Managed care excludes black physicians, group says

Health systems accused of not hiring doctors, cutting off contracts

January 25, 2000|By Shanon D. Murray | Shanon D. Murray,SUN STAFF

WASHINGTON -- The National Medical Association charged yesterday that managed care organizations systematically exclude African-American physicians from their provider networks, limiting patients' ability to choose care from black doctors.

The NMA -- a medical society representing about 25,000 black doctors -- also drafted and endorsed a "prescription" for the HMO industry, including ensuring that managed care physician groups reflect the ethnic makeup of the patients they serve.

Not only are health plans not accepting African-American doctors, the group said, but they are also terminating the contracts of some who are members.

The NMA did not offer statistical evidence or name HMOs, but at a Washington news conference a panel of 10 doctors -- including some from Baltimore -- offered their experiences as signs of an industrywide problem.

Black doctors are routinely excluded from health plans primarily because they tend to serve mostly black patients who tend to be sicker and require more expensive medical care, said Walter W. Shervington, NMA's president and chief executive officer at New Orleans Adolescent Hospital.

"Sometimes business doesn't get it," he said. "If [health plans] can make money without expanding their provider networks, then why change?

"But patients should have choice, and as things stand now, there is no choice," he said, adding that studies have shown that patients respond to treatment better if they are treated by a physician of the same ethnic background, or one who is culturally sensitive.

An independent study of the situation does not support the doctors' allegation, and a representative of the industry denied that HMOs are discriminating against blacks.

A University of California at San Francisco study published in the March 4, 1998, Journal of American Medicine showed that nonwhite doctors were no more likely than white doctors to be denied or terminated from HMO contracts.

The study also showed that nonwhite doctors participated in HMOs in the same or greater numbers than white doctors. The study covered 13 large urban counties in California.

The doctors at the news conference acknowledged that they have little more than anecdotal evidence of any widespread move by HMOs to keep them out. But they said they hope greater public awareness will fuel further research and documentation.

"We all know there is a problem, but we haven't been able to quantify it yet," said Shervington. "No, we don't have a Harvard University study on this, but we know a problem exists."

Susan Pisano, spokeswoman for the American Association of Health Plans, a Washington-based trade group representing 1,000 health plans nationwide, denied the group's allegations but said the AAHP will request a meeting with the NMA to talk with the doctors about their experiences.

"We don't know as much as we need to know," she said. "We want to talk to the physicians firsthand to try and do what we can to address their concerns.

"It's in our interest, as well as our patients' interest, to have our networks be diverse," Pisano said.

The NMA launched its campaign primarily because of a recent case brought to the group's attention by Lenox S. Dingle Jr., a general surgeon who practices at Mercy Medical Center in Baltimore. Dingle said a patient who underwent a mastectomy for breast cancer in October opted for reconstructive surgery.

She wanted a black surgeon experienced in such operations, but her health plan referred her to a doctor who specialized in hand surgery, Dingle said.

Her appeals to go to another black surgeon outside the network were denied, as was the black surgeon's application to join the patient's health plan.

The patient's request for an exception was granted after a hearing in which the NMA participated, Dingle said.

The Associated Press contributed to this article.

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