Study: Ratings bias declined for young doctors after new review system was adopted

Doctors meeting in a hallway.

Charles Rex Arbogast/AP

3 min read

Researchers have found that an overhaul of the performance review system for judging young doctors has led to a large reduction in ratings bias against Black, Latino, and Asian medical residents, although bias persists in the evaluations of U.S.-born Black residents.

A study published in December in the Annals of internal Medicine journal compared bias trends in the performance evaluations of hospital residents before and after 2014, when a new evaluation system was introduced that reduced reviewer discretion in the process.

The researchers included senior author Marcella Alsan, Angelopoulos Professor of Public Policy at Harvard Kennedy School, who is a physician, healthcare economist, and public health expert. The lead author was Bradley Gray, senior health services researcher at the American Board of Internal Medicine. Co-authors were Rebecca Lipner and Jonathan Vandergrift, also of the ABIM; Robert Roswell of the Zucker School of Medicine at Hofstra Northwell; and Alicia Fernandez of the University of California-San Francisco.

In the U.S. medical education system, doctors who graduate from medical school usually go on to serve as residents in hospitals for two or more years, treating patients and undergoing further training, often in a specialty field. Doctors go through detailed evaluations during their residencies, and Black, Latino and Asian residents have reported experiencing evaluation bias that can limit their career prospects.

The adoption of the Milestone evaluation system in 2014 addressed shortcomings including lack of clear descriptions of performance expectations and overreliance on program directors to evaluate residents. The new system gave more weight to clinical competency, committee ratings, and other more structured measurements, along with guidance on increasing the number and diversity of those doing the subjective evaluations.

The researchers looked at ratings data for nearly 60,000 residents who completed residencies in internal medicine before and after the new rating system was adopted, and they compared the more subjective performance ratings with more objective standardized test results on certification exams and other physician scores.

The study found large decreases in ratings bias against minority group residents in the years after adoption of the new ratings system. These groups included U.S.-born and foreign-born Asian and Latino residents and non-U.S.-born Black residents. However, the bias decrease was smaller for U.S.-born Black residents, leaving a substantial and concerning gap.

“Importantly, still more needs to be done to improve the situation for U.S.-born Black physicians,” Alsan added. “And there are too few Black doctors in the United States to begin with.”