Care for the Underserved Not Influenced by Doctors' Religious Attendance

CHICAGO, July 31 -- Although religious doctors are more likely to consider medicine a calling, that doesn't translate into caring for more underserved patients, a survey has revealed.
Whether judged by "intrinsic religiosity" or frequency of church attendance, religious doctors cared for underserved patients at about the same rate that their less religious counterparts did, according to a report in the July/August issue of Annals of Family Medicine.
In fact, doctors who reported no religious affiliation at all were the most likely to practice among underserved populations (35%). Practitioners who were self-described as highly spiritual, but not necessarily religious, also cared for more underserved patients, said Farr A. Curlin, M.D., of the University of Chicago, and colleagues.
"The present study suggests that although physicians who practice among the underserved may explain their work in religious terms, religious physicians do not appear to disproportionately care for the underserved," the authors concluded.
From the earliest days of Hippocratic medical practice, codes of medical ethics have urged physicians to care for the poor, Dr. Curlin and colleagues noted. Even so, many poor patients and communities remain medically underserved.
Physicians have a variety of motives, including religious beliefs, for practicing among underserved populations. However, the investigators said, the association between physicians' religious characteristics and work among the underserved had not been examined previously.
Dr. Curlin and colleagues conducted a mail survey of a random sample of 2,000 U.S. physicians representing a variety of clinical specialties. The researchers received 1,260 responses (63%). Overall, 26% of respondents reported that their patient populations are considered underserved.
The investigators assessed intrinsic religiosity by respondents' answers to two questions about the extent to which religious beliefs influence the physicians' lives and activities. Both questions were drawn from a validated scale for religious motivation.
Among physicians deemed to be highly religious, 29% practiced among underserved populations, compared with 22% of the moderately religious and 27% of those with low intrinsic religiosity. Of physicians who reported at least twice-monthly church-going, 26% practiced among the underserved, the same as physicians reporting less frequent church attendance and slightly less than physicians who reported no church attendance (28%).
The authors reported that 32% of highly spiritual physicians cared for the underserved versus 26% among moderate spiritual doctors and 21% of practitioners who ranked low in spirituality (P<0.05).
Physicians who strongly agreed that religious beliefs influence medical practice were significantly more likely to practice among the underserved (36%, P<0.05) compared with doctors who felt less strongly (23%) or disagreed (26%).
Doctors whose families emphasized service to the poor were significantly more likely to practice among underserved populations (P<0.05). Physicians who strongly agreed that medicine is calling were more likely to care for underserved patients (31%), but the difference was not significantly different from physicians who felt less strongly (25%) or disagreed (25%).
A separate analysis limited to primary-care physicians yielded results similar to those of the entire survey cohort.
In the highly unlikely event that admissions officials ever consider medical school applicants' religious inclinations, Dr. Curlin and colleagues offered the following advice:
"[O]ur findings suggest that admissions officials should ignore both the general religiousness of candidates and their sense of calling to medicine, and should give preference to applicants who consider themselves very spiritual, who either have no religion or strongly agree that the religion they have influences their practice of medicine, or who agree that their families of origin emphasized service to the poor."
The authors reported no conflicts of interest. The study was funded by the Greenwall Foundation and the Robert Wood Johnson Clinical Scholars Program.Additional source: Annals of Family MedicineSource reference: Curlin FA et al. "Do religious physicians disproportionately care for the underserved?" Ann Fam Med 2007;5:epub.