Black Representation In Primary Care Tied To Lower Mortality



Black Representation In Primary Care Tied To Lower Mortality

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Access to primary care services has been linked to better population health outcomes, including increased life expectancy and decreased mortality rates. However, primary care availability remains uneven across the country, with some communities facing significant barriers to accessing essential health services.

For example, patients in the health care safety net and those who experience geographic, financial, insurance-related, linguistic, or discrimination-related barriers may face significant difficulties accessing primary care. Additionally, while primary care availability is essential for everyone, studies suggest that access to primary care may be particularly critical for Black individuals.  

As per JAMA Network, racial and ethnic minority primary care providers have been shown to provide extreme care to historically underserved groups. Building a more diverse physician workforce has been identified as expanding access to care, providing culturally competent care, and reducing health disparities.

However, Black and other racial and ethnic minority individuals have historically been underrepresented in health professions requiring advanced training. 

While the literature suggests that diversifying the physician workforce can improve care access and utilization, patient adherence, physician communication, and patient experience of care measures, evidence of the potential gains in clinical and public health outcomes is limited.

This investigation explores the county-level association between the degree of Black representation in the primary care workforce and key population health markers, including mortality rates, life expectancy, and health disparities between Black and White individuals.  

A new cohort study conducted from 2009 to 2019 found moderate workforce diversity gains occurred, with a 9.8% increase in the number of US counties with one or more Black primary care physicians (PCPs). However, the study also revealed that over half of all US counties had no Black PCPs during each time point, despite more than 70% of all US counties having one or more Black residents.

Black PCPs tended to be underrepresented relative to the Black county-level population. The percentage of US counties with one or more PCPs, irrespective of race and ethnicity, ranged from 90.9% to 94.2% in 2009, 2014, and 2019.  

The study used multilevel or mixed-effects growth models to examine counties with 1 or more Black PCPs to determine whether increases in Black PCP representation levels were associated with better mortality outcomes among Black individuals.

The study found that greater Black PCP representation levels were associated with longer life expectancy and were inversely associated with all-cause mortality rates for Black individuals. More excellent representation was also associated with a minor difference in all-cause mortality rates between Black and White individuals.


The association between Black PCP representation and life expectancy was more significant in counties with high poverty levels than in counties with low or average poverty levels. After controlling for other covariates, primary care availability did not have a statistically significant association with life expectancy or mortality rates among Black individuals.  

The study highlights the importance of primary care physicians as a source of continuous, comprehensive care for their patients, preventing and managing disease across the lifespan and coordinating the care provided to their patients elsewhere in the health care system.

In addition, PCPs promote patients physical, mental, and general health and well-being; engage patients in actively participating in managing their health; often address the broader determinants of health within patients’ environment; and work to ensure equitable patient access to necessary health resources. 

The study also emphasized the value of diversity, inclusion, and equity in the PCP workforce. Black individuals are underrepresented in most health professions that require multiple years of advanced training, including medicine, and numerous barriers limit the entry of Black students into medical careers.

Potential interventions to address this include implementing changes in the admissions, hiring, and promotions processes at universities, such as holistic review and efforts to better nurture an educational and training environment that is structured for inclusion.   

The Health Resources and Services Administration offers resources to support building an increasingly diverse national health workforce through its Health Careers Opportunity Program, Scholarships for Disadvantaged Students program, and Centers of Excellence program.

Efforts to expand structural diversity within the health workforce can be complemented by other strategies, such as strengthening cultural competency curricula and implementing educational approaches that elevate the principles of diversity, equity, and inclusion.

Example programs include Doctors Back to School from the AMA and the Action Collaborative for Black Men in Medicine from the AAMC, in partnership with the National Medical Association. 

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