Study Finds Racial Disparities in Physician Payments for Outpatient Care

A recent national study by researchers Aaron Schwartz, David Asch, and Rachel M. Werner highlights significant racial disparities in physician payments for outpatient care across the United States. Analyzing data from 2014 to 2021, the study found that physicians receive notably lower payments for treating Hispanic and non-Hispanic Black patients compared to white patients, with disparities most pronounced in pediatric care. Insurance coverage, particularly lower reimbursement rates from Medicaid, was identified as a primary driver of these payment gaps, though disparities persisted even after adjusting for patient health, visit content, and geographic factors. The analysis included over 150,000 outpatient visits from nearly 39,000 unique patients, revealing that payments to physicians were approximately 8.8% lower for visits with Black patients and 9.8% lower for visits with Hispanic patients relative to white patients. Pediatric visits showed the largest payment gaps, with physicians receiving nearly 14% less for Black children and over 15% less for Hispanic children compared to white children. Geriatric patient visits showed smaller but still significant payment differences. Importantly, fee-for-service Medicare, with its standardized payment rates, did not exhibit these racial payment disparities, suggesting that varying Medicaid reimbursement rates contribute heavily to the inequities. Medicaid covered a disproportionate share of visits for Black and Hispanic patients, which correlates with lower physician payments under this insurance type. Adjusting for demographic and clinical variables did not significantly change the findings, and insurance coverage explained approximately 44% of the observed disparities. Simulation models indicated that standardizing insurance coverage among patient groups could substantially narrow these payment gaps and potentially reduce associated disparities in healthcare utilization, especially for pediatric populations. This study underscores systemic inequities in physician compensation related to patient race and ethnicity, influenced largely by insurance payment structures. It suggests that addressing Medicaid reimbursement policies could be a key step towards mitigating financial disincentives for providers serving minority populations and improving equity in healthcare delivery. The research was published in the November 2025 issue of JAMA Health Forum.