Relation between the Race and Economic Status of Patients and Who Performs Their Surgery

We evaluated the relation between race and economic status of surgical patients and their likelihood of being treated by a surgeon in training rather than by a staff surgeon. Blacks were 2.2 to 4.3 times more likely than whites to be under the care of surgeons in training (P<0.001). This relation has remained unchanged over the past two decades. It remained when the method of payment was via self-payment or private insurance, but disappeared when patients being paid for by Medicaid were considered. In addition, black emergency patients were more likely than white emergency patients to be cared for by surgeons in training. (N Engl J Med 297:90–91, 1977) The constitution of the World Health Organization states, “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” Clearly, if a health service is to be offered, it must be offered equally to all who need it. Recent decades have witnessed much activity and many pronouncements of concern about social inequities in the United States. Although change has undoubtedly occurred, its magnitude has often been difficult to estimate. Overt, discriminatory acts by individuals are easy to see and count, whereas.