While kidney disease disproportionately affects African-Americans, few black medical students and residents are being trained to provide specialized care to blacks with end-stage renal disease, according to a report written by researchers with the Minneapolis Veterans Affairs Medical Center and the National Institute of Diabetes and Digestive and Kidney Diseases published in the Clinical Journal of the American Society of Nephrology.
More minority nephrologists needed: study
African-Americans account for about 13% of the U.S. population, but in 2007—the most recent year for which complete data was available—they accounted for 31.7% of the U.S. patient population with end-stage renal disease. Also in 2007, black students accounted for 6.7% of the country's medical-school graduating class, and only 5.4% of medical residents training in internal medicine were black. Forty-nine nephrology fellows in the U.S. that year—6.1%—were black. In 2008, the percentage dropped to 3.8% with only 31 African-Americans receiving nephrology fellowships.
The authors said that multiple strategies are needed to increase the number of minorities in medical schools in general and that specific efforts to recruit African-Americans into nephrology need to be "magnified."
Perceived discrimination can foster distrust that can pose barriers to successful patient care and adherence to medical recommendations or participation in clinical trials, the authors said. They noted, however, that a racial difference between a provider and a patient does not mean that the two individuals' relationship is doomed to fail.
"The degree to which racial discordance plays a role in the care relationship in nephrology is uncertain," the report states. "Furthermore, there is no evidence that trust cannot develop between racially discordant patients and providers."
Nevertheless, the authors conclude, "Given the integral role of patient and physician race concordance in the therapeutic relationship, efforts to increase the number of African-American nephrology trainees may help to optimize patient care and improve outcomes."
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