Officers who outrank their military physicians and personnel who have been recently promoted receive better attention and care in Defense Department health facilities than lower-ranking service members, new research on military emergency room visits has found.

The study, published Thursday in the journal Science, also found racial bias in treatment and care in military ERs, with white physicians "exerting less effort" on Black patients.

While the study also found that white physicians treated higher-ranking Black patients with more care, their treatment was still only on par with lower-ranking white patients. Black military doctors treated lower-ranking patients of either race fairly equally, the study found, but they provided high-ranking Black patients "off-the-charts" care.

The researchers, with the University of Texas at San Antonio and Carnegie Mellon University, conducted the study to further understand implicit bias in health care in civilian settings as well as military care. Stephen Schwab, the study's co-author, said that, while bias regarding gender and race is often the subject of research, the role that power dynamics play in medical services is less understood.

The military, with its obvious rank structure, presents opportunities to understand this relationship, he said.

"The military is doing everything it can to reduce these biases. Part of it is understanding the scope of the issue. It's not just race and gender, it's also power and wealth," Schwab, a retired Army lieutenant colonel who now works at the University of Texas at San Antonio, said in an interview with Military.com on Friday.

For the study, the researchers examined data from 1.5 million emergency department visits in the military health system, looking at the rank of a patient compared with the doctor's rank and examining treatment response, including resources expended such as medical tests, imaging and certain prescriptions, and outcomes, such as hospital admissions at the time of the ER visit or within 30 days afterward.

They found that higher-ranking patients received 3.6% more physician effort and resources and were 15% less likely than lower-ranking patients to have poor outcomes.

Lower-ranking patients seen by doctors attending to higher-ranking patients at the same time were 3.4% more likely to have poorer outcomes, according to the study.

Clarence E. "Bud" Anderson arrived in the European Theater of World War II in 1943, an experienced pilot at a time when many of his contemporaries had around an hour of experience in the cockpit. Anderson had been flying since 1941, when he was just 19 years old, and he brought that experience to the air war above occupied Europe. His aviation career would span four decades, earning him the coveted "triple ace" designation and a well-deserved place in the National Aviation Hall of Fame.

Anderson died in his sleep at his home in Auburn, California, on May 17, 2024, just a little over a year after the Air Force bestowed him with a post-retirement promotion to brigadier general. He was 102 years old.

Northern California was always home for Anderson. He was born in Oakland on Jan. 13, 1922, and attended high school in Auburn. When he turned 19, the United States had still not entered World War II, but he gained his pilot's license that year through the Civilian Pilot Training Program. After the attack on Pearl Harbor, he joined the Army Air Forces as an aviation cadet. Upon completion of fighter pilot training, he was sent to England with the 357th Fighter Group.

Then-Lt. Anderson would be trained to fly the P-39 Airacobra fighter, but the 357th would soon get a new weapon, the legendary P-51 Mustang. The pilots of the 357th would get little time to train with the P-51; as their commander famously told them, "You can learn to fly `51s on the way to the target."

This is where his experience counted the most. In his Mustang, nicknamed "Old Crow" for his favorite brand of bourbon, Anderson would fly 116 combat missions over two tours, logging some 480 hours and 16 air-to-air kills, usually while escorting bombers on their way to targets in Europe. To be named an "ace" required five confirmed combat kills.

Downing 16 enemy fighters not only made Anderson a "triple ace," it made him the highest scoring pilot in the 363rd Fighter Squadron. He had entered combat as a captain at age 22; by the time he returned home in 1945, he was a 23-year-old major.

"In the sky those damned Germans must've thought they were up against Frankenstein or the Wolfman," Chuck Yeager, the legendary pilot and fellow member of the 363rd, would later write of Anderson in his 1985 autobiography. "Andy would hammer them into the ground, dive with them into the damned grave, if necessary, to destroy them."