racial-ethnic stereotyping
Race-ethnicity has been shown to influence physician-patient communication during clinical encounters and physician decision making ( 10 , 11 ). Physicians tend to view patients from minority groups as less intelligent, less effective communicators, less compliant, more likely to abuse alcohol and drugs, and less likable than white patients ( 8 , 12 ). Although distressing, these facts are consistent with social categorization (or social cognition) theory ( 10 , 12 ). This theory, originating in the social psychology literature, posits that humans use categorization to make vast amounts of social information manageable. Characteristics are unconsciously assigned to social groups (for example, racial-ethnic groups), and those characteristics are then unconsciously applied to individuals through stereotyping ( 13 ). Physicians may be especially vulnerable to stereotyping because of time pressures and the need to make rapid assessments—that is, physicians have more social information to process, so rely more heavily on social categorization ( 14 ).
Social categorization and racial-ethnic stereotyping likely influence physician behavior and decision making. However, because these are unconscious processes, physicians may be unaware of them and may underestimate their own contributions to racial-ethnic disparities. Understandably, physicians may be reluctant to explore their unconscious biases; it would be difficult for most physicians, who have dedicated their careers to helping others, to confront their own contributions to racial-ethnic inequality ( 10 ). Nonetheless, attempts to eliminate disparities will not be successful as long as health care providers believe that the sources of disparities are entirely external to themselves. Physicians must become aware of their own unconscious biases in order to change the behaviors that contribute to racial-ethnic inequalities.
We hypothesized that there are several prerequisites for changing physician behavior: physicians must be aware that racial-ethnic disparities exist, physicians must believe that they may contribute to disparities, and physicians must be motivated to change their behavior. The purpose of this study was to evaluate the extent to which psychiatrists have achieved these prerequisites and to identify factors that are associated with achievement of each.
Methods
Study sample
Data were collected through an online survey of American Psychiatric Association (APA) members conducted from April 2006 to August 2006. The survey was also distributed at the APA’s Institute on Psychiatric Services in October 2006. For the online portion of the study, names and addresses of 2,000 randomly selected member psychiatrists were purchased from the APA. A letter of introduction and unique access code were mailed to each; a printed survey was available. A maximum of three contact attempts were made. Of the 2,000 individuals identified, a correct address could not be obtained for 24 and seven were retired or deceased. Of the final sample of 1,969 eligible members, 186 psychiatrists (9%) completed the survey online.
