The authors of a recently published paper found racial segregation affects patients’ selection of where to undergo elective, same-day surgery.1

Researchers compared two boroughs in New York City: Manhattan and the Bronx. Although the two communities are adjacent, they are markedly different, according to Numa Pompilio Perez, MD, a study co-author and general surgery resident, Massachusetts General Hospital in Boston.

“Manhattan is the richest borough in New York City, and the Bronx is the poorest,” Perez says. “Manhattan has the majority of academic medical centers and more top-rated hospitals.”

Perez and colleagues examined elective cardiothoracic, colorectal, general, and vascular surgeries. White patients who lived in the Bronx were significantly more likely than black patients to undergo elective surgery in Manhattan operating rooms.

“After adjusting for age and race, putting it all together with a comorbidity score, and adjusting for everything, we saw that whites are 2.7 times more likely than blacks to leave the Bronx and get their care in Manhattan,” Perez reports.

Investigators stratified data by race to see if differences persisted when they looked at only Medicare patients, for whom care is supposed to be equal. “Medicare is everywhere, and there should be no difference in access,” Perez argues. “But even for people who had Medicare, whites were two times more likely than blacks to leave the Bronx and get their care in Manhattan.”

Perez and colleagues compared these findings to the 1950s and 1960s when white Americans began leaving cities for the suburbs to separate from other populations. “This kind of movement, and these choices of where you get your surgery, are reminiscent of that,” Perez offers. “They’re concerning because we could potentially end up with a healthcare system where whites get their care in one place and blacks and others get their care in another place.”

While the authors shed light on the trend, they could not find a definitive answer for why white patients choose to undergo surgery in Manhattan and black patients do not. “Even among Manhattan residents, racial minorities were more likely to leave Manhattan and go to the Bronx, so it was bidirectional,” Perez says.

One theory is that Bronx hospitals seemed more welcoming to racial minorities because there are more minorities on staff, Perez suggests. “We may say that our doors are open to anyone who wants to come in,” he adds. “How do these racial minorities feel when they come to your door?”

Perez suggests asking several questions: If all patients see are paintings of illustrious white founders, how does that make them feel as African Americans? If a patient is Hispanic, is there a single interpreter around? How does it make a minority patient feel if the things that patient needs are considered an afterthought? Are facilities staffed with any healthcare providers who look like minority patients?

“There are decisions a healthcare organization can make when they are staffing, decorating, and figuring out the necessary resources to make a population feel welcome,” Perez says. “We are not closing our doors to racial minorities, but we’re failing to do certain things that make them feel welcome.”

When hospitals and surgery centers choose new locations, they might also consider satellite locations in minority communities. Although there are financial and other considerations, organizations still can make decisions to structure their geographical footprint in their area and to appeal more to minority patients. Provide help with payer information and make people feel welcome.

“People make choices, and go to the hospital system where they feel more welcome and feel like they belong,” Perez says. “Then, one family tells the next person about their experience.”

REFERENCE

  1. Perez NP, Stapleton SM, Tabrizi MB, et al. The impact of race on choice of location for elective surgical care in New York City. Am J Surg 2020; Jan 24. pii: S0002-9610(20)30044-1. doi: 10.1016/j.amjsurg.2020.01.033. [Epub ahead of print].