Advertisement

A National Assessment of the Association Between Patient Race and Physician Visit Time During New Outpatient Urology Consultations

  • Jude Appiah
    Affiliations
    Department of Urology, New York University Grossman School of Medicine, New York, NY, USA
    Search for articles by this author
  • LaMont Barlow
    Affiliations
    Department of Urology, New York University Grossman School of Medicine, New York, NY, USA

    Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA

    VA New York Harbor Healthcare System, New York, NY, USA
    Search for articles by this author
  • Nnenaya A. Mmonu
    Affiliations
    Department of Urology, New York University Grossman School of Medicine, New York, NY, USA

    Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
    Search for articles by this author
  • Danil V. Makarov
    Affiliations
    Department of Urology, New York University Grossman School of Medicine, New York, NY, USA

    Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA

    VA New York Harbor Healthcare System, New York, NY, USA
    Search for articles by this author
  • Allison Sugarman
    Affiliations
    Department of Urology, New York University Grossman School of Medicine, New York, NY, USA

    Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
    Search for articles by this author
  • Richard S. Matulewicz
    Correspondence
    Address correspondence to: Richard S. Matulewicz, MD MSCI MS, New York University, Dept of Population Health, 227 E 30th St, 6th Floor Room 629G, New York, NY, USA 10016.
    Affiliations
    Department of Urology, New York University Grossman School of Medicine, New York, NY, USA

    Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA

    VA New York Harbor Healthcare System, New York, NY, USA
    Search for articles by this author

      Abstract

      Objective

      To determine if there is an association between patient race and physician time spent with the patient during outpatient urology consultations.

      Methods

      We identified all adult urology new outpatient visits in the National Ambulatory Medical Care Survey dataset for 2012-2016. Patient race was dichotomized as White or non-White. Our primary outcome was time spent during the visit between the patient and urologist. Using population-level weighting, we compared differences in mean time spent during visits with White and non-White patients. Mixed-effects linear regression was used to adjust for confounding factors and to account for clustering among individual physicians. Secondary outcomes included number of services provided and if ancillary providers were seen.

      Results

      Over the 5 year period, 1668 raw visits met criteria and were used to estimate 21million new outpatient urology visits nationwide. 80% of all visits were with White patients. Mean physician time spent among visits with white patients was 23.9 minutes and 24.4 minutes for non-White patients. There was no difference in number of services provided but visits with non-white patients were less likely to include an ancillary provider. After adjustment, there was no significant difference in mean time spent with the urologist among visits with White and non-White patients (difference 0.9 minutes, 95% CI: -0.6-2.4). There were also no differences in adjusted mean time spent among return visits or new visits for hematuria, urologic cancers, or BPH.

      Conclusion

      We found no statistically significant difference in time spent with a urologist during outpatient office consultations between White and non-White patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Thornton RL
        • Glover CM
        • Cene CW
        • Glik DC
        • Henderson JA
        • Williams DR.
        Evaluating strategies for reducing health disparities by addressing the social determinants of health.
        Health affairs. 2016; 35: 1416-1423
        • FitzGerald C
        • Hurst S.
        Implicit bias in healthcare professionals: a systematic review.
        BMC Med Ethics. 2017; 18: 19
        • Franks P
        • Fiscella K
        • Meldrum S.
        Racial disparities in the content of primary care office visits.
        J Gen Intern Med. 2005; 20: 599-603
        • Sohn H.
        Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course.
        Popul Res Policy Rev. 2017; 36: 181-201
        • Dutta A
        • Uno H
        • Holman A
        • Lorenz DR
        • Gabuzda D.
        Racial differences in prostate cancer risk in young HIV-positive and HIV-negative men: a prospective cohort study.
        Cancer Causes Control. 2017; 28: 767-777
        • Chen LM
        • Farwell WR
        • Jha AK.
        Primary care visit duration and quality: does good care take longer?.
        Arch Intern Med. 2009; 169: 1866-1872
        • Chung KC
        • Hamill JB
        • Kim HM
        • Walters MR
        • Wilkins EG.
        Predictors of patient satisfaction in an outpatient plastic surgery clinic.
        Ann Plast Surg. 1999; 42: 56-60
        • Eaton J
        • Reed D
        • Angstman KB
        • et al.
        Effect of visit length and a clinical decision support tool on abdominal aortic aneurysm screening rates in a primary care practice.
        J Eval Clin Pract. 2012; 18: 593-598
        • Halfon N
        • Stevens GD
        • Larson K
        • Olson LM.
        Duration of a well-child visit: association with content, family-centeredness, and satisfaction.
        Pediatrics. 2011; 128: 657-664
        • Qiao WP
        • Powell ES
        • Witte MP
        • Zelder MR.
        Relationship between racial disparities in ED wait times and illness severity.
        Am J Emerg Med. 2016; 34: 10-15
        • Olfson M
        • Cherry DK
        • Lewis-Fernández R.
        Racial differences in visit duration of outpatient psychiatric visits.
        Arch Gen Psychiatry. 2009; 66: 214-221
      1. Rui P OT. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2016_namcs_web_tables.pdf.

        • Coco A
        • Mainous AG.
        Relation of time spent in an encounter with the use of antibiotics in pediatric office visits for viral respiratory infections.
        Arch Pediatr Adolesc Med. 2005; 159: 1145-1149
        • Gottschalk A
        • Flocke SA.
        Time spent in face-to-face patient care and work outside the examination room.
        Ann Fam Med. 2005; 3: 488-493
        • Textor J
        • van der Zander B
        • Gilthorpe MS
        • Liskiewicz M
        • Ellison GT.
        Robust causal inference using directed acyclic graphs: the R package 'dagitty'.
        Int J Epidemiol. 2016; 45: 1887-1894
        • Shapiro DD
        • Msaouel P.
        Causal diagram techniques for urologic oncology research.
        Clin Genitourin Cancer. 2020;
        • Shen MJ
        • Peterson EB
        • Costas-Muniz R
        • et al.
        The effects of race and racial concordance on patient-physician communication: a systematic review of the literature.
        J Racial Ethn Health Disparities. 2018; 5: 117-140