BY TIM BONFIELD
The Cincinnati Enquirer
A group representing most of Cincinnati's black physicians claims the way many managed-care health plans do business disproportionately excludes black doctors from their networks.
The Cincinnati Medical Association plans a press conference this evening to detail its concerns. The group does not accuse health plans of outright racism. Instead, it says most health plans are not being sensitive enough to black patients who often prefer to see black doctors.
"Racial diversity is just as important as geographic access," said Dr. Camille Graham, a pediatrician and president of the Cincinnati Medical Association. "I have people who come to me from 30 miles away because I'm black. The insurance companies are not hearing that message."
Racial issues in medicine have surfaced rarely in recent years. But several black doctors contacted by The Cincinnati Enquirer -->say things are getting worse for black patients and doctors as the health-care system evolves.
"We're just seeing the beginning of this," Dr. Graham said. "All of us are fearful that this will become a trend. If that happens, 10 years from now there won't be any African-American physicians in Cincinnati."
Black physicians make up about 2 percent of the estimated 4,500 practicing physicians in Greater Cincinnati, slightly less than the national average of 3 percent. Yet Dr. Graham said black doctors actually treat most of the black patients in the area, who comprise about 12 percent of the metro-area population and 38 percent of the city of Cincinnati.
The preference for black doctors among black people is no different from a Jewish person who prefers a Jewish doctor or a woman who prefers seeing a female gynecologist.
"I don't think you would find many health plans today that still have all-male ob - gyn panels," Dr. Graham said.
Yet in many specialties, such as cardiology or urology, there are only one or two black doctors in town. That means when a health plan drops even one black doctor, it becomes a much bigger issue than dropping one or two white doctors.
"I'm extremely concerned," said Dr. Walter Broadnax, one of the area's two black neurologists. "As a solo practitioner I have seen managed care cut into my practice. If you're not on the panels, you don't get to see the patients."
The Cincinnati Medical Association specifically criticized a recent decision by Anthem Blue Cross & Blue Shield to drop two black orthopedic surgeons from its Anthem Series 200 and Community Choice plans. They were the only two black doctors in town doing adult orthopedic surgery.
One of them, Dr. Clyde Henderson, also is president of the Cincinnati Orthopedic Society, and was involved in launching a union that represents more than 85 orthopedists in town.
"I don't know what their motives are," Dr. Henderson said. "All I know is that we were dropped without cause. We tried to have meetings with (Anthem), but information was not forthcoming."
In July, Anthem officials said the cuts were made because the Series 200 plan had too many doctors. On Wednesday, Anthem spokeswoman Kendra Overbeck said there were no anti-union or racial issues involved. In fact, Anthem does not know the race of the 2,000-plus doctors in its various health plans because it doesn't ask, she said.
"We do not base any of our decisions about providers on sex, race, ethnic background, religion or nationality," Ms. Overbeck said.
Whether a health plan's business decisions are color-blind, black doctors say they feel the pinch even more than white doctors.
"I don't see anything sinister going on, but I do see a strong lack of sensitivity from some of these large health plans," said Dr. Joe Hackworth, a black cardiologist and a former president of the Academy of Medicine of Cincinnati.
HMOs spend a lot of time and money rating doctors to decide which ones get on their networks. Factors include whether doctors see high volumes of enrolled patients or incur high costs when treating patients. HMOs also prefer doing business with larger groups of doctors.
All these business strategies work against black doctors. Many black primary care doctors can look bad on the cost side because they see higher-than-average volumes of low-income patients, who tend to suffer more health problems.
Many black specialists, who depend heavily on referrals from black primary care doctors, have lower patient volume than competing white specialists. That's bad news for black doctors when an HMO decides it has too many specialists.
Meanwhile, very few black doctors are members of large groups. That's partly because their patients like it that way and partly because black doctors are not invited or do not want to join white-dominated groups.
Now, black doctors say health plans -- and employers who make health-benefit decisions -- need to pay more attention to diversity.
"This is not just a local issue. Call any five cities and you'll find that black doctors there are concerned about access to managed-care panels as well," said Dr. O'dell Owens, former University of Cincinnati trustee and infertility specialist who now runs the women's health program for the Franciscan Health System.
If seeing a black doctor increases trust for a patient, that person will be more likely to get regular screening tests, follow instructions for medications, maybe even listen when the doctor says stop smoking or cut back on high-fat foods, Dr. Owens said.
"For patients, it does make a difference," he said.
