title: Physician implicit attitudes and stereotypes about race and quality of medical care.
abstract: BACKGROUND
  Recent reports speculate that provider implicit attitudes about race may contribute to racial/ethnic health care disparities.
  
  
  OBJECTIVE
  We hypothesized that implicit racial bias exists among pediatricians, implicit and explicit measures would differ and implicit measures may be related to quality of care.
  
  
  METHODS
  A single-session, Web survey of academic pediatricians in an urban university measured implicit racial attitudes and stereotypes using a measure of implicit social cognition, the Implicit Association Test (IAT). Explicit (overt) attitudes were measured by self-report. Case vignettes were used to assess quality of care.
  
  
  RESULTS
  We found an implicit preference for European Americans relative to African Americans, which was weaker than implicit measures for others in society (mean IAT score = 0.18; P = 0.01; Cohen's d = 0.41). Physicians held an implicit association between European Americans relative to African Americans and the concept of "compliant patient" (mean IAT score = 0.25; P = 0.001; Cohen's d = 0.60) and for African Americans relative to European Americans and the concept of "preferred medical care" (mean IAT score =-0.21; P = 0.001; Cohen's d = 0.64). Medical care differed by patient race in 1 of 4 case vignettes. No significant relationship was found between implicit and explicit measures, or implicit measures and treatment recommendations.
  
  
  CONCLUSIONS
  Pediatricians held less implicit race bias compared with other MDs and others in society. Among pediatricians we found evidence of a moderate implicit "perceived patient compliance and race" stereotype. Further research is needed to explore whether physician implicit attitudes and stereotypes about race predict quality of care.
authors.affiliation: University of Washington, School of Social Work, Seattle, Washington 98105-6299, USA. sabinja@u-washington.edu
authors.forename: Janice A
authors.initials: JA
authors.lastname: Sabin
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Greenwald
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D011287:Prejudice; D011787:Quality of Health Care; D013239:Stereotyped Behavior; D014481:United States