiliation: The Pennsylvania State University, 128 Willard Building, University Park, PA 16802, USA. fbriscoe(-atsign-)psu.edu

Grants: P01 HS 10861 (Agency:AHRQ HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.

Journal: Journal of the National Medical Association (J Natl Med Assoc), published in United States. (Language: eng)

Reference: 2006-Aug; vol 98 (issue 8) : pp 1318-25

Dates: Created 2006/08/18; Completed 2006/09/14; Revised 2007/11/14;

PMID: 16916130, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

African Americans
Career Choice
Female
Health Maintenance Organizations - manpower
Humans
Job Satisfaction

Male
Marketing of Health Services
Middle Aged
Physicians - supply & distribution
Retrospective Studies
United States

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