Racial Concordance, Rather Than Cultural Competency Training, Can Change Outcomes

In their article, “Physician Cultural Competency Training and Impact on Behavior: Evidence From the 2016 National Ambulatory Medical Care Survey,” the authors conclude that cultural competency training has likely been integrated into medical education and that there was no difference in behavior toward patients between those who received cultural competency training and those who did not.1 We applaud the authors for taking this deep dive into the impact of cultural competency training, and we recognize that there continues to be an effort to improve the care of our patients. Cultural competency training has been shown to increase provider knowledge and confidence with caring for multicultural patients, yet there is little evidence that broader goals of improved patient outcomes are achieved.2 Racial concordance, however, has been shown to improve patient outcomes and should be the new focus of all institutions seeking to reduce health inequities.3

Provider-patient race concordance can achieve broader, systemic goals of improving cross-cultural care delivery and improved patient outcomes.4 For instance, racial concordance is more clearly associated with better communication between patients and providers in one systematic review that involved Black patients.3 Another health system showed higher Press Ganey patient satisfaction scores between racially/ethnically concordant patients and their physicians.4 Other studies showed a greater patient acceptance of invasive procedures during preventative visits (eg, blood draws and injections) and improved show rates for longitudinal care visits between race-concordant patients and physicians.5,6 In view of this, cultural competency efforts and resources can be shifted toward recruiting, training, and integrating more racially concordant providers to reduce health inequities.

We call upon academic institutions and our health care system at large to invest in programs and initiatives that aim to recruit, retain, and advance underrepresented in medicine (URIM) students and disadvantaged people of color into the field of medicine. This can include creating effective prehealth pathway programs in low-income communities7 as well as partnering with the Student National Medical Association to help with the recruitment of URIM students into medical school.8 For residency recruitment, it includes reducing sources of unintended bias and increasing value placed on journey travelled, both of which have been associated with improved matching rates of underrepresented minorities in family medicine.9,10 While cultural competence training is likely ubiquitous, increasing racial concordance of the health care workforce and patients can reduce health inequities. The sooner we shift, the quicker we can see results.