https://sci-hub.tw/https://www.pnas.org/content/early/2020/08/12/1913405117

Physician–patient racial concordance and disparities in birthing mortality for newborns
Brad N. Greenwooda, Rachel R. Hardemanb, Laura Huangc, and Aaron Sojournerd,
School of Business, George Mason University, Fairfax, VA 22030; b
School of Public Health, University of Minnesota–Twin Cities, Minneapolis, MN 55455;

Harvard Business School, Harvard University, Boston, MA 02163; and d
Carlson School of Management, University of Minnesota–Twin Cities, Minneapolis, MN 55455

Edited by Christopher W. Kuzawa, Northwestern University, Evanston, IL, and approved July 16, 2020 (received for review August 2, 2019)

Recent work has emphasized the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

I’ve read the full paper and I’ll note a few things.

1/ This is a large study, with n=1800000. Whatever this is about, it’s not an anomaly because of small data size.
2/ It is conducted only in one state, Florida, which is ethnically quite unique in US: obv, it would be good to see whether this holds up in states with a different ethnic mix.
3/ Interestingly, for white babies, there’s no significant effect from varying the race of the doctor.
4/ The authors appear to be very confident that this is a causative relationship: ie that “doctor-patient racial concordance” is to be advocated, rather than just noting that there is a correlation and leaving others to determine the significance.
5/ “Physician race is not coded by the data and is captured from publicly searchable pictures of the physician” Yikes

The study did use multivariate analysis to try to isolate the correlation effects from other factors, viz.

Our primary interest is whether the Black–White newborn mortality risk differs depending on physician race. This is cap- tured by β3. The estimator is an ordinary least squares (OLS) to avoid interpretation issues associated with nonlinear estimators like logit regression (35). Huber–White SEs, clustered on the physician, are applied to avoid the heteroscedasticity problems OLS creates. We first estimate the pooled regression without controls. We subsequently include controls for insurance pro- vider (e.g., Medicaid, self-pay) and for the 65 most-prevalent comorbidities ; quarter-year fixed effects; hospital fixed effects; hospital-year fixed effects; and physician fixed ef- fects. Note that the inclusion of physician fixed effects does cause β2, physician race, to be dropped from the model as it is time invariant. Hospital-year fixed effects are included in deference to the concern that the effects might change over time, and across location. Finally, we split the sample by physician race to allow the controls to enter through physician race.

The effect is more pronounced for babies with “one or more comorbidities”.

I can’t see any big holes in the study but I do wonder at their confidence that there’s a causative relationship. As well as trying this in other states, it would be good to isolate those comorbidities: there may be specific grave childhood illnesses that are dealt with disproportionately by white doctors in Florida, but that affect black babies more than white babies, and this would show up as a correlation in death rate.

Now, I’m not a doctor… but neither are the authors. This is a paper by business and management specialists, published in a multidisciplinary journal. I’ll be interested to see analysis of this paper by medical people.

dv said:

https://sci-hub.tw/https://www.pnas.org/content/early/2020/08/12/1913405117

Physician–patient racial concordance and disparities in birthing mortality for newborns
Brad N. Greenwooda, Rachel R. Hardemanb, Laura Huangc, and Aaron Sojournerd,
School of Business, George Mason University, Fairfax, VA 22030; b
School of Public Health, University of Minnesota–Twin Cities, Minneapolis, MN 55455;

Harvard Business School, Harvard University, Boston, MA 02163; and d
Carlson School of Management, University of Minnesota–Twin Cities, Minneapolis, MN 55455

Edited by Christopher W. Kuzawa, Northwestern University, Evanston, IL, and approved July 16, 2020 (received for review August 2, 2019)

Recent work has emphasized the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

I’ve read the full paper and I’ll note a few things.

1/ This is a large study, with n=1800000. Whatever this is about, it’s not an anomaly because of small data size.
2/ It is conducted only in one state, Florida, which is ethnically quite unique in US: obv, it would be good to see whether this holds up in states with a different ethnic mix.
3/ Interestingly, for white babies, there’s no significant effect from varying the race of the doctor.
4/ The authors appear to be very confident that this is a causative relationship: ie that “doctor-patient racial concordance” is to be advocated, rather than just noting that there is a correlation and leaving others to determine the significance.
5/ “Physician race is not coded by the data and is captured from publicly searchable pictures of the physician” Yikes

The study did use multivariate analysis to try to isolate the correlation effects from other factors, viz.

Our primary interest is whether the Black–White newborn mortality risk differs depending on physician race. This is cap- tured by β3. The estimator is an ordinary least squares (OLS) to avoid interpretation issues associated with nonlinear estimators like logit regression (35). Huber–White SEs, clustered on the physician, are applied to avoid the heteroscedasticity problems OLS creates. We first estimate the pooled regression without controls. We subsequently include controls for insurance pro- vider (e.g., Medicaid, self-pay) and for the 65 most-prevalent comorbidities ; quarter-year fixed effects; hospital fixed effects; hospital-year fixed effects; and physician fixed ef- fects. Note that the inclusion of physician fixed effects does cause β2, physician race, to be dropped from the model as it is time invariant. Hospital-year fixed effects are included in deference to the concern that the effects might change over time, and across location. Finally, we split the sample by physician race to allow the controls to enter through physician race.

The effect is more pronounced for babies with “one or more comorbidities”.

I can’t see any big holes in the study but I do wonder at their confidence that there’s a causative relationship. As well as trying this in other states, it would be good to isolate those comorbidities: there may be specific grave childhood illnesses that are dealt with disproportionately by white doctors in Florida, but that affect black babies more than white babies, and this would show up as a correlation in death rate.

Now, I’m not a doctor… but neither are the authors. This is a paper by business and management specialists, published in a multidisciplinary journal. I’ll be interested to see analysis of this paper by medical people.

Have they allowed for the good possibility that there are way more white doctors in this field?

Peak Warming Man said:

dv said:

https://sci-hub.tw/https://www.pnas.org/content/early/2020/08/12/1913405117

Physician–patient racial concordance and disparities in birthing mortality for newborns
Brad N. Greenwooda, Rachel R. Hardemanb, Laura Huangc, and Aaron Sojournerd,
School of Business, George Mason University, Fairfax, VA 22030; b
School of Public Health, University of Minnesota–Twin Cities, Minneapolis, MN 55455;

Harvard Business School, Harvard University, Boston, MA 02163; and d
Carlson School of Management, University of Minnesota–Twin Cities, Minneapolis, MN 55455

Edited by Christopher W. Kuzawa, Northwestern University, Evanston, IL, and approved July 16, 2020 (received for review August 2, 2019)

Recent work has emphasized the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

I’ve read the full paper and I’ll note a few things.

1/ This is a large study, with n=1800000. Whatever this is about, it’s not an anomaly because of small data size.
2/ It is conducted only in one state, Florida, which is ethnically quite unique in US: obv, it would be good to see whether this holds up in states with a different ethnic mix.
3/ Interestingly, for white babies, there’s no significant effect from varying the race of the doctor.
4/ The authors appear to be very confident that this is a causative relationship: ie that “doctor-patient racial concordance” is to be advocated, rather than just noting that there is a correlation and leaving others to determine the significance.
5/ “Physician race is not coded by the data and is captured from publicly searchable pictures of the physician” Yikes

The study did use multivariate analysis to try to isolate the correlation effects from other factors, viz.

Our primary interest is whether the Black–White newborn mortality risk differs depending on physician race. This is cap- tured by β3. The estimator is an ordinary least squares (OLS) to avoid interpretation issues associated with nonlinear estimators like logit regression (35). Huber–White SEs, clustered on the physician, are applied to avoid the heteroscedasticity problems OLS creates. We first estimate the pooled regression without controls. We subsequently include controls for insurance pro- vider (e.g., Medicaid, self-pay) and for the 65 most-prevalent comorbidities ; quarter-year fixed effects; hospital fixed effects; hospital-year fixed effects; and physician fixed ef- fects. Note that the inclusion of physician fixed effects does cause β2, physician race, to be dropped from the model as it is time invariant. Hospital-year fixed effects are included in deference to the concern that the effects might change over time, and across location. Finally, we split the sample by physician race to allow the controls to enter through physician race.

The effect is more pronounced for babies with “one or more comorbidities”.

I can’t see any big holes in the study but I do wonder at their confidence that there’s a causative relationship. As well as trying this in other states, it would be good to isolate those comorbidities: there may be specific grave childhood illnesses that are dealt with disproportionately by white doctors in Florida, but that affect black babies more than white babies, and this would show up as a correlation in death rate.

Now, I’m not a doctor… but neither are the authors. This is a paper by business and management specialists, published in a multidisciplinary journal. I’ll be interested to see analysis of this paper by medical people.

Have they allowed for the good possibility that there are way more white doctors in this field?

Why would that account for the fact that mortality is higher for black babies when attended by white doctors rather than black doctors?

dv said:

Peak Warming Man said:

dv said:

https://sci-hub.tw/https://www.pnas.org/content/early/2020/08/12/1913405117

Physician–patient racial concordance and disparities in birthing mortality for newborns
Brad N. Greenwooda, Rachel R. Hardemanb, Laura Huangc, and Aaron Sojournerd,
School of Business, George Mason University, Fairfax, VA 22030; b
School of Public Health, University of Minnesota–Twin Cities, Minneapolis, MN 55455;

Harvard Business School, Harvard University, Boston, MA 02163; and d
Carlson School of Management, University of Minnesota–Twin Cities, Minneapolis, MN 55455

Edited by Christopher W. Kuzawa, Northwestern University, Evanston, IL, and approved July 16, 2020 (received for review August 2, 2019)

Recent work has emphasized the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

I’ve read the full paper and I’ll note a few things.

1/ This is a large study, with n=1800000. Whatever this is about, it’s not an anomaly because of small data size.
2/ It is conducted only in one state, Florida, which is ethnically quite unique in US: obv, it would be good to see whether this holds up in states with a different ethnic mix.
3/ Interestingly, for white babies, there’s no significant effect from varying the race of the doctor.
4/ The authors appear to be very confident that this is a causative relationship: ie that “doctor-patient racial concordance” is to be advocated, rather than just noting that there is a correlation and leaving others to determine the significance.
5/ “Physician race is not coded by the data and is captured from publicly searchable pictures of the physician” Yikes

The study did use multivariate analysis to try to isolate the correlation effects from other factors, viz.

Our primary interest is whether the Black–White newborn mortality risk differs depending on physician race. This is cap- tured by β3. The estimator is an ordinary least squares (OLS) to avoid interpretation issues associated with nonlinear estimators like logit regression (35). Huber–White SEs, clustered on the physician, are applied to avoid the heteroscedasticity problems OLS creates. We first estimate the pooled regression without controls. We subsequently include controls for insurance pro- vider (e.g., Medicaid, self-pay) and for the 65 most-prevalent comorbidities ; quarter-year fixed effects; hospital fixed effects; hospital-year fixed effects; and physician fixed ef- fects. Note that the inclusion of physician fixed effects does cause β2, physician race, to be dropped from the model as it is time invariant. Hospital-year fixed effects are included in deference to the concern that the effects might change over time, and across location. Finally, we split the sample by physician race to allow the controls to enter through physician race.

The effect is more pronounced for babies with “one or more comorbidities”.

I can’t see any big holes in the study but I do wonder at their confidence that there’s a causative relationship. As well as trying this in other states, it would be good to isolate those comorbidities: there may be specific grave childhood illnesses that are dealt with disproportionately by white doctors in Florida, but that affect black babies more than white babies, and this would show up as a correlation in death rate.

Now, I’m not a doctor… but neither are the authors. This is a paper by business and management specialists, published in a multidisciplinary journal. I’ll be interested to see analysis of this paper by medical people.

Have they allowed for the good possibility that there are way more white doctors in this field?

Why would that account for the fact that mortality is higher for black babies when attended by white doctors rather than black doctors?

Possibly the cost of full fees for all university students, except for the exceptional students who’ve gained a scholarship.

I’m not sure if this is MV’s point or not.

Presumably most black babies are born in hospitals with a high proportion of black patients.

It is likely that these hospitals have a low status as desirable places to work, at least amongst white doctors.

So the only white doctors working there are those who can’t get work anywhere else.

Whereas the black doctors find it difficult to find work elsewhere no matter how good they are.

So the average standard of the black doctors is higher than the average standard of the white doctors, in these hospitals.

Conversely, in the high prestige white hospitals, only the very best black doctors are accepted, so the standard of the black doctors in hospitals with mainly white patients is at least as good as the white doctors.

The Rev Dodgson said:

I’m not sure if this is MV’s point or not.

Presumably most black babies are born in hospitals with a high proportion of black patients.

It is likely that these hospitals have a low status as desirable places to work, at least amongst white doctors.

So the only white doctors working there are those who can’t get work anywhere else.

Whereas the black doctors find it difficult to find work elsewhere no matter how good they are.

So the average standard of the black doctors is higher than the average standard of the white doctors, in these hospitals.

Conversely, in the high prestige white hospitals, only the very best black doctors are accepted, so the standard of the black doctors in hospitals with mainly white patients is at least as good as the white doctors.

Well this seems like a possibility.

dv said:

The Rev Dodgson said:

I’m not sure if this is MV’s point or not.

Presumably most black babies are born in hospitals with a high proportion of black patients.

It is likely that these hospitals have a low status as desirable places to work, at least amongst white doctors.

So the only white doctors working there are those who can’t get work anywhere else.

Whereas the black doctors find it difficult to find work elsewhere no matter how good they are.

So the average standard of the black doctors is higher than the average standard of the white doctors, in these hospitals.

Conversely, in the high prestige white hospitals, only the very best black doctors are accepted, so the standard of the black doctors in hospitals with mainly white patients is at least as good as the white doctors.

Well this seems like a possibility.

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

Michael V said:

dv said:

The Rev Dodgson said:

I’m not sure if this is MV’s point or not.

Presumably most black babies are born in hospitals with a high proportion of black patients.

It is likely that these hospitals have a low status as desirable places to work, at least amongst white doctors.

So the only white doctors working there are those who can’t get work anywhere else.

Whereas the black doctors find it difficult to find work elsewhere no matter how good they are.

So the average standard of the black doctors is higher than the average standard of the white doctors, in these hospitals.

Conversely, in the high prestige white hospitals, only the very best black doctors are accepted, so the standard of the black doctors in hospitals with mainly white patients is at least as good as the white doctors.

Well this seems like a possibility.

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

If you’ve got the cash, even trump could be a physician in the states…

Michael V said:

dv said:

The Rev Dodgson said:

I’m not sure if this is MV’s point or not.

Presumably most black babies are born in hospitals with a high proportion of black patients.

It is likely that these hospitals have a low status as desirable places to work, at least amongst white doctors.

So the only white doctors working there are those who can’t get work anywhere else.

Whereas the black doctors find it difficult to find work elsewhere no matter how good they are.

So the average standard of the black doctors is higher than the average standard of the white doctors, in these hospitals.

Conversely, in the high prestige white hospitals, only the very best black doctors are accepted, so the standard of the black doctors in hospitals with mainly white patients is at least as good as the white doctors.

Well this seems like a possibility.

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

Yeah that makes sense too.

dv said:

The Rev Dodgson said:

I’m not sure if this is MV’s point or not.

Presumably most black babies are born in hospitals with a high proportion of black patients.

It is likely that these hospitals have a low status as desirable places to work, at least amongst white doctors.

So the only white doctors working there are those who can’t get work anywhere else.

Whereas the black doctors find it difficult to find work elsewhere no matter how good they are.

So the average standard of the black doctors is higher than the average standard of the white doctors, in these hospitals.

Conversely, in the high prestige white hospitals, only the very best black doctors are accepted, so the standard of the black doctors in hospitals with mainly white patients is at least as good as the white doctors.

Well this seems like a possibility.

There might also be an ‘opportunity’ variable if the hospital system uses a similar grading of neo-natal facilities to the Australian model. That is, the white doctors might work in the neo-natal units with the sickest babies, for some reason. Neo-natal intensive care training is only available in a predominantly white area, for example?

One of my Ambo mates has about 85% of his patients die on him. It’s not because he’s a bad Ambo, but because his patients are the sickest.

poikilotherm said:

Michael V said:

dv said:

Well this seems like a possibility.

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

If you’ve got the cash, even trump could be a physician in the states…

Yeah. Pretty much what I had in mind, although my mind’s eye was not quite as extreme.

poikilotherm said:

Michael V said:

dv said:

Well this seems like a possibility.

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

If you’ve got the cash, even trump could be a physician in the states…

He does seem to know a lot about Hydroxychloroquine.

dv said:

Peak Warming Man said:

dv said:

https://sci-hub.tw/https://www.pnas.org/content/early/2020/08/12/1913405117

Physician–patient racial concordance and disparities in birthing mortality for newborns
Brad N. Greenwooda, Rachel R. Hardemanb, Laura Huangc, and Aaron Sojournerd,
School of Business, George Mason University, Fairfax, VA 22030; b
School of Public Health, University of Minnesota–Twin Cities, Minneapolis, MN 55455;

Harvard Business School, Harvard University, Boston, MA 02163; and d
Carlson School of Management, University of Minnesota–Twin Cities, Minneapolis, MN 55455

Edited by Christopher W. Kuzawa, Northwestern University, Evanston, IL, and approved July 16, 2020 (received for review August 2, 2019)

Recent work has emphasized the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

I’ve read the full paper and I’ll note a few things.

1/ This is a large study, with n=1800000. Whatever this is about, it’s not an anomaly because of small data size.
2/ It is conducted only in one state, Florida, which is ethnically quite unique in US: obv, it would be good to see whether this holds up in states with a different ethnic mix.
3/ Interestingly, for white babies, there’s no significant effect from varying the race of the doctor.
4/ The authors appear to be very confident that this is a causative relationship: ie that “doctor-patient racial concordance” is to be advocated, rather than just noting that there is a correlation and leaving others to determine the significance.
5/ “Physician race is not coded by the data and is captured from publicly searchable pictures of the physician” Yikes

The study did use multivariate analysis to try to isolate the correlation effects from other factors, viz.

Our primary interest is whether the Black–White newborn mortality risk differs depending on physician race. This is cap- tured by β3. The estimator is an ordinary least squares (OLS) to avoid interpretation issues associated with nonlinear estimators like logit regression (35). Huber–White SEs, clustered on the physician, are applied to avoid the heteroscedasticity problems OLS creates. We first estimate the pooled regression without controls. We subsequently include controls for insurance pro- vider (e.g., Medicaid, self-pay) and for the 65 most-prevalent comorbidities ; quarter-year fixed effects; hospital fixed effects; hospital-year fixed effects; and physician fixed ef- fects. Note that the inclusion of physician fixed effects does cause β2, physician race, to be dropped from the model as it is time invariant. Hospital-year fixed effects are included in deference to the concern that the effects might change over time, and across location. Finally, we split the sample by physician race to allow the controls to enter through physician race.

The effect is more pronounced for babies with “one or more comorbidities”.

I can’t see any big holes in the study but I do wonder at their confidence that there’s a causative relationship. As well as trying this in other states, it would be good to isolate those comorbidities: there may be specific grave childhood illnesses that are dealt with disproportionately by white doctors in Florida, but that affect black babies more than white babies, and this would show up as a correlation in death rate.

Now, I’m not a doctor… but neither are the authors. This is a paper by business and management specialists, published in a multidisciplinary journal. I’ll be interested to see analysis of this paper by medical people.

Have they allowed for the good possibility that there are way more white doctors in this field?

Why would that account for the fact that mortality is higher for black babies when attended by white doctors rather than black doctors?

A hospital with four doctors, one of those doctors is black.
Four black babies admitted, each doctor looks after one each. All babies die.
Investigator looking at hospital records years later and sees a lot more black babies die when being treated by white doctors.

poikilotherm said:

Michael V said:

dv said:

Well this seems like a possibility.

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

If you’ve got the cash, even trump could be a physician in the states…

Could that actually be true?

I mean he is quite thick, how could he possibly pass?

sibeen said:

poikilotherm said:

Michael V said:

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

If you’ve got the cash, even trump could be a physician in the states…

Could that actually be true?

I mean he is quite thick, how could he possibly pass?

He’d make the exams great again.

sibeen said:

poikilotherm said:

Michael V said:

Not quite what I meant, but it is a point well made.

Here’s another version of what I was thinking:

Over all, coming out of university – because of cost – there will be considerably less black doctors, but of considerably higher average grades – because of the proportion of (black) scholarship holders versus (black) full fee-paying students.

The converse will be true for the white doctors.

It has to do with average family incomes in the white versus black parts of the whole whole community.

If you’ve got the cash, even trump could be a physician in the states…

Could that actually be true?

I mean he is quite thick, how could he possibly pass?

Have someone else do the assessments, hire an interpreter who knows the subject and feeds him the answer, the usual cheating strategies (copying etc), present false documents to claim exemption. I see most of these strategies almost any day I go training overseas students in Melbourne.