Article Figures & Data
Tables
Characteristics No. (%) or Mean (SD) Note: Totals do not all sum to 1,144 because of partial nonresponse. Percentages do not all sum to 100 because of rounding error. * Includes atheist, agnostic, and none. Demographic characteristics Age, years, mean (SD) 49.0 (8.3) Women 300 (26) Ethnicity Asian 138 (12) Black, non-Hispanic 26 (2) Hispanic/Latino 57 (5) White, non-Hispanic 869 (78) Other 31 (3) Region South 386 (34) Midwest 276 (24) Northeast 264 (23) West 216 (19) Foreign medical graduates 224 (20) Practice characteristics Primary specialty Family practice 158 (14) General internal medicine 129 (11) Internal medicine subspecialties 231 (20) Obstetrics and gynecology 80 (7) General pediatrics 87 (8) Pediatric subspecialties 60 (5) Psychiatry 100 (9) Surgical subspecialties 100 (9) Other 197 (17) Board certified 988 (87) Receive educational loan repayment 14 (1) Work in an academic health center 354 (32) Religious characteristics Spirituality Low 294 (26) Moderate 535 (48) High 293 (26) Intrinsic religiosity Low 407 (37) Moderate 292 (27) High 399 (36) Attendance at religious services Never 114 (10) Once a month or less 499 (44) Twice a month or more 515 (46) Religious affiliation None* 117 (10) Catholic 244 (22) Jewish 181 (16) Other religion 157 (14) Protestant 428 (38) Religious beliefs influence medicine Strongly disagree/disagree 485 (43) Agree 426 (38) Strongly agree 208 (19) Intrinsic motivations for work Family emphasized service to the poor Strongly disagree/disagree 232 (21) Agree 548 (49) Strongly agree 343 (31) Practice of medicine is a calling Strongly disagree/disagree 316 (29) Agree 438 (40) Strongly agree 352 (32) - Table 2.
All Physicians (N = 1,144): Self-Reported Practice Among the Underserved, Stratified by Physician Sex, Specialty, Religious Characteristics, and Intrinsic Motivations
Practice Among the Underserved Bivariate Multivariate Characteristics (n*) % P Value OR (95% CI) Note: Bivariate results present percentages of physicians in each predictor category (left-hand column) who reported that their patient population is considered underserved. Tests of association are by survey design adjusted χ2 tests. These values are followed by multivariate odds ratios (ORs) with 95% confidence intervals (95% CIs), which are by survey design adjusted logistic regression tests that control for age, sex, primary specialty, ethnicity, region, foreign medical graduation, board certification, loan repayment, and working in an academic medical center (tests for sex and specialty also control for religious characteristics and intrinsic motivations). * The n values vary slightly from those in Table 1 because of partial nonresponse. † P <.05. Sex Male (817) 25 .03 1.0 (referent) Female (284) 32 1.0 (0.7–1.6) Primary specialty Family practice (156) 31 1.0 (referent) General internal medicine (128) 26 0.7 (0.4–1.2) Medicine subspecialties (223) 21 0.6 (0.3–1.0) Obstetrics and gynecology (77) 23 .04 0.6 (0.3–1.3) General pediatrics (84) 34 1.1 (0.6–2.2) Pediatric subspecialties (55) 38 1.2 (0.5–2.8) Psychiatry (96) 40 1.8 (1.0–3.2) Surgical subspecialties (97) 25 0.7 (0.4–1.3) Other (185) 21 0.6 (0.3–1.0) Religious characteristics Spirituality Low (283) 21 1.0 (referent) Moderate (516) 26 .02 1.4 (0.9–2.0) High (287) 32 1.7 (1.1–2.7)† Intrinsic religiosity Low (394) 27 1.0 (referent) Moderate (281) 22 .15 0.8 (0.5–1.2) High (388) 29 1.1 (0.8–1.6) Attendance at religious services Never (112) 28 1.0 (referent) Once a month or less (480) 26 .90 1.0 (0.6–1.6) Twice a month or more (499) 26 1.0 (0.6–1.6) Religious affiliation None (110) 35 1.0 (referent) Catholic (236) 26 0.7 (0.4–1.2) Jewish (173) 16 .02 0.3 (0.2–0.6)† Other religion (135) 28 1.0 (0.5–1.9) Protestant (418) 28 0.7 (0.4–1.1) Religious beliefs influence medicine Strongly disagree/disagree (467) 26 1.0 (referent) Agree (415) 23 .005 0.8 (0.6–1.2) Strongly agree (202) 36 1.6 (1.1–2.5)† Intrinsic motivations for work Family emphasized service to poor Strongly disagree/disagree (225) 20 1.0 (referent) Agree (533) 27 .05 1.3 (0.9–2.1) Strongly agree (329) 31 1.7 (1.0–2.7)† Practice of medicine is a calling Strongly disagree/disagree (302) 25 1.0 (referent) Agree (427) 25 .22 0.9 (0.6–1.4) Strongly agree (343) 31 1.2 (0.8–1.8) - Table 3.
Primary Care Physicians (n = 374): Self-Reported Practice Among the Underserved, Stratified by Physician Sex, Religious Characteristics, and Intrinsic Motivations
Practice Among the Underserved Bivariate Multivariate Characteristics (n*) % P OR (95% CI) Note: Bivariate results present percentages of physicians in each predictor category who report their patient populations are considered underserved. Tests of association are by survey design adjusted χ2 tests. These values are followed by multivariate odds ratios (ORs) with 95% confidence intervals (95% CIs), which are by survey design adjusted logistic regression tests that control for age, sex, ethnicity, region, foreign medical graduation, board certification, loan repayment, and working in an academic medical center (test for sex also controls for religious characteristics and intrinsic motivations). * The n values do not all sum to 374 because of partial nonresponse. † P <.05. Sex Male (248) 30 .80 1.0 (referent) Female (120) 31 0.7 (0.3–1.3) Religious characteristics Spirituality Low (87) 20 1.0 (referent) Moderate (164) 29 .01 2.0 (1.0–4.1)† High (116) 39 3.0 (1.5–6.1)† Intrinsic religiosity Low (110) 30 1.0 (referent) Moderate (106) 22 .08 0.9 (0.4–1.7) High (140) 36 1.4 (0.8–2.5) Attendance at religious services Never (29) 40 1.0 (referent) Once a month or less (157) 28 .43 0.6 (0.3–1.5) Twice a month or more (180) 30 0.8 (0.3–1.8) Religious affiliation None (37) 40 1.0 (referent) Catholic (75) 32 0.7 (0.3–1.8) Jewish (35) 22 .51 0.4 (0.2–1.3) Other religion (58) 27 0.8 (0.3–2.1) Protestant (162) 29 0.7 (0.3–1.5) Religious beliefs influence medicine Strongly disagree/disagree (143) 27 1.0 (referent) Agree (145) 23 <.001 0.9 (0.5–1.5) Strongly agree (76) 49 3.0 (1.6–5.5)† Intrinsic motivations for work Family emphasized service to poor Strongly disagree/disagree (77) 20 1.0 (referent) Agree (181) 33 .08 1.8 (0.9–3.5) Strongly agree (108) 33 1.9 (0.9–4.0) Practice of medicine is a calling Strongly disagree/disagree (103) 25 1.0 (referent) Agree (135) 25 .61 1.1 (0.6–2.0) Strongly agree (123) 31 1.5 (0.8–2.7) - Table 4.
Associations of Physicians’ Religious Characteristics With 2 Intrinsic Work Motivations
Characteristics Family Emphasized Service to Poor (Strongly Agree) (%) P Value (χ2) Practice of Medicine is a Calling (Strongly Agree) (%) P Value (χ2) Note: Percentages of physicians from each religious category who strongly agreed with each of the 2 measures of intrinsic motivation. For example, among those with low spirituality, 21% strongly agreed that their family emphasized service to the poor. Tests of association are by survey design adjusted χ2 tests. * Includes atheist, agnostic, and none. All physicians (N = 1,144) 29 – 30 – Spirituality Low 21 17 Moderate 28 <.001 26 <.001 High 41 53 Intrinsic religiosity Low 23 18 Moderate 28 <.001 26 <.001 High 37 47 Religious attendance Never 27 22 Once a month or less 25 .01 24 <.001 Twice a month or more 34 38 Religious affiliation None* 24 20 Catholic 27 28 Jewish 26 <.001 20 <.001 Protestant 28 37 Other religion 48 35 Religious beliefs influence medicine Strongly disagree/disagree 21 16 Agree 27 <.001 26 <.001 Strongly agree 54 73
Additional Files
The Article in Brief
Do Religious Physicians Disproportionately Care for the Underserved?
Farr A. Curlin, MD, and colleagues
Background Many religions encourage their members to care for people who are poor and marginalized. This study looks at religious characteristics and a sense of calling among doctors. In particular, it examines whether doctors who are more religious, and/or who view their practice of medicine as a calling, are also more likely to care for underserved patients.
What This Study Found Doctors who report that they practice among the underserved describe themselves as highly spiritual. Their religious beliefs tend to influence their practice of medicine, and they tend to come from families that emphasize serving the poor. Doctors who are more religious in general are more likely to view the practice of medicine as a calling but not more likely to practice among the underserved.
Implications
- Doctors who are more religious do not care for the underserved more than other doctors. Those who report being highly spiritual, however, are more likely to report practice among the underserved.
- The authors call for ongoing research over the course of doctors� medical training to determine how their religious and spiritual commitments, sense of calling, and other factors lead some, but not others, to practice among the underserved.
