Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Marcella Nunez-Smith

Subject Area(s)

Medicine

Abstract

Patient refusal of physician (PRoP) refers to instances in which a patient refuses to be cared for by a given physician because of the physician's socio-demographic characteristics, such as gender, age, race/ethnicity, religion, national origin, or perceived sexual orientation. Minority physicians experience PRoP more often than non-minority physicians, and thus PRoP may become a growing concern as the healthcare workforce diversifies. Little is known, however, about hospital leadership awareness of and response to these circumstances. This study aims to describe the proportion of teaching hospitals with formal guidance on PRoP and to characterize hospital leaders' perspectives on addressing this issue. The following hypotheses are tested: 1) few hospitals will have formal guidance in place, 2) hospital leaders' opinions about addressing PRoP will vary, correlating with their personal socio-demographic characteristics, and 3) most respondents will report PRoP as an uncommon occurrence at their hospital, but one that nevertheless warrants attention. We used the 2007 American Hospital Association Annual Survey Database to perform a cross-sectional study of chief medical officers (CMOs) at a national sample of teaching hospitals in 2010. Cognitive interviews with hospital administrators informed questionnaire development. CMOs were emailed the online questionnaire with several waves of follow-up. Frequency statistics were used to describe the proportion of responding hospitals with formal statements addressing PRoP, while bivariate analyses were performed to investigate any association between the existence of a policy and hospital characteristics, as well as CMO perspectives and CMO socio-demographic characteristics. Of the hospital CMOs we contacted (n=426), 221 responded, yielding a response rate of 52%. A majority (88%) of participating hospitals did not have any formal statement (e.g. policy, protocol, procedure) addressing PRoP; lower volume (<10,000 annual admissions) hospitals were more likely than higher volume (10-29,999) hospitals to have formal guidance (23% of low volume vs. 5% of higher volume hospitals). Convening the ethics committee or an ad hoc advisory group was a frequently utilized (14%) response to PRoP at hospitals without formal statements. Nearly half of hospitals typically reassign physicians, whether immediately (7%) or if the patient continues to refuse after further conversation (41%). Overall, while survey respondents were fairly evenly split on whether PRoP is an issue that should be further addressed at their hospital (46% agree, 49% disagree), over half (53%) anticipate enacting formal guidance on PRoP in the future. Because racial/ethnic minority physicians experience PRoP more often than their non-minority colleagues, addressing this issue is a potential strategy for hospitals striving to improve the institutional climate for a diverse workforce. With over three quarters of CMOs indicating that relevant industry guidelines would assist their hospitals in addressing PRoP, professional organizations have the opportunity to provide desired support to hospitals by issuing best practice recommendations.

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This is an Open Access Thesis.

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