Do Religious Physicians Disproportionately Care for the Underserved?

This is a very interesting piece. For those of us that have been following the articles on this general topic by Curlin, et. al., the overall findings are not particularly surprising. It is the subtleties that are fascinating.

Physicians work in settings that serve the poor for a variety of reasons. I’m reminded of the comment by a recent CCHF conference speaker. When joining a large metropolitan public hospital staff, she was asked: “What kind of an “M” are you: Marxist, Messianic or Mad?”

My experience and perspective draws me to the relationship between faith (especially Christian faith) and care for the underserved. The authors state that “Physicians who are more religious do not appear to disproportionately care for the underserved.” I’m not really surprised by this finding, however disturbing it may be for those of us that understand that our faith clearly calls us to service and care for the poor and underserved.

My sense is that there are important differences that are not adequately captured by the nature of the variables used. For example, “Religious affiliation” is represented by the nominal categories: “None; Catholic; Jewish; Other religion; and Protestant.” Given the nature of this inquiry, I would speculate that within the “Protestant” category, for example, there are important differences between those physicians affiliated with religious bodies that have strong social justice traditions (e.g., Mennonite) and those with conservative, more individualistic and pietistic emphases (e.g., many conservative Evangelicals). Some of the potential (intra-Protestant) differences are hinted at by the distribution of responses for variables such as “Family emphasized service to poor” and “Practice of medicine is a calling.” There is a strong association between these variables and the “Spirituality” and “Intrinsic religiosity” variables, (Table 4). It would be interesting to see if physicians scoring high on most or all of these variables (“Family emphasized service to the poor;” “Practice of medicine is a calling;” “Religious belief influences medicine;” and “Spirituality”) are more highly represented among those caring for the underserved.

Competing interests:   None declared

As lead author of this manuscript, I appreciate the comments of my colleagues. I embrace efforts like the "4% solution" of CMDA, as a way of helping doctors think through how they might practice medicine faithfully with respect to the poor. Victor Kolade is undoubtedly correct that educational debt constrains doctors intentions to practice among the underserved, but it is not clear to me why that burden would fall disproportionately on religious physicians. Jonathan Biggar correctly notes that we did not account for physicians' practice overseas or even for their part time volunteering locally. We do not know whether religious physicians disproportionately engage in those forms of care. However, more than 1 in 20 religious physicians would have to practice overseas for religious physicians to have a significantly higher rate of caring for the underserved based on that unmeasured factor. It is unlikely such a high proportion do in fact practice overseas. In the end, we don't find much difference in practice among the underserved based on physicians' religious characteristics. It remains for religious physicians, and the communities that form them, to make the connection between their religious commitments and the care of the underserved.

Competing interests:   None declared

I found the article on physician spirituality and care of the underserved intriguing (1). While acknowledging the limitations listed by the authors, I noted an absence of testing for possible effects of years of practice and/or profession of faith. Fewer than 5% of respondents had received loan repayment assistance; without such a boost, it can easily take 30 years to repay medical school debt (2). Perhaps a number of religious physicians are waiting to pay off their debt or retire to commit significant chunks of their practice to underserved populations. Indeed, religious literature includes teaching that adherents should minister to the sick with resources they have freely received (3). If our society will invest more in physician training and reimbursement, more physicians will feel empowered to attend to the underserved.

References

1. Curlin FA, Dugdale LS, Lantos JD, Chin MH. Do religious physicians disproportionately care for the underserved? Ann Fam Med. 2007;5(4):353- 360.

2. Bishop M. Life Math. JAMA. 2007;298(3):266-268.

3. Matt. 10:8. The Holy Bible.

Competing interests:   None declared