Colorblind Racial Ideology and Physician Use of Race in Medical Decision-Making

Background Colorblindness is a racial ideology that minimizes the role of systemic racism in shaping outcomes for racial minorities. Physicians who embrace colorblindness may be less likely to interrogate the role of racism in generating health disparities and less likely to challenge race-based treatment. This study evaluates the association between physician colorblindness and the use of race in medical decision-making. Methods This is a cross-sectional survey study, conducted in September 2019, of members of the Minnesota Academy of Family Physicians. The survey included demographic and practice questions and two measures: Color-blind Racial Attitudes Scale (CoBRAS; measuring unawareness of racial privilege, institutional discrimination, and blatant racial issues) and Racial Attributes in Clinical Evaluation (RACE; measuring the use of race in medical decision-making). Multivariable regression analyses assessed the relationship between CoBRAS and RACE. Results Our response rate was 17% (267/1595). In a multivariable analysis controlling for physician demographic and practice characteristics, CoBRAS scores were positively associated with RACE (beta = 0.05, p = 0.02). When CoBRAS subscales were used in place of the overall CoBRAS score, only unawareness of institutional discrimination was positively associated with RACE (beta = 0.18, p = 0.01). Conclusions Physicians who adhere to a color blind racial ideology, particularly those who deny institutional racism, are more likely to use race in medical decision-making. As the use of race may be due to a colorblind racial ideology, and therefore due to a poor understanding of how systemic racism affects health, more physician education about racism as a health risk is needed.