Racial Differences in Coronary Artery Bypass Rates

To the Editor. —I believe the article "Racial and Community Factors Influencing Coronary Artery Bypass Graft Surgery Rates for All 1986 Medicare Patients" by Goldberg et al¹ has missed a key point. Comparisons should be made by hospitals. If the difference is maintained when looked at by hospitals, we have a very serious problem. However, I suspect that city/county and charity hospitals overall have lower rates for bypass surgery and treat a larger portion of blacks. Suburban and larger private hospitals probably have higher rates for bypass surgery and treat fewer blacks on average than comparable city/county or charity hospitals in the same city.

The reasons for such hospital differences are multiple but probably reflect on the care given by resident and teaching staff who are overworked in charity hospitals and receive no financial benefit from more surgery. By contrast, the financial benefit to surgeons in practice may result