black infant mortality - are black doctors getting better results?
some of you may recall that the wise supreme court justice jackson claimed in her dissent on the court's racial preference decision that survival rates for black newborns double when they have black doctors.
“For high-risk black newborns, having a black physician more than doubles the likelihood that the baby will live, and not die.”
a remarkable claim i thought, & one that was based on a paper issued in 2020.
https://doi.org/10.1073/pnas.1913405117
well, a new paper has been issued attempting to replicate those findings.
https://www.pnas.org/doi/epub/10.1073/pnas.2409264121
& what they find is that the reason why black doctors show better results is that the 'worst' cases, where infants have low birth weight, are attended to more often by white doctors. since white doctors are taking the tougher cases with more challenges, statistically they are going to have 'worse' results.
Our study shows how an important research design decision can yield an empirical finding of racial concordance in newborn mortality. Specifically, the influential research in ref. 1 did not control for the impact of very low birth weights (i.e., under 1,500 g) on newborn mortality. Although these types of births are rare, they occur more frequently in the Black population, and they account for a very high fraction of mortality. It turns out that a disproportionately large number of Black newborns with very low birth weights are attended by White physicians. We show that once we control for the impact of very low birth weights on mortality, the estimate of the racial concordance effect is substantially weakened and becomes statistically insignificant in models that account for other factors that determine newborn mortality.
that brings up the issue of why it is the case that the tough cases are going to non-black doctors, while the easier cases tend to be with black doctors.
seems fairly obvious to me the answer is in the skill & ability of the doctors. blacks are admitted to medical schools with lower mcat scores, they fail out of school more often, they graduate with lower marks, & they are disciplined by their professional orgs more often.
so black doctors, with their lower skill set on average, are much less likely to have the kind of seniority & skill to be assigned the most challenging, difficult cases.
the wise justice jackson was correct that black doctors do have lower mortality rates, but she was wrong to see that as an argument for favoring admission of more blacks to medical school.
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