Like Rest of Society, Doctors Implicitly Favor Whites Over Blacks

In the first large study to explore possible unconscious bias among physicians, researchers have found that doctors mirror the attitudes of the majority in society and implicitly favor whites over blacks.

“This supports speculation that subtle race bias may affect health care, but does not imply that it will,” said University of Washington researcher Janice Sabin, who presented the study here Tuesday (Oct. 28) at the American Public Health Association’s annual meeting. “This research is too preliminary to know if there is a direct relationship between physicians’ implicit, or unconscious, racial attitudes and the quality of medical care.”

Sabin, who is an acting assistant professor of medical education and biomedical informatics, said: “Our findings fit with previous research showing bias is common in the general population. But we have to remember people are not racist if they hold an implicit bias.”

Data from the study were drawn from a sample of more than 400,000 anonymous people who took the race attitude Implicit Association Test online during a 28-month period between 2004 and 2006. More than 2,500 of those test-takers identified themselves as doctors. The race attitude and a variety of other tests that examine various forms of bias are found on the Web site of Project Implicit (https://implicit.harvard.edu/implicit/) operated by the University of Washington, University of Virginia and Harvard University.

The Implicit Association Test captures subconscious, or implicit, bias by asking people to quickly associate positive or negative words with a series of photographs. In the race test the photographs are of black and white faces.

“We don’t call what these tests show prejudice. We talk about it as hidden bias or unconscious bias, something that most people are unaware they even possess,” said Anthony Greenwald, a UW psychology professor who created the Implicit Association Test and was part of the research team on the new study.

The people who took the test were predominantly American. Overall, 86 percent of participants said they lived in the United States. Of 2,535 physicians taking the test, 76 percent identified themselves as U.S. residents. Test-takers were predominantly white – 69 percent of the entire sample and 66 percent of the doctors. There were smaller samples of blacks, Asians and Hispanics.

The majority of physicians in all racial and ethnic groups showed an implicit preference for white Americans compared to black Americans except for black physicians, who on average did not favor either group.

The researchers also looked at the factors of gender and other advanced college education and found virtually the same results. Women exhibited slightly lower, but still significant, implicit preference for whites. The story was the same for more than 6,100 people who said they had law degrees and more than 7,900 individuals who said they had doctoral degrees.