Abstract
Background:
Recent efforts aim to determine whether patient-provider race concordance improves health outcomes for minority patient populations. Patient-physician race discordance is uniquely elevated in professional athletics.
Purpose:
To evaluate racial concordance between rostered players and their respective team physicians in 2 major professional sports leagues in the United States—the National Basketball Association (NBA) and Major League Baseball (MLB).
Study Design:
Cross-sectional study.
Methods:
Publicly available data were collected in June of 2023 to identify NBA and MLB players and team physicians. The sex and reported or perceived race of the players and team physicians were determined by 2 independent observers who analyzed reported demographic data, photographs, and names of these individuals, with disagreements resolved by a third independent observer. Team physicians’ medical training, medical specialty, languages spoken, and years in practice were obtained using publicly available internet-based sources or by contacting the clinical staff directly.
Results:
In both the NBA and the MLB, there was a statistically significant difference in racial composition between players and team physicians (P < .0001 for both). In addition, despite a high percentage (30.7%) of Hispanic/Latino players in the MLB, just 11.6% of MLB team physicians spoke Spanish, and >50% (18/30) of MLB organizations lacked a team physician who spoke Spanish.
Conclusion:
Substantial race discordance was found between professional athletes and head team physicians. Physicians more closely mirroring the patient populations that we treat—including professional athletes—may positively affect health care relationships and improve patient/provider barriers.
Race concordance between patients and health care providers is associated with improved patient experiences. Patients who perceive racial/ethnic similarities to their physician often report higher scores on the Press Ganey Outpatient Medical Practice Survey, which is used to evaluate a patient's experience. 12 Moreover, the degree of patient participation during medical visits, which improves the quality of health services, may be affected by the race/ethnicity of the provider. For example, patients rate their providers’ decision-making process as more participatory when they are of the same race compared with race-discordant circumstances, highlighting the importance of improving cross-cultural communication in race-discordant situations.2,5
One area where there may be a high rate of patient-physician race discordance is in professional sports, particularly in the National Basketball Association (NBA) and Major League Baseball (MLB). Previous studies have analyzed the demographics of team physicians in professional athletics and found low rates of minority representation.13,15 While these studies outline the characteristics of team physicians, there is a need to compare these data with the demographics of the athletes to more fully evaluate race concordance/discordance.
This study aimed to evaluate the race discordance between professional athletes and their team physicians for both the NBA and MLB. This information may be used in the future to guide studies focused on how race discordance between players and team physicians may affect their health care and to guide professional athletic organizations to improve diversity, equity, and inclusion initiatives in team physician selection and appointments.
Methods
Cohort Identification
The NBA and MLB—2 United States (US) professional sports leagues, each consisting of 30 teams—were evaluated in this study. Publicly available, internet-based data were collected in June 2023 to identify players and team physicians for each team within these leagues. NBA players in this study were actively rostered players at the time of data collection, and MLB players in this study were those on the 40-man roster at the time of data collection, which includes those on the 60-day injured list. Primary and assistant team physicians were identified on the staff directories on league-sponsored team web pages.
Data Collection
Reported or perceived race and sex of the players and team physicians were determined by 2 independent observers who analyzed reported demographic data, photographs, and names of these individuals, with disagreements resolved by a third independent observer (A.G., K.S., A.C.). 13 The race designations used in this study were White, Black, Asian, Hispanic/Latino, and Native American, which reflects those used by the American Academy of Orthopaedic Surgeons in its diversity reports. The 2+1 independent observer style of data collection was performed to minimize the potential misclassification bias that may occur when individuals are assigned to categories such as race and sex. Additional data collected for team physicians included medical training, specialty, foreign languages spoken, and years in practice. These data were obtained using either publicly available sources or by directly contacting team physicians’ clinical staff. The number of years since finishing residency or fellowship training was used to calculate years in practice.
Statistical Analysis
Chi-square tests were conducted to assess the difference in race composition between team physicians and players for both NBA and MLB, with the statistical significance set at the alpha = .05 level.
Results
Player Characteristics
A total of 508 rostered NBA players and 1342 rostered MLB players were identified. The NBA players were 19.1% White and 80.9% minorities (78.3% Black, 1.8% Hispanic/Latino, and 0.8% Asian), and the MLB players were 61.3% White and 38.7% minorities (5.4% Black, 30.7% Hispanic/Latino, 2.5% Asian, and 0.1% Native American) (Table 1).
NBA and MLB Players by Race a
Data are reported as n (%). MLB, Major League Baseball; NBA, National Basketball Association.
Team Physician Characteristics
For the NBA and MLB, 132 and 147 team physicians were identified, respectively. NBA team physicians were 81.1% White and 18.9% minorities (6.1% Black, 2.3% Hispanic/Latino, and 10.6% Asian), and MLB team physicians were 83.7% White and 16.3% minorities (4.1% Black, 2% Hispanic/Latino, and 10.2% Asian) (Table 2). All NBA and MLB team physicians spoke English. Of NBA team physicians, 20.5% spoke ≥1 foreign languages. Of those who spoke foreign languages, 15.2% spoke Spanish, 5.3% spoke a different foreign language, and 3% spoke both Spanish and an additional foreign language (Table 2). Of MLB team physicians, 15% spoke ≥1 foreign languages. Of those who spoke foreign languages, 11.6% spoke Spanish, 3.4% spoke a different foreign language, and 1.4% spoke both Spanish and an additional foreign language. In addition, 18 of the 30 MLB teams lacked a Spanish-speaking physician on staff. No significant difference was observed in the proportions of Hispanic/Latino players on MLB teams with versus without Spanish-speaking team physicians (χ2 = 0.657; df = 1; P = .418).
NBA and MLB Team Physicians by Race, Sex, Medical Training, Medical Specialty, Languages Spoken, and Years in Practice a
Data are reported as n (%) unless otherwise indicated. DO, doctor of osteopathic medicine; MD, doctor of medicine; MLB, Major League Baseball; NBA, National Basketball Association; PhD, doctor of philosophy.
Other degrees: DDS (Doctor of Dental Surgery) or DPM (Doctor of Podiatric Medicine) for NBA team physicians; DO (Doctor of Optometry) for MLB team physicians.
Other specialties: ophthalmology (6.8%), cardiology (5.3%), oral/maxillofacial surgery (3%), psychiatry (3%), physical medicine and rehabilitation (2.3%), dermatology (0.8%), otolaryngology (0.8%), infectious disease (0.8%), podiatry (0.8%), neurology (0.8%), and gastroenterology (0.8%) for NBA team physicians; ophthalmology (2.7%), cardiology (2%), emergency medicine (1.4%), neurology (1.4%), optometry (0.7%), radiology (0.7%), infectious disease (0.7%), psychiatry (0.7%), physical medicine and rehabilitation (0.7%), endocrinology (0.7%), and dermatology (0.7%) for MLB team physicians.
Data not available for 3 physicians.
A statistically significant difference was found in racial composition between players and team physicians in both the NBA (χ2 = 248.57; df = 4; P < .0001) and MLB (χ2 = 73.80; df = 4; P < .0001). Figure 1 shows a visual representation of the racial breakdown of NBA and MLB players versus team physicians.
The racial breakdowns of NBA and MLB players and team physicians. MLB, Major League Baseball; NBA, National Basketball Association.
Discussion
In this study, we identified 80.9% of NBA players and 38.7% of MLB players as minorities. While the percentage of individuals with minority status in the medical school student body has increased from 20% to 50% over the past 40 years, some specialties such as orthopaedic surgery have been lacking in racial and ethnic diversity.3,6,8,9,10 For instance, despite 13.3% of the US population being Black and 17.6% being Hispanic, only 4.1% and 2.7% of orthopaedic trainees represent these minority groups, respectively. 3 Furthermore, the number of underrepresented minorities in orthopaedic surgery residencies has decreased over time, likely due to difficulty attracting underrepresented applicants that perpetuates the limited diversity in the field. 1 The present study highlights the lack of racial diversity among team physicians in the NBA and MLB, with 81.1% of NBA and 83.7% of MLB team physicians documented as White. These data suggest that racially discordant player-team physician relationships exist within these 2 professional sports leagues. While this discordance may negatively affect the quality of health care perceived by the athletes, evaluating perceptions was not the purpose of this study; therefore, the race discordance observed does not provide proof of negative perceptions among the professional athletes assessed.
Patient participation is another key component of successful health care, and language barriers can hinder the ability of physicians and patients to have a meaningful clinical connection. 5 The MLB is unique with its high percentage of Spanish-speaking, Hispanic/Latino players (30.7%). Our results show that only 11.6% of MLB team physicians speak Spanish. In addition, at the time of this study, more than half of the MLB organizations lacked at least 1 Spanish-speaking team physician (18/30). This potential barrier to clinical conversation may limit some Hispanic/Latino MLB players from connecting with their care providers and participating in the shared decision-making process.
Professional athletes comprise a unique subset of the US population, not only in terms of racial diversity, but also with respect to increased physical demands, associated increased risk of injury, and time pressure of injured athletes to return to sports. In addition, while professional athletes often have superb access to health care, they commonly rely on agents and upper management to appoint their treatment providers, which may act as a barrier preventing players from choosing race-concordant physicians. For these reasons, it would be highly unlikely to see complete racial concordance between players and team physicians, although increasing minority representation in orthopaedic surgery and sports medicine-related fields may minimize this discordance and increase the athletes’ perceived quality of care.
A proposed solution to increasing minority representation among team physicians is early exposure of individuals of minority status to the fields of orthopaedic surgery and sports medicine, which may be critical to the development of their career interests. 7 Other US professional sports leagues like the National Football League (NFL) have begun to use this strategy. The NFL has joined the National Football League Physician Society and the Professional Football Athletic Trainer Society to bring medical students of diverse backgrounds to work with current NFL club medical staff. 4 The NFL hopes that their programming will increase the future diversity of team physicians, which they state has the potential to improve their athletes’ overall health. The NBA and MLB have similar platforms and may have the potential to sponsor programs that could boost minority participation in medical specialties that would benefit their players’ health and wellbeing. In addition, a multilayered approach whereby head team physicians add assistant team physicians and support staff that more closely resemble the athletes may improve this race disparity. Recent trends demonstrate an increase in minority representation among orthopaedic sports medicine societies—such as the Arthroscopy Association of North America and the American Orthopaedic Society of Sports Medicine—and continuing in this direction will help drive change on this front. 11
In the future, follow-up studies of the NBA and MLB would be important to track the progress of minority representation among team physicians over time. To further explore a potential cause for such lack of diversity, evaluating the demographics of the coaches, owners, and upper management who appoint team physicians is of interest for future study. Also, studying player-physician race concordance in female professional athletics is of interest, especially for those with a high percentage of players with minority backgrounds, such as the Women's National Basketball Association, where players of color make up 81.1% of its players. 14 Additionally, while our data and other previous research demonstrate the underrepresentation of female physicians in medical specialties, such as orthopaedic surgery, it would be important to continue following these trends over time, especially for team physicians in female professional athletics, where player-physician sex concordance may be critical for high-quality health care. 9
Limitations
This study has limitations. As it is a cross-sectional study, we cannot establish causal relationships from our analysis. Furthermore, the analysis performed in this study offers a snapshot of prevalence, and therefore cannot establish trends over time. For this reason, future longitudinal studies would be fruitful. In addition, because professional athletes have unique access to health care resources, studies using data from nonprofessional athlete populations may have poor external validity to this niche athlete population. Last, we acknowledge that the players and physicians in this study did not identify their race and that our methodology may fail to account for the unique experience of multiracial individuals. Relying on observer agreement has the potential to introduce misclassification bias in our analysis. The 2+1 independent observer style of data collection was performed to minimize this potential. With this limitation of our methods in mind, we hope to highlight the lack of validated, publicly available player/team physician demographic information made accessible by professional sports leagues and call for an increase in transparency moving forward.
Conclusion
The purpose of this study was to evaluate race concordance between rostered NBA and MLB players and their respective team physicians. We identified a statistically significant difference in the racial composition of both NBA and MLB players and their team physicians, which indicates a high rate of discordant player-physician relationships. For the MLB, which is composed of many Hispanic/Latino players, only 11.6% of team physicians spoke Spanish, and more than half of MLB teams lacked a Spanish-speaking physician on staff. The race discordance between professional athletes and their team physicians that we identified may represent a barrier to optimal health care relationships.
Footnotes
Final revision submitted July 29, 2024; accepted August 27, 2024.
One or more of the authors has declared the following potential conflict of interest or source of funding: N.G. has received education payments from Medwest Associates; consulting fees from Encore Medical and Wright Medical; nonconsulting fees from Arthrex; and honoraria from Encore Medical. D.S. has received education payments from Medwest Associates; consulting fees from Stryker and Zimmer Biomet; and nonconsulting fees from Wright Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Ethical approval was not sought for the present study.
