There is some truth behind the stereotype of the Asian American doctor. Asian Americans make up 7% of the US population, but represent more than 17% of practicing physicians—making them the largest minority in the field, according to the Association of American Medical Colleges (AAMC).
Yet for all the running jokes about Asian parents hoping, wishing, and praying that their offspring enter the medical profession, Asian Americans are actually not remotely as interested in being on the other side of the doctor’s desk. According to a study published last month in JAMA Internal Medicine, they are the ethnic group that’s least likely to see specialists.
The study, which compares the rates of specialist visits between race and ethnicities, found that all minorities are underrepresented in access to most specialized medical visits, reflecting overall inequalities in healthcare.
Adjusting for age, the study looked at 29 specialties, and found that Black people had lower levels of visits in 23, Hispanics in 26, and Native Americans in about half. Among the specialties with the most significant gaps were dermatology (skin), otolaryngology (head and neck), and pulmonology (respiratory system).
On the other hand, Black, Hispanic, and Native American individuals are more likely to see nephrologists (kidney) and hematologists (blood, marrow, lymphatic system) than anyone else, pointing to chronic conditions that are exacerbated by low socioeconomic status as well as racism.
The reasons are complex, and many of them systemic, says Christopher Cai, the study’s lead author and a resident physician at Harvard Medical School. Minorities—particularly Black, Hispanic, and Native Americans—tend to live in areas with lower supplies of specialists, and larger percentages of them have Medicare or Medicaid, which offer lower reimbursement rates and are more often not accepted by specialists.
Further, he says, there might be an issue of underrepresentation—people of color who are doctors, particularly Black people, are more likely to work in institutions that have more minority patients, but they still face barriers to entering and practicing the medical profession.
Things might be different, however, for Asian Americans, who are the least represented in specialty visits. They lag in 26 of the 29 specialties considered and have significantly lower rates of visits in 21 of the specialties.
While some of the systemic issues of cost, access, as well as barriers such as language apply to this group too, there are also important differences. Compared to other ethnic groups, including white people, Asians in the study were the most likely to have private insurance (66% of them did) and have some college education (50%). Income was also the highest: more than 63% of Asian study responders earned above 300% of the federal poverty level, compared to 62% for whites, 37% for Blacks, and 35% for Hispanics.
The findings are in line with other research related to medical access by race. As of 2019, nearly 25% Asian Americans reported not having a personal doctor, up from 22% in 2015, despite high insurance rates in the community.
Asian Americans are an extremely diverse minority, which makes it especially hard to come to conclusions as to the lack of specialized care they receive, says Cai. Yet the reasons are likely different, at least in some measure, to the ones affecting other minorities’ access to specialized care.
The issue of discrimination affects Asian Americans, too, but overall this minority group has better health levels (and also the longest life expectancy in the US, although not across all subgroups). There might even be cultural reasons, Cai says, including linguistic barriers, lack of familiarity with available services, and a tendency to delay non-urgent care.