Racial, ethnic discrimination against patients is impacting care, healthcare workers say

Nearly half of U.S. healthcare workers have seen racial or ethnic discrimination against patients firsthand, and more agree that it’s either a major problem or a crisis, according to a recent Commonwealth Fund survey.

The poll of 3,000 healthcare workers, which oversampled less represented worker races/ethnicities, suggests that many respondents believe patients can receive disparate care based on their demographics. It also found that dealing with discrimination is a substantial source of stress for many healthcare workers.

“Even among those demographic groups less likely to report witnessing discrimination, the percentages saying they have witnessed discrimination remains troublingly high,” the foundation wrote in its report, which was released Feb. 16 and reflects findings from six healthcare worker focus groups alongside the survey. “Our results reflect a problem recognized by significant percentages of healthcare workers across race, ethnicity, gender, age, region of the country, job type and type of healthcare facility.”

Forty-seven percent of the survey’s respondents reported seeing discrimination against patients in their workplaces, with almost three-quarters of these saying they had seen it within the past three years.

Those who said they had seen it were more often Black, Latino or younger, according to the report. The reports of observed discrimination were also more frequent among the respondents who had worked in facilities with mostly Black or mostly Latino patients and lower in regard to facilities with mostly white patients or no clear majority.

Forty-eight percent of survey respondents said they believed medical providers are more accepting when a white patient advocates for themselves as opposed to a patient of color doing the same. Fifty-seven percent said that patients who speak a language other than English don’t always receive equal treatment quality as those who do speak it.

Of note, the Commonwealth Fund highlighted that responses affirming the prompt around self-advocacy were 20% higher among Black survey respondents. For the language prompt, agreement was 15% higher among Latino healthcare workers.

“The higher agreement among Black and Latino healthcare workers indicates that they have unique observations on quality of care when it comes to the racial or ethnic communities to which they belong,” the group wrote. “These unique observations may be just one reason to value a diverse workforce.”

In total, 52% of the survey’s respondents considered discrimination toward patients to be a major problem (33%) or a crisis (19%), with higher reports of concern among younger, Black or Latino healthcare workers. Those aged 60 or older were less likely to indicate racism against patients as a major issue or crisis, though a third still did.

Forty-seven percent of the survey respondents said that, within the past five years, racism or discrimination in the healthcare field has been a source of some (31%) or a lot (16%) of personal stress—the latest sign of widespread stress prevalent across the healthcare workforce. Just under half of Black, Latino and Asian American/Pacific Islander respondents placed themselves in the “a lot of stress” camp, and stress was more frequent among those who worked at facilities with mostly Latino or Black patients.

A recent study found that healthcare workers who witness racism by other clinical staff often lack options allowing them to discuss and report such experiences,” the report’s authors wrote. “Our research indicates that healthcare workers also struggle with the added emotional labor of dealing with discrimination in their workplaces—a heightened concern for those attempting to recruit and retain nurses, physicians and other staff of color.”

In search of solutions, the Commonwealth Fund floated various potential strategies health system leaders and policymakers could adopt to address discrimination against patients.

Those that were deemed “somewhat effective” or better by at least two-thirds of the sample included: anonymous reporting channels, regular examination of policies for equitable outcomes, required classes on discrimination at professional schools, more opportunities to listen to people of color, evaluation of how non-English-speaking patients are treated and healthcare worker training to spot discrimination.

The Commonwealth Fund fielded its survey from March 14 to April 5, 2023. The 3,000-person sample included 450 Asian American/Pacific Islander healthcare workers, 549 Black workers, 550 Latino workers, 1,266 white workers and 185 others. It came just a few months after 41 participants of various backgrounds and healthcare workplaces participated in six focus groups.

The group’s findings may not come as a shock to many in the industry. A recent poll of nearly 1,000 nurses from the Robert Wood Johnson Foundation found plenty of firsthand reports of racism or discrimination, either from colleagues in the healthcare workforce or from the patients themselves.

Another study released last summer by the Urban Institute found evidence that Black parents were more likely than others to report that their children were treated unfairly during care due to their race or ethnicity, country of origin or primary language. These often led to disruptions in care.