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Minority Doctors Skeptical of Health Reforms : Medicine: Black doctor says he has been target of bias in peer reviews. He and others fear expansion of managed care plans run primarily by Anglos would harm minority physicians and patients.

June 01, 1993|DOUGLAS P. SHUIT | TIMES STAFF WRITER

Dr. Patrick Chavis, a Compton obstetrician and gynecologist who delivers about 1,000 babies a year, has this fantasy: He puts on a suit of armor and goes into the delivery room clad in metal from head to toe.

"I would do my deliveries in armor, so they wouldn't know I was a black man. I'd be a hell of a doctor. They would say: 'Look at Dr. Chavis, coming in here every day and kicking butt. What a man!"' said Chavis, 40.

But there is no suit of armor to shield Chavis.

Instead, Chavis and other African-American and Latino physicians in California--the two largest underrepresented minority groups in medicine--must battle on a daily basis the vexing problems of being minorities among the mostly white ranks of medical doctors.

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For Chavis, this has meant disciplinary actions taken against him by panels of all-white physicians and the humiliating experience of having another physician look over his shoulder while he treated his patients. It meant being singled out for criticism on procedures that white physicians performed without a question being raised, he said. And it also meant watching angrily as his patients, most of whom are receiving public assistance under the Medi-Cal program, were ushered into a room, known as "the Medi-Cal room," that was separated from private patients.

Chavis said his experience as a black physician in a white world went something like this: "If you say anything, you become a troublemaker. If you sue anyone, then you become litigious. If you aren't always smiling, then something is wrong with you. Then, if you are always smiling, they say: 'Dr. Chavis must be overstretched. He deals with all these patients and he is still happy. Something must be wrong.' "

All this led to headaches, loss of sleep and, ultimately, the filing of a lawsuit alleging racial discrimination against Long Beach Memorial Medical Center.

Chavis won the lawsuit in September, and a jury awarded him damages of $1.1 million. Since then, a judge overturned the jury's verdict, appeals have been filed and there could be another trial.

Beyond the immediate issues raised by his problems at Long Beach Memorial, the Compton physician's experiences underscore some of the key problems health officials are wrestling with as they attempt to overhaul public and private health care delivery systems.

Many health care professionals believe that African-American and Latino physicians, along with their patients, will be especially vulnerable if there is a wholesale shift of public patients away from the traditional fee-for-service system into "managed care" plans, as is being contemplated in Washington, Sacramento and around the country.

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The fears spring from the kind of experience related by Chavis and the historical problems of exclusion and inequality in the health industry that skew along racial and ethnic lines, such things as who gets health insurance and how much health care executives earn.

A recent nationwide study published in the Journal of the American Medical Assn. found that 39% of Latinos under age 65--or 7.2 million people--were uninsured in 1989. That rate is three times higher than the rate of uninsured Anglos and nearly twice that of uninsured African-Americans.

Another recent study, sponsored by the American College of Healthcare Executives and the National Assn. of Health Services Executives, found that African-American health executives did not rise as far as their white counterparts and earned substantially less, a median of $53,000 annually, compared to the $67,000 a year for their Anglo counterparts.

Nationally, medicine still remains a heavily white male-dominated profession. Although some groups, such as Asian-Americans and Anglo women, have been growing in numbers, the ranks of African-American and Latino physicians remain low. During the 1950s and '60s, when 10% of the population was black, only 2.2% of all physicians in the United States were black, according to the Assn. of American Medical Colleges. There were similarly low rates of Latinos and American Indians.

Hoping to counter what one association official called "unequal opportunity in medicine," the association in 1970 started a program to increase the first-year medical school enrollments of the underrepresented groups to 12% of all students. Last year it finally reached that goal.

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In the tangle of today's emerging managed care systems, the concern of health officials is concentrated in two areas: finding a place for the low numbers of African-American and Latino physicians, and structuring a delivery system that will meet the needs of underserved neighborhoods shunned by mainstream medicine.

Though these problems are common enough, they are expected to become even more troublesome with a greater shift to managed care. Black physicians today practice in areas that have been shunned by many HMOs, and many of their patients, lacking insurance or enough money to pay for medical services, have been turned away by corporate medical practices.

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