How does one explain the difference in Black women undergoing C-sections more frequently than their white peers? Princeton Alumni Weekly’s recently profiled researcher, Janet Currie, has one answer stemming from her paper, “Drivers of Racial Differences in C-Sections”: “provider discretion,” a term that seems closely akin to an accusation of racial bias in doctors.
According to the paper, both a financial motive and doctor’s effort may play a role in a physician’s decision to perform this surgical procedure. Such are the elements of a hypothetical economics model. But, in the real world of hospitals, physicians are not cognizant of any financial incentives, often being ignorant of a patient’s health insurance. Their focus is on care and mitigating risk to both mother and baby. Further, during times of high demand, resource limitations in a hospital are real; an obstetrician’s “effort” is not a matter of his or her own preference as the article suggests. It takes a medical team.
Beyond any dubious physician motivations, the study’s design is descriptive and not causal. The paper’s medical risk factors assign a relatively low weight to maternal health concerns like eclampsia, which Black women are more likely to experience. Some risks are omitted as in the case of infections like HIV. Hypertension is not classified by severity but rather treated as a single variable. Complications of labor, like excessive vaginal bleeding or prolonged labor, are absent.
Yet, despite the incomplete accounting for medical risks, one key message in the article was omitted by much of the lay press and by the Alumni Weekly’s article: No racial concordance effect was observed. In other words, Black doctors were just as likely to display the same “provider discretion” as white doctors when deciding on C-sections for Black women.
It troubles us to see an economic study on physician behavior receiving so little critique. Unfortunately, it too easily fits into a divisive narrative on race where implicit bias is the driving cause. While we do not deny a disparity, we offer that its cause is linked to an exhaustive number of risk factors difficult for any study to fully consider, as well as access to care, health literacy, and socioeconomic factors. We urge these researchers to adjust their view, step back from the claims of “provider discretion,” and partner with their medical colleagues to better understand how we can improve health care for all.
Editor’s note: Goldfarb (board chair) and Miceli (medical director) are officers of Do No Harm, an organization whose mission is “to safeguard health care from ideological threats.”
How does one explain the difference in Black women undergoing C-sections more frequently than their white peers? Princeton Alumni Weekly’s recently profiled researcher, Janet Currie, has one answer stemming from her paper, “Drivers of Racial Differences in C-Sections”: “provider discretion,” a term that seems closely akin to an accusation of racial bias in doctors.
According to the paper, both a financial motive and doctor’s effort may play a role in a physician’s decision to perform this surgical procedure. Such are the elements of a hypothetical economics model. But, in the real world of hospitals, physicians are not cognizant of any financial incentives, often being ignorant of a patient’s health insurance. Their focus is on care and mitigating risk to both mother and baby. Further, during times of high demand, resource limitations in a hospital are real; an obstetrician’s “effort” is not a matter of his or her own preference as the article suggests. It takes a medical team.
Beyond any dubious physician motivations, the study’s design is descriptive and not causal. The paper’s medical risk factors assign a relatively low weight to maternal health concerns like eclampsia, which Black women are more likely to experience. Some risks are omitted as in the case of infections like HIV. Hypertension is not classified by severity but rather treated as a single variable. Complications of labor, like excessive vaginal bleeding or prolonged labor, are absent.
Yet, despite the incomplete accounting for medical risks, one key message in the article was omitted by much of the lay press and by the Alumni Weekly’s article: No racial concordance effect was observed. In other words, Black doctors were just as likely to display the same “provider discretion” as white doctors when deciding on C-sections for Black women.
It troubles us to see an economic study on physician behavior receiving so little critique. Unfortunately, it too easily fits into a divisive narrative on race where implicit bias is the driving cause. While we do not deny a disparity, we offer that its cause is linked to an exhaustive number of risk factors difficult for any study to fully consider, as well as access to care, health literacy, and socioeconomic factors. We urge these researchers to adjust their view, step back from the claims of “provider discretion,” and partner with their medical colleagues to better understand how we can improve health care for all.
Editor’s note: Goldfarb (board chair) and Miceli (medical director) are officers of Do No Harm, an organization whose mission is “to safeguard health care from ideological threats.”