Effect of physician and patient gender concordance on patient satisfaction and preventive care practices

International study of physicians' opinion on physician-patient sex concordance when treating athletes

BACKGROUND

The effect of physician-patient sex concordance in medicine has been reported in many studies. Whether physicians believe that the sex concordance between physician and athlete influences treatment has not been investigated.

OBJECTIVE

To determine whether physicians believe that the sex concordance between physician and athlete influences treatment.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PARTICIPANTS

One thousand one hundred ninety-three sports medicine physicians in 51 countries. Participants were sports medicine physicians trained in orthopedics (n = 443 [37.1%]) and nonorthopedics (n = 750 [62.9%]).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants were asked to decide whether sex of the physician made them better suited to care for athletes of concordant or different sexes along with their personal background.

RESULTS

Orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians regarding the statement "MALE sports medicine physicians are better suited than their female counterparts to care for MALE athletes" (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.91, p = .02), and compared to sports medicine physicians based in Europe, those based in Asia agreed more to this statement (OR 7.91, 95% CI 4.60-13.60, p < .01). In addition, regarding the statement "FEMALE sports medicine physicians are better suited than their male counterparts to care for FEMALE athletes," compared to sports medicine physicians based in Europe, those based in Asia (OR 9.12, 95% CI 5.63-14.79, p < .01) and North America (OR 2.18, 95% CI 1.46-3.25, p < .01) agreed more and orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians (OR 0.61, 95% CI 0.39-0.93, p = .02) to this statement.

CONCLUSIONS

Sports medicine physicians trained in orthopedics felt sex concordance was less important than physicians trained in other specialties. Asian sports medicine physicians believed sex concordance was more important compared to physicians in other regions.

Gender Inequality Improvement in Medical School Admissions in Japan

Purpose: To investigate the effects of gender discrimination in Japan's medical school admission process and to assess whether the situation has improved since the disclosure of such discrimination in 2018. Materials and Methods: A cross-sectional study was conducted using secondary data from the Ministry of Education, Culture, Sports, Science, and Technology. The proportions of male and female applicants vis-à-vis all successful candidates admitted from 2016 to 2021 were analyzed; four medical schools were found to be systematically guilty of discriminatory admission practices. Acceptance rate ratios (ARRs) were estimated, and difference-in-differences (DID) analysis was used to examine the differences in ARRs between the two groups-the 4 and 75 medical schools that were and were not reported, respectively-in the predisclosure (2016-2018) and postdisclosure (2019-2021) periods. Results: Female applicants were subjected to discriminatory admission practices at the four reported medical schools in the predisclosure period. However, postdisclosure, those four medical schools had higher female than male acceptance rates in all 3 years. DID analysis revealed a statistically significant estimated average treatment effect on the treated of 0.25148 (95% confidence interval [0.00455-0.49840]), indicating a 0.25-point increase in ARRs relative to the other 75 medical schools. Conclusions: Discriminatory practices against female applicants have decreased since the disclosure in 2018, with the acceptance rate of female students exceeding that of male students for the first time in 2021. In response to these findings, we propose recommendations to further promote gender equality in medicine.

A Practical Guide to Implementing Holistic Review during Surgery Resident Selection

Provider workforce diversity is a key component of improving healthcare quality and addressing healthcare disparities. Furthermore, the traditional approach of "score-centered" application metrics do not consistently correlate with meeting milestones in surgery, nor do they adequately predict a surgical resident's clinical strength and operative abilities. We present here an adaptable process by which surgical residency programs can identify their values and incorporate holistic review into their resident selection process to improve resident selection and physician workforce diversity.

Primary Care Delivery Perceptions and Their Associations with Physician and Patient Gender

INTRODUCTION

We aim to survey patients' opinions on perceived differences in patient care delivered by male and female physicians.

METHODS

Patients of primary care practices at Mayo Clinic, Arizona completed a survey sent through the electronic health record. The survey evaluated opinion regarding their primary care physician (PCP)'s overall healthcare provision capabilities and any perceived differences based on gender.

RESULTS

4983 patients' responses were included in final analysis. Compared to male patients, most female patients preferred to have a female PCP (78.1% vs. 32.7%, p < 0.01). Having a preference for female physicians was correlated with higher overall opinion of female physicians. The majority of male patients did not hold a difference in opinion regarding male versus female physicians (p < 0.01). Male patients were half as likely to have a better opinion and nearly 2.5 times more likely to have a worse opinion of female physicians (p < 0.01) compared to female patients. Patients preferring female physicians were nearly 3 times more likely to have a better opinion of female physicians compared to patients with no preference (p < 0.01).

CONCLUSION

In a primary care setting, majority of female patients compared to male patients preferred female physicians as their PCP and had higher opinion of the care delivery of female physicians. These findings may influence how practices should assign primary care physicians to new patients and add underlying context to patient satisfaction ratings.

Factors influencing gender preference towards surgeons among Jordanian adults: an investigation of healthcare bias

Studies investigating gender bias against female surgeons yielded conflicting results ranging from neutrality to a clear preference towards male surgeons. Yet, such bias remains understudied within Middle Eastern nations. We aimed to assess preferences of surgeons' gender among Jordanians and explore reasons for possible gender bias across different surgical specialties. A total of 1708 respondents were examined using a cross-sectional, self-administered questionnaire to evaluate the gender preferences of surgeons, characteristics associated with preferred surgeon's gender, and surgeon's preference in certain specialties. Nearly 52.0% of participants had no gender preference for surgeons. Among those with a preference, 75.7% preferred male surgeons while 24.3% preferred female surgeons. Reputation, knowledge, and experience were the most important factors when choosing a surgeon. Male surgeons were viewed as more trustworthy, knowledgeable, experienced, and communicative. Female surgeons were dominantly perceived as more compassionate, cooperative, and prone to listen. Male respondents were 5 times more likely to choose a surgeon of similar gender (OR 5.687; CI 3.791-8.531). Male surgeons were favored for cardiovascular and orthopedic surgeries. Similarly, female surgeons were favored in gynecological and obstetric surgeries, plastic surgeries, and breast surgeries. Female gender (OR 6.193; CI 4.077-9.408), living outside Amman (OR 1.517; CI 1.066-2.160), and being married (OR 2.504; CI 1.601-3.917) were all significant positive predictors of preferring female surgeons. Our findings highlight differences in gender preference and perception of surgeons among Jordanian adults.

The Gender of the Sender: Assessing Gender Biases of Greetings in Patient Portal Messages

Purpose: The purpose of the study was to determine if the use of professional titles in patient electronic health record (EHR) messages varied by gender of the physician receiving the message and gender of the patient sending the message. Methods: We conducted a retrospective observational study evaluating 285,744 messages for a patient's greeting to their physician. Logistic regression mixed effects models were fit to estimate the relationship between title use and gender. Results: Female physicians received 189,442 (66%), and female patients sent 183,579 (64%) messages. Female physicians received an average of 1754 messages each (sd = 1615, median [IQR] = 1624 [255-3040]), which was significantly more than the average 1235 messages for males (sd = 1527, median [IQR] = 385 [103-1857], Mann-Whitney-Wilcoxon p-value = 0.006). Female patients were more likely to send messages using professional titles (OR = 1.37, CI = 1.28-1.47, p < 0.001). Female physicians were no more likely than male physicians to receive professional titles (OR = 1.06, CI = 0.89-1.27, p = 0.500). Conclusions: Female physicians received significantly more EHR messages than men, and female patients were more likely to use a professional title when addressing their physician, regardless of gender. Across all patients, physician gender did not influence the rate of professional title used.

Press Ganey® Ratings in Urology: Who is at Risk of Bias?

OBJECTIVE

To evaluate effect of patient and physician demographics on Press Ganey® (PG) survey ratings for urologists.

METHODS

PG surveys (02/2020 - 08/2021) for urologists at a single tertiary care center were analyzed. Univariate and multivariate logistic regression models were used to assess the relationship between patient and physician-level covariates and the primary outcome of a "topbox" Overall Doctor Rating (topbox-ODR) score of 9 or 10 out of 10.

RESULTS

4,155 surveys of 20 attending urologists (8 female (F)) across 7 subspecialties, were assessed. Mean ODR score for F physicians was 9.2 (SD 1.7) compared to 9.5 (SD 1.3) for males (M), p < 0.001. Univariate regression demonstrated that F patients are less likely (OR 0.27, p < 0.001) to give topbox-ODRs than M patients, and F physicians are 58% less likely (OR 0.42, p = 0.01) to receive topbox-ODRs than M physicians. Oncologists are more likely to receive topbox-ODRs (OR 3.3, p = 0.009) than all other subspecialists. Multivariate regression demonstrated that M patients are more likely to give M physicians top-box-ODRs (OR 0.32, p = 0.02), while F patients are less likely to give topbox-ODRs to physicians of both genders (M: OR 0.24, p < 0.001; F: 0.21, p < 0.001). Physicians in practice for >10 years are 66% less likely to receive topbox-ODRs (OR 0.33, p = 0.002).

CONCLUSIONS

Urologists who care for F patients are at risk of being affected by bias in PG physician ratings. M physicians who care for M patients appear to be at the least risk; while F physicians who care for F patients appear to be at the highest risk.

The Financial Implications of Being a Female Fellow: Does Another Year Help Close the Gap?

In 2018, the American College of Foot and Ankle Surgeons Compensation and Benefits Survey illustrated a wage gap between male and female doctors of podiatric medicine in the United States. The purpose of the present study was to assess if an additional year of fellowship training closes that gap. To calculate the net present value, weighted mean general income data from female doctors of podiatric medicine with and without fellowship training was obtained. Demographic and clinical income data (based on 2080 hours) for 17 female graduates from 14 American College of Foot and Ankle Surgeons recognized fellowship programs was collected using an anonymous online survey. Income from general payments was collected from manual searches of Open Source Payments. Socioeconomic data from the 2018 American College of Foot and Ankle Surgeons compensation and benefits survey was used to calculate the net present value of the nonfellowship trained doctors of podiatric medicine for comparison. Overall, the net present value of female doctors of podiatric medicine with and without fellowship training was $1.91 million and $2.4 million, respectively. The comparative net present value and cumulative net income difference over 30 years for female doctors of podiatric medicine with and without fellowships was -$492,159.00 and -$820,000.00, respectively. The mean comparative income difference for fellowship trained female doctors of podiatric medicine annually was as follows: clinical (-$26,082.00) and general (+$1101.54). Based on the data, with consideration to the limitations of the study, the financial implications of fellowship on the gender wage gap is currently unclear. Additional research is warranted.

Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey

OBJECTIVE

To analyse whether patient-general practitioner (GP) interaction, measured by their disagreement, varies among overweight or obese patients compared with normal-weight patients.

METHODS

Twenty-seven GPs and 585 patients participated in the quantitative phase of the multidisciplinary INTERMEDE project and answered "mirrored" questionnaires collecting both GPs and patients' perceptions on information and advice given at the end of the consultation. Multilevel logistic regressions were performed to explore associations between patient body mass index (BMI) and patient-GP disagreement on information and advice given during the consultation.

RESULTS

Disagreement increased with the patients' excess weight, and it was particularly pronounced for advice given by GPs on weight and lifestyle issues. Compared with patients with a "normal" BMI, overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio [OR] = 10.7, 95% confidence interval [CI] = 4.1-27.3), advice given on doing more physical activity (OR = 1.9, 95% CI = 1.1-3.4), and nutritional advice (OR = 2.9, 95% CI = 1.5-5.6).

CONCLUSION

These disagreements could degrade the quality of patient-physician relationship. Our study provides an opportunity for GPs to reflect on how they communicate with overweight and obese patients, particularly with regard to lifestyle and weight-related advice and interventions taking into account the patient's representations.

A Bitter Pill to Swallow? The Consequences of Patient Evaluation in Online Health Question-and-Answer Platforms

Online health question-and-answer platforms (OHQPs), where patients post health-related questions, evaluate advice from multiple doctors and select their most preferred answer, are a prominent channel for patients to receive medical advice in China. They are gaining traction globally and have the potential to circumvent resource-based, geographic, or circumstantial barriers that limit access to care. At the same time, they are underregulated in contrast to brick-and-mortar points of care. Ours is the first study to evaluate the quality of healthcare advice promoted by these platforms and to provide insight into how patients respond to advice. We found that, though advice is generally good, patients cannot discern good advice from bad, choose poor advice (when offered) as often as good advice, and do so to a greater extent in vulnerable categories such as pediatrics, cancers/tumors, and internal medicine. Moreover, we found that OHQPs exacerbate care avoidance. Our findings suggest that platform owners and policymakers should ensure that signals of expert consensus are provided to patients to better assist their choices on OHQPs. We also unveiled bad actors on OHQPs, including drug promoters and spammers, indicating that stronger oversight and accountability mechanisms are needed. Physician peer reviewing and auditing can address both problems.

The surgical gender gap: the impact of surgeon gender in medicine and gynecologic surgery

PURPOSE OF REVIEW

The purpose of this review is to summarize the current literature evaluating the effect of surgeon gender on patient outcomes and satisfaction, and the impact of gender bias on female surgeons.

RECENT FINDINGS

The proportion of female physicians has increased in recent years, especially in Obstetrics and Gynecology. Recent literature assessing this impact supports equivalent or superior medical and surgical outcomes for women surgeons and physicians. It also reveals superior counseling and communication styles as perceived by patients. However, women in medicine receive lower patient ratings in competence, medical knowledge, and technical skills despite the existing evidence. Additionally, female physicians experience pay inequality, limited advancement opportunities, higher prevalence of microaggressions, and higher rates of burnout.

SUMMARY

Recognition of gender bias is essential to correcting this issue and improving the negative impact it has on female physicians, our patients, and the field of women's health.

How responding in Spanish affects CAHPS results

BACKGROUND

The most widely used surveys for assessing patient health care experiences in the U.S. are the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Studies examining the associations of language and ethnicity with responses to CAHPS surveys have yielded inconsistent findings. More research is needed to assess the effect of responding to CAHPS surveys in Spanish.

METHODS

Subjects were patients who had received care at a study community health center in Connecticut within 6 or 12 months of being sent a CAHPS survey that asks about care experiences. The survey included four multi-item measures of care plus an overall rating of the provider. Sampled patients were mailed dual language (English and Spanish) cover letters and questionnaires. Those who did not respond after follow-up mailings were contacted by bilingual interviewers to complete the survey by telephone. We tested three hypotheses for any observed differences by ethnicity and language: 1. Spanish speakers are more likely than others to choose extreme response options. 2. The semantic meaning of the Spanish translation is not the same as the English version of the questions, resulting in Spanish speakers giving different answers because of meaning differences. 3. Spanish speakers have different expectations regarding their health care than those who answer in English. Analyses compared the answers on the survey measures for three groups: non-Hispanics answering in English, Hispanics answering in English, and Hispanics answering in Spanish.

RESULTS

The overall response rate was 45%. After adjusting for differences in demographic characteristics and self-rated health, those answering in Spanish gave significantly more positive reports than the other two groups on three of the five measures, and higher than the non-Hispanic respondents on a fourth.

CONCLUSIONS

Those answering in Spanish gave more positive reports of their medical experiences than Hispanics and non-Hispanics answering in English. Whether these results reflect different response tendencies, different standards for care, or better care experiences is a key issue in whether CAHPS responses in Spanish need adjustment to make them comparable to responses in English.

Factors Associated With Dimensions of Patients' Trust in Chiropractic Doctors in the International Medical University Healthcare Chiropractic Center: An Exploratory Study

Objective

The purpose of this study was to investigate the association between patients' sociodemographic factors (age, sex, ethnicity, and education background) and dimensions of patients' trust in chiropractic doctors in Malaysia.

Methods

This cross-sectional study was conducted in the International Medical University Healthcare Chiropractic Center with a total of 302 respondents. Self-administered questionnaires were enclosed in an envelope and passed to participants by the researchers. Descriptive statistics are presented in tables and figures. Each dimension of the patients' trust was compared against the sociodemographic factors. The variables included were sex, age, ethnicity, and education background, along with their dimensions of trust.

Results

There were 106 male respondents (35.1%) and 196 female respondents (64.9%) between 21 and 40 years of age. In all of the trust dimensions, education background was the only statistically significant variable (P < .05).

Conclusion

Several sociodemographic factors were associated highly with the trust dimensions explored. Patients' education background was the only sociodemographic factor to show a statistically significant relationship to all 10 trust dimensions. Sex, age, and ethnicity showed significant associations with some of the trust dimensions explored in this study.

Update: Diversity and Practice Patterns of International Craniomaxillofacial Surgeons

BACKGROUND

The authors' group characterized the cranio-maxillo-facial workforce 10 years ago, revealing high levels of career satisfaction but significant gender disparity. This study provides an updated profile of the international cranio-maxillo-facial workforce.

METHODS

A 30-question electronic survey was distributed to 387 cranio-maxillo-facial surgeons with membership in the American Society of Craniofacial Surgeons, American Society of Maxillofacial Surgeons, and International Society of Craniofacial Surgery. Questions related to demographics, training background, practice setting, surgical volume, career satisfaction, and perceived discrimination. Independent samples t test was used to compare continuous variables.

RESULTS

The authors received 91 responses (response rate = 23.5%). The majority of respondents were White (n = 73, 80.2%), non-Hispanic (n = 85, 93.4%), heterosexual (n = 72, 79.1%), cisgender males (n = 74, 81.3%). Practice setting was primarily academic, 65.9% (n = 60) and group/hospital-based 88.3% (n = 68), with two-thirds of respondents practicing in the United States. Female surgeons reported earlier planned retirement (66 versus 70 years, P = 0.012) and more personal encounters with discrimination of any kind (69% versus 29%, P = 0.033). US craniofacial surgeons reported more racial and sexual orientation-based discrimination compared with non-US surgeons (P = 0.049 and P = 0.048, respectively). Older surgeons (>55 years old) reported less perceived gender discrimination (P = 0.041). There was no difference between subgroups in career satisfaction or likelihood of repeating/recommending a cranio-maxillo-facial fellowship.

CONCLUSIONS

Female representation in cranio-maxillo-facial surgery on an international scale has increased over the past decade, but this study demonstrates persistent, disparate perception of workplace discrimination by gender, practice region, and age.

Sex Disparity Persists in Pain Medicine: A Cross-Sectional Study of Chairpersons Within ACGME-Accredited Chronic Pain Fellowship Programs in the United States

OBJECTIVE

To compare the representation of female and male chairpersons and evaluate their respective demographic, academic, and program-related characteristics in academic chronic pain institutions.

METHODS

We identified all chronic pain fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME) on April 19, 2021. We queried institutional websites or contacted programs directly to identify the respective departmental/divisional program chairperson. We abstracted data on program chairpersons from public databases and performed statistical comparisons of demographic, academic, and program-related characteristics between female and male program chairpersons.

RESULTS

Of the 111 ACGME-accredited chronic pain fellowship programs, we identified the current chairperson at 87 programs (78.4%). There were 17 female chairpersons (19.5%) and 70 male chairpersons (80.5%). A higher proportion of female chairpersons reported an academic rank of assistant professor compared with male chairpersons (35.3% vs 11.4%, P = .027). Male chairpersons published more peer-reviewed articles compared with female chairpersons (median 32.0 vs 10.0 publications, P = .001). Concordantly, male chairpersons achieved a higher H-index score compared with female chairpersons (median 10.0 vs 3.0, P = .001). No differences were identified in other academic or program-related characteristics.

CONCLUSION

This cross-sectional study illuminates important details on sex-related differences in the chronic pain program chair role. Women chairpersons are underrepresented, have fewer peer-reviewed publications, and achieved a lower H-index score compared with male chairpersons. Establishing these baseline associations provides a reference for future studies to evaluate changes over time.

Prevalence of Workforce Diversity Research Among Surgical Specialties in the United States: How Does Plastic Surgery Compare?

BACKGROUND

Plastic surgeons are not as diverse as expected in relation to the increasingly diverse patient and medical student population. The authors assess the state of diversity in 8 primary surgical specialties in the United States and evaluate trends in research interest in diversity over the past 30 years.

METHODS

Articles regarding diversity in surgery from 1990 to 2020 were systematically reviewed. The Association of American Medical Colleges Physician Specialty Data Reports and the Accreditation Council for Graduate Medical Education Data Resource Books provided resident/fellow and faculty data from 2011 to 2016. Trends were analyzed over time per specialty.

RESULTS

From 1990 to 2020, a total of 199 publications related to diversity were identified among the various surgical specialties. Orthopedic surgery had significantly more publications per year compared with other specialties (P < 0.05). Every specialty demonstrated a significant increase in publications about diversity over time (P < 0.05). A majority of publications were related to sex rather than underrepresented in medicine topics. The proportion of female surgeons was significantly higher for plastic surgery than for orthopedic surgery and neurosurgery (P < 0.001). Plastic surgery exhibited the highest growth rate in female residents (+1.6% per year, P < 0.001). The proportion of underrepresented minorities composing surgical trainees has not significantly increased in any surgical specialty between 2011 and 2016 (P > 0.05).

CONCLUSIONS

Although diversity representation in surgery has somewhat improved, the rate is too slow to match the growing diversity of the US population. Outcomes have been disparate between specialties and demonstrate greater increases in sex equality relative to ethnic/racial equality. Evidence-based interventions need to be developed and implemented.

Disparities in Creating a Diverse Surgical Oncology Physician Workforce: Just a Leaky Pipeline?

Demographic shifts in the Unites States population highlight the growing need for a diverse physician workforce to care for communities of color and to eliminate existing disparities in cancer care and outcomes for these potentially vulnerable patients. The current surgical oncology workforce lacks adequate racial and ethnic representation, and the pool of medical students and surgical trainees who are underrepresented in medicine (URM) is scant. This review critically evaluates data, summarizes challenges in the recruitment and retention of URM surgeons to surgical oncology, and provides strategies to address these workforce deficits.

Is Patient-Physician Gender Concordance Related to the Quality of Patient Care Experiences?

BACKGROUND

There is great interest in identifying factors that are related to positive patient experiences such as physician communication style. Documented gender-specific physician communication and patient behavior differences raise the question of whether gender concordant relationships (i.e., both the provider and patient share the same gender) might affect patient experiences.

OBJECTIVE

Assess whether patient experiences are more positive in gender concordant primary care relationships.

DESIGN

Statewide telephone surveys. Linear mixed regression models to estimate the association of CAHPS scores with patient gender and gender concordance.

SUBJECTS

Two probability samples of primary care Medicaid patients in Connecticut in 2017 (5/17-7/17) and 2019 (7/19-10/19).

MAIN MEASURES

Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey augmented with questions about aspects of care most salient to PCMH-designated organizations and two questions to assess access to mental health services.

KEY RESULTS

There were no significant effects of gender concordance and differences in experiences by patient gender were modest.

CONCLUSIONS

This study did not support the suggestion that patient and physician gender and gender concordance have an important effect on patient experiences.

Female Representation and Academic Leadership in Facial Plastic and Reconstructive Surgery

OBJECTIVES/HYPOTHESIS

Despite increasing the numbers of women entering the field, underrepresentation of women in otolaryngology has been reported. In the subspecialty of facial plastic and reconstructive surgery (FPRS), female representation and academic leadership have not been formally characterized. Our study aims to identify female representation and academic leadership roles in FPRS.

STUDY DESIGN

Cross sectional analysis.

METHODS

Analysis was performed using the 2020 American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) membership directory. Board-eligible and board-certified FPRS surgeons were included. Data regarding academic rank, leadership position, academic productivity, and years in practice were collected from publicly available departmental websites. Academic productivity was measured using h-index.

RESULTS

Of 1,421 members queried in the 2020 AAFPRS membership directory, 13.0% were female and 86.9% were male. Most practitioners (87.0%) work in a private practice setting, but of the 13.0% of academic FPRS surgeons, 25.9% were female. Most female facial plastic surgeons in academic practice were Assistant Professors (72.9%), whereas ranks were evenly distributed among male FPRS surgeons. Three (4.3%) of 69 AAFPRS fellowship directors were women, and 1 (1.8%) of 56 present or past AAFPRS presidents was female. Female FPRS surgeons had fewer years in practice and lower h-indices compared with male surgeons.

CONCLUSIONS

Female FPRS surgeons hold fewer academic leadership positions and have lower academic productivity in comparison to male FPRS surgeons. Future studies are needed to elucidate the etiology of these gender differences.

LEVEL OF EVIDENCE

Cross-sectional analysis Laryngoscope, 2021.

The effect of physician self-disclosure on patient self-disclosure and patient perceptions of the physician

OBJECTIVES

Physician self-disclosure is typically seen as patient-centered communication because it creates rapport and is seen as an expression of empathy. Given that many physician behaviors affect patients differently depending on whether they are shown by a female or male physician, we set out to test whether physician self-disclosure affects patients' intentions to self-disclose and patients' perceptions of their physicians depending on physicians' gender.

METHOD

Two hundred and forty-four participants were recruited and randomly assigned to read one of 4 vignettes as if they were the patient in the dialogue (analogue patient design). They were then asked to report how they would react to the physician and how they perceived the him or her.

RESULTS

Physicians who self-disclosed were perceived as more empathic than physicians who did not, regardless of physician and patient gender. Physician self-disclosure had an effect on the behavioral intentions of the analogue patients, and this was moderated by physician gender. Analogue patients indicated to be more willing to self-disclose to female than to male physicians who self-disclosed.

CONCLUSION

It is important to consider physician gender when training physicians in patient-centered communication because the same behavior can have different effects on patients depending on whether it originates from a female or a male physician.

PRACTICAL IMPLICATIONS

Physicians can use self-disclosure to express empathy. When female physicians do so, they might obtain more personal information from patients, which can positively affect diagnosis and treatment.

Acceptance of female urologists among patients with suspected prostate disease

Backgrounds

The number of practicing female urologists is rising. The aim of this study is to evaluate the acceptance of female urologists by male patients and their partners.

Methods

Men who underwent a prostate MRI or a prostate biopsy between January and December 2018 and their partners, were sent questionnaires prior to the examination. Two types of questionnaires were used. One questionnaire asked “I want to be seen by: (I) a male urologist or (II) a female urologist or (III) no preference” (Group_np), the other questionnaire only offered two possible answers: “I want to be seen by: (I) a male urologist or (II) a female urologist” (Group_m,f). All other questions were on prostate MRI and prostate biopsies.

Results

Overall, 377 questionnaires were sent to patients. One hundred and ninety-six questionnaires (52.0%) were returned. In Group_np, 34.7% wanted to be seen by a male urologist, 60.8% of patients chose “no preference”. The answers of the patients’ female partners in Group_np did not differ statistically significant (57.3% chose “no preference”, 0% chose a female urologist). In Group_m,f, 54.5% of patients preferred a male urologist, one patient wanted to be seen by a female urologist, 44.3% did not answer the question. In Group_m,f, there was no statistically significant difference in preference in regard to the doctor’s gender between the patients and their female partners (57% of partners wanted a male urologist, 0% wanted a female urologist).

Conclusions

A large number of patients with prostate disease and their partners prefer male urologists rather than female urologists.

Defining the Variance: The Current State of Female and URM Concordance of Urology Resident Workforce to the General U.S. Population

OBJECTIVE

To compare the current representation of women and underrepresented minorities in medicine (URM) of the urologic resident workforce to the general U.S.

POPULATION

MATERIALS AND METHODS

Data on current gender and racial distribution of U.S. urology residents was obtained from the 2019-2020 ACGME Data Resource Book and compared to the projected 2019 U.S. population as reported in the U.S. Census data. In this study, URM status included Black/African American, Hispanic/Latino, Native American/Alaskan, Native Hawaiian or Pacific Islander and Other. For each gender and race/ethnicity, the percent differences in representation were calculated by subtracting the frequency in the general U.S. population from that of the urology resident workforce and two sample z-tests were performed.

RESULTS

1734 urology residents were identified in 2019-2020, of which 471 (27.2%) were female and 258 (14.9%) were URM. Two sample z-tests revealed a significantly lower representation in urologic residency programs for women (-23.6%, P-value < .05) and URMs (-19.1%, P-value < .05). Race/ethnicity subgroup analyses revealed underrepresentation of Black/African American (-9.7%, P-value < .05), Hispanic/Latino (-14.2%, P-value < .05), Native American/Alaskan (-1.1%, P-value < .05).

CONCLUSION

Women and URMs continue to be significantly underrepresented in urology residency relative to the general U.S.

POPULATION

Further study should better understand barriers to entering the urologic workforce and identify strategies to encourage interest in urology among female and URM prospective trainees.

The role of disclosure & perceptions about providers in health discussions among gay and bisexual young men

OBJECTIVES

Gay and bisexual men may feel discomfort discussing sensitive topics such as sexual behaviors and substance use with their health providers, which may prevent them from receiving important health information. This study investigates whether patients' perceptions of their provider's sexual orientation predicts patient-provider discussions of sexual and general health topics, and whether this relationship is moderated by patients' disclosure of sexual orientation to providers.

METHODS

Data were collected online from a sample of 576 gay and bisexual men living in the USA, aged 18-26. Adjusted risk ratios were estimated by using modified Poisson regression with robust error variance.

RESULTS

Participants who believed their providers were gay or bisexual were more likely to have discussed sexual health topics, but not general health topics; simple slopes analyses revealed that this effect was stronger among those who had not disclosed to their providers. Disclosure was also consistently associated with increased likelihood of discussing almost all topics.

CONCLUSIONS

Findings highlight differences in communication based on disclosure and perceived sexual orientation of provider, suggesting the need to further explore how these differences influence young gay and bisexual men's health.

PRACTICE IMPLICATIONS

Dyads may be more likely to discuss sexual health topics when patients believe their providers are sexual minorities themselves. In addition, patient-provider dyads may be likelier to discuss various health topics when providers are aware of patients' sexual minority statuses.

Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.

Objective Data Reveals Gender Preferences for Patients' Primary Care Physician

BACKGROUND AND OBJECTIVES

Most studies based on self-reported data indicate that female patients more often than males have a same-gender preference for their primary care physician (PCP). Because self-reported preferences may not reflect true preferences, we analyzed objective data to investigate patients' preferences for PCP gender.

METHODS

Analyses were performed on 2192 new patients seen within a university-based healthcare system by 13 PCPs (2 male, 11 female) during 2017. New patients were asked about their PCP gender preference when assigned a PCP. We compared the expected prevalence (proportion of males/females in overall patient population) and observed prevalence (gender distribution of patients for each PCP) by PCP gender. A mixed model with PCP as a random effect examined the odds of male and female patients being assigned a same-gender physician.

RESULTS

The expected prevalence of new patients was 65% female and 35% male. The observed prevalence (95% confidence interval [CI]) of male patients among male and female PCPs was, respectively, 59.7% (49.0%-69.5%) and 28.0% (24.0%-32.4%), with neither CI containing the expected prevalence of male patients (35%). Similarly, the observed prevalence of female patients among male and female PCPs was, respectively, 40.3% (95% CI 30.5%-51.0%) and 72.0% (95% CI 67.6%-76.0%), with neither CI containing the expected prevalence of female patients (65%).

CONCLUSIONS

Both male and female patients often preferred to see a same-gender PCP with this preference more pronounced in males. Future research should seek to clarify the relationships between patients' gender preferences, patient-physician gender concordance/discordance, patient satisfaction, and health outcomes.

Women in Cardiology: Role of Social Media in Advocacy

Digital and social media have transformed the field of medicine. They are powerful tools that academic and non-academic physicians and healthcare providers are using to influence others, promote ideas, obtain knowledge, disseminate research and communicate with others. The history of advocacy for women in medicine and the role of social media in influencing the choice of women to choose Cardiology as a career and its role in advocacy for Women in Cardiology (WIC) have been reviewed. It has changed the way cardiologists learn, educate, and interact with each other. Social media has proven especially useful in advocating for WIC, but whether it can help improve the numbers of female doctors going into Cardiology remains to be seen. In addition to encouraging women to pursue cardiology, social media has drawn attention to key women's rights issues affecting practicing female cardiologists.

Physician Gender Preference Amongst Females Attending Obstetrics/Gynecology Clinics

INTRODUCTION

The objective of our study was to explore the views and perceptions of female patients attending the obstetrics and gynecology (OB/GYN) outpatient department towards the gender of their healthcare provider, to look for any preference that might exist in this regard, and to highlight any discrimination towards male obstetricians/gynecologists.

MATERIAL AND METHODS

A cross-sectional study was conducted from November 2020 to March 2021 at Combined Military Hospital, Lahore. A total of 280 female patients were included in the study and interviewed consecutively. A self-designed questionnaire was administered. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY). Chi-square test was used to determine for any statistical significance and p≤0.05 was considered significant. Numerical data were represented as percentages.

RESULTS

Over 280 female patients participated in our study, out of which 132 were married and 148 were single. Thirteen of these patients were uneducated, 40 had completed high school and 227 patients had obtained a bachelor's level of education; 120 patients were aged 15-25 years, 95 patients were aged 26-35 years, 30 patients were aged 36-45 years, and 35 patients were aged >46. Women with less education preferred to be seen by a female obstetrician/gynecologist, whereas those with higher education were less biased (p=0.0001). Married patients preferred to be seen by female obstetrician/gynecologists as compared to single patients (p=0.0004). A significant proportion of females were impartial in terms of physician competence but those who did have a preference preferred female obstetrician/gynecologist based on three significant variables: competence, rapport building and empathy, and personal comfort.

CONCLUSION

A female gender preference exists in obstetrics and gynecology clinic attendees. This is significant in those who are married and those with no formal education. Overall, a significant proportion of women feel a higher comfort level with female doctors and find it easier to discuss their medical issues and develop rapport.

Women in Maxillofacial Surgery and Otolaryngology; Career Obstacles and Success Factors

ABSTRACT

Little is known on career factors and expectations for female oral and maxillofacial surgeons (OMFS) in developing countries. The study aimed to explore career perceptions of females in 2 related surgical specialties: oral and maxillofacial surgery and otolaryngology (ENT) with a focus on career obstacles and success factors. A structured questionnaire was distributed to female surgeons working in Jordan in the 2 surgical specialties. Questions addressed socio-professional characteristics and career-promoting and hindering factors. All surgeons registered in both specialties were invited. A total of 56 surgeons participated in the survey. Age range was 29 to 55 years (mean = 38.55 ± 5.799). Significantly more OMFS surgeons were single (P = 0.000) younger (P = 0.003), and had fewer years of experience (P = 0.01) than ENT surgeons. Significantly more ENT surgeons perceived the "hard working" attribute and "better communication skills" as career-promoting factors (P = 0.04, P = 0.015, respectively). Further, significantly more ENT surgeons believed that females in the surgical profession help in changing the traditional surgical stereotype linked with the male gender (93.8% ENT in contrast to 75% OMFS, P = 0.047), and expressed a preference for female mentors (48% ENT in contrast to 0% OMFS, P = 0.000). The results of this study indicate that female OMFS surgeons have different socio-professional characteristics and perceptions to their peers in ENT surgery, and this mainly manifested in professional experience, marital status, and important career perceptions. They seem to lack confidence in female participation and promotion of the surgical career, and they show preference for having exclusively male mentors.

Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey

ABSTRACT

Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.

What attributes do patients prefer in a family physician? A cross-sectional study in a northern region of Portugal

OBJECTIVES

To determine which modifiable and non-modifiable attributes patients prefer in a family physician, as well as to analyse participants' characteristics associated with their choices.

DESIGN

Cross-sectional study.

SETTING

Family healthcare units (FHU) in the city of Braga and Barcelos (Northern Portugal).

PARTICIPANTS

Adults aged 18 years or more, enrolled in the selected FHU.

MAIN OUTCOME MEASURES

The preferred attributes were assessed with a questionnaire delivered in the FHU. These attributes included gender, age and nationality and the importance of being Portuguese, of greeting with a handshake, of welcoming in the waiting area, of using an identification badge and of wearing a white coat.

RESULTS

A total of 556 questionnaires were included in the analysis; 66% and 58% of the participants had no preference for the gender or age of the family physician, respectively. Using a multinomial logistic regression, male participants were 3.8 times more likely to have a preference for a male physician than having no preference, in comparison to female participants (OR 3.864, 95% CI 1.96 to 7.61). More than 69% of the participants considered greeting with a handshake, using an identification badge and wearing a white coat important or very important. There was a statistically significant association between being Portuguese and the major importance given to the use of an identification badge (β=0.68, 95% CI 0.23 to 1.12).

CONCLUSIONS

Our data show that modifiable attributes of the family physician (greeting, presence of an identification badge and wearing a white coat) are important for patients. Potential changes in family physician attitude in consultation could ultimately affect patient-physician relationship.

Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings

IMPORTANCE

The Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings.

OBJECTIVE

To evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019.

EXPOSURES

Patient-physician racial/ethnic and gender concordance.

MAIN OUTCOMES AND MEASURES

The primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance.

RESULTS

In total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90).

CONCLUSIONS AND RELEVANCE

In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.

Association between patient-physician gender concordance and patient experience scores. Is there gender bias?

BACKGROUND

Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias.

OBJECTIVE

Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care.

METHODS

We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score.

RESULTS

Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients' odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score.

CONCLUSION

Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.

Trends in Internal Medicine Faculty by Sex and Race/Ethnicity, 1980-2018

IMPORTANCE

Increasing diversity in the physician workforce is a fulcrum for reducing health disparities. Efforts to increase the diversity in the internal medicine (IM) workforce may improve health equity among an increasingly diverse population with increasing prevalence of chronic disease.

OBJECTIVES

To assess diversity trends in the academic IM workforce and evaluate how well these trends reflected medical student diversity and the changing demographic composition of the general population.

DESIGN, SETTING, AND PARTICIPANTS

This secondary analysis of a cross-sectional study analyzed data from January 1, 1980, to December 31, 2018, from the Association of American Medical Colleges Faculty Roster and Applicant Matriculant File, which capture full-time US medical school faculty and matriculants, respectively, and population data through 2017 from the US Census Bureau.

MAIN OUTCOMES AND MEASURES

The study calculated the proportions of women and individuals from racial/ethnic groups that are traditionally underrepresented in medicine (URM) among IM faculty and faculty in all other clinical departments. These data were compared with the proportions of female and URM matriculants in US medical schools and the proportions of women and individuals from underrepresented racial/ethnic groups in the population. The analysis was stratified by sex, race/ethnicity, and intersections of sex and race/ethnicity.

RESULTS

From 1980 to 2018, the absolute number of full-time IM faculty increased from 10 964 to 42 547. Although IM was the department classification with the most women faculty, in 2018 it continued to have a lower proportion of women (n = 17 165 [40.3%]) compared with all other clinical departments (n = 48 936 [43.2%]). Among IM faculty, the percentage of URM faculty members more than doubled during the study period (from 4.1% to 9.7%) but still made up only a small portion of faculty members. The percentage of female matriculants among medical school matriculants increased steadily (from 28.7% in 1980 to 51.6% in 2018) and was nearly identical to their population representation in 2017 (50.7% compared with 50.8%). Although the percentage of URM matriculants had nearly doubled since 1980 (from 11.3% to 18.1%), it still lagged far behind the proportion of individuals in the US population who are members of underrepresented racial/ethnic groups (18.1% vs 31.5% in 2017).

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that progress has been made in diversifying academic IM faculty; however, it does not yet reflect the diversity of medical students or the US population. Continued efforts to increase the diversity of the academic IM workforce are needed.

The Importance of Concordance Between Patients and Their Subspecialists

Concordance, the concept of patients having shared demographic/socioeconomic characteristics with their physicians, has been associated with improved patient satisfaction and outcomes in primary care but has not been studied in subspecialty care. The objective of this study was to investigate whether patients value concordance with their specialty physicians. The authors assessed the importance of concordance in subspecialist care in 2 cohorts of participants. The first cohort consisted of patients seeking care at a multispecialty orthopedic clinic. The second cohort consisted of volunteer participants recruited from an online platform. Each participant completed a survey scored on an ordinal scale which characteristics of their physicians they find important for their primary care physician (PCP) and a specialist. The characteristics included age, sex, ethnicity, sexual orientation, primary language spoken, and religion. The difference in concordance scores for PCPs and specialists were compared with paired t tests with a Bonferroni correction. A total of 118 patients were recruited in clinic, and a total of 982 volunteers were recruited online. In the clinic cohort, the level of importance for patient-physician concordance of age, ethnicity, language, and religion was not significantly different between PCPs and specialists. In the volunteer cohort, the level of importance for concordance of age, sex, national origin, language, and religion was not significantly different between PCPs and specialists. The volunteers recruited online had significantly higher concordance scores than the patients recruited in clinic for most variables. Patients find patient-physician concordance as important in specialty care as they do in primary care. This may have similar effects on patient outcomes in specialty care. [Orthopedics. 2020;43(5):315-319.].

Gender, Soft Skills, and Patient Experience in Online Physician Reviews: A Large-Scale Text Analysis

Background

Online physician reviews are an important source of information for prospective patients. In addition, they represent an untapped resource for studying the effects of gender on the doctor-patient relationship. Understanding gender differences in online reviews is important because it may impact the value of those reviews to patients. Documenting gender differences in patient experience may also help to improve the doctor-patient relationship. This is the first large-scale study of physician reviews to extensively investigate gender bias in online reviews or offer recommendations for improvements to online review systems to correct for gender bias and aid patients in selecting a physician.

Objective

This study examines 154,305 reviews from across the United States for all medical specialties. Our analysis includes a qualitative and quantitative examination of review content and physician rating with regard to doctor and reviewer gender.

Methods

A total of 154,305 reviews were sampled from Google Place reviews. Reviewer and doctor gender were inferred from names. Reviews were coded for overall patient experience (negative or positive) by collapsing a 5-star scale and coded for general categories (process, positive/negative soft skills), which were further subdivided into themes. Computational text processing methods were employed to apply this codebook to the entire data set, rendering it tractable to quantitative methods. Specifically, we estimated binary regression models to examine relationships between physician rating, patient experience themes, physician gender, and reviewer gender).

Results

Female reviewers wrote 60% more reviews than men. Male reviewers were more likely to give negative reviews (odds ratio [OR] 1.15, 95% CI 1.10-1.19; P<.001). Reviews of female physicians were considerably more negative than those of male physicians (OR 1.99, 95% CI 1.94-2.14; P<.001). Soft skills were more likely to be mentioned in the reviews written by female reviewers and about female physicians. Negative reviews of female doctors were more likely to mention candor (OR 1.61, 95% CI 1.42-1.82; P<.001) and amicability (OR 1.63, 95% CI 1.47-1.90; P<.001). Disrespect was associated with both female physicians (OR 1.42, 95% CI 1.35-1.51; P<.001) and female reviewers (OR 1.27, 95% CI 1.19-1.35; P<.001). Female patients were less likely to report disrespect from female doctors than expected from the base ORs (OR 1.19, 95% CI 1.04-1.32; P=.008), but this effect overrode only the effect for female reviewers.

Conclusions

This work reinforces findings in the extensive literature on gender differences and gender bias in patient-physician interaction. Its novel contribution lies in highlighting gender differences in online reviews. These reviews inform patients’ choice of doctor and thus affect both patients and physicians. The evidence of gender bias documented here suggests review sites may be improved by providing information about gender differences, controlling for gender when presenting composite ratings for physicians, and helping users write less biased reviews.

Effect of Physician Gender and Race on Simulated Patients' Ratings and Confidence in Their Physicians: A Randomized Trial

IMPORTANCE

Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians.

OBJECTIVE

To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged.

DESIGN, SETTING, AND PARTICIPANTS

This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures.

INTERVENTIONS

A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis.

MAIN OUTCOMES AND MEASURES

A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician's diagnosis, and (5) likelihood to request additional tests.

RESULTS

Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants' race, gender, racial prejudice, or sexism.

CONCLUSIONS AND RELEVANCE

No significant differences were observed for simulated patients' evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04190901.

Identifying the Key Elements of Racially Concordant Care in a Freestanding Birth Center

INTRODUCTION

There is empirical evidence that the quality of interpersonal care patients receive varies dramatically along racial and ethnic lines, with African American people often reporting much lower quality of care than their white counterparts. Improving the interpersonal relationship between clinicians and patients has been identified as one way to improve quality of care. Specifically, research has identified that patients feel more satisfied with the care that they receive from clinicians with whom they share a racial identity. However, little is known about how clinicians provide racially concordant care. The goal of this analysis was to identify the key components of high-quality care that were most salient for African American birthworkers providing perinatal care to African American patients.

METHODS

We conducted semistructured interviews (30 to 90 minutes) with clinicians (N = 10; midwives, student midwives, and doulas) who either worked at or worked closely with an African American-owned birth center in North Minneapolis, Minnesota. We used inductive coding methods to analyze data and to identify key themes.

RESULTS

Providing racially concordant perinatal care to African American birthing individuals required clinicians to acknowledge and center the sociocultural realities and experiences of their patients. Four key themes emerged in our analysis. The first overarching theme identified was the need to acknowledge how cultural identity of patients is fundamental to the clinical encounter. The second theme that emerged was a commitment to racial justice. The third and fourth themes were agency and cultural humility, which highlight the reciprocal nature of the clinician-patient relationship.

DISCUSSION

The most salient aspect of the care that birthworkers of color provide is their culturally centered approach. This approach and all subsequent themes suggest that achieving birth equity for pregnant African American people starts by acknowledging and honoring their sociocultural experiences.

Factors Associated With Patient Satisfaction in Outpatient Department of Suva Sub-divisional Health Center, Fiji, 2018: A Mixed Method Study

Background: With evolving health care industry toward patient centered orientation, inputs from the patients' perspective is valuable. Improved patient satisfaction is associated with increased levels of adherence to treatment processes and recommended prevention, and improved health outcomes. Hence, this study was conducted to assess the current level of patient satisfaction and explore its determinants in the Suva Subdivision health centers, Fiji, 2018.

Methods: This was a mixed method cross-sectional study employing both quantitative and qualitative designs. A random sample of 410 participants attending the outpatient services completed the self-administered structured questionnaire. The questionnaire focused on socio-demographic features, waiting time, doctors' communication, and patient trust. Data from 375 questionnaires (response rate of 91%) was analyzed in SPSS where descriptive analysis and univariate and multivariate logistic regression was done at 0.05 level of significance and 95% confidence interval to find the determinants of patient satisfaction. From these 375 participants, 20 participants were purposefully selected for audio recorded interview guided by a semi-structured questionnaire and data was analyzed using thematic analysis.

Results: The majority of the patients were generally fully satisfied with their consultation (69.3%). Univariate logistic regression showed that age, gender, education level, waiting time, doctors' communication behavior, and patient trust level were significantly associated with patient satisfaction independently. After controlling for all the variables, gender, number of visits, waiting time, and patient trust were significantly associated with trust. Those who had full trust in the doctors, were more likely to be fully satisfied with their consultation (aOR of 18; p = 0.0001) and those who got seen within 1 h, were more likely to be satisfied with their consultation (aOR of 3.3; p = 0.0001). Though, the patients voiced that getting a satisfying consultation was worth the wait. The doctors' attitude and way of communication also made a difference to the patient's level of satisfaction.

Conclusions: This study showed that patient satisfaction is positively associated with patient trust, doctors' interpersonal skills and communication behavior and negatively associated with waiting time. Hence, doctors upgrading their communication skills and health service managers strategizing ways to improve waiting time can contribute to better patient trust and thus lead to better patient satisfaction and positively influence health outcomes.

Social factors as career obstacles for female oral and maxillofacial surgeons in three Middle Eastern countries

Despite the feminization of dentistry in many areas of the world, female representation in the field of oral and maxillofacial surgery (OMFS) is poor. The purpose of this study was to identify factors perceived by female oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia as being obstacles to their career progression and to compare them to factors identified by their male colleagues. This was a cross-sectional questionnaire-based study. A Google Forms questionnaire was designed to collect data on socio-demographics and perceived career obstacles in OMFS. This was distributed to oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia. Statistically significant differences between the genders were evident in terms of marital status (P=0.001), spouse's education (P=0.005), and spouse's occupation (P<0.001). When compared to male surgeons, female surgeons more often considered that their spouse's occupation hindered their career progression (P<0.001). Female surgeons, but not male surgeons, perceived sexism and social factors such as marriage, children, and the attitudes of society to be major career obstacles (P<0.005). In conclusion, female maxillofacial surgeons in some Middle Eastern countries were found to have different socio-demographic characteristics compared to their male colleagues and they considered sexism, marriage, children, and the attitudes of society to be major career obstacles.

(Dis)Incentivizing Patient Satisfaction Metrics: The Unintended Consequences of Institutional Bias

Background: Patient satisfaction surveys as a metric for quality-based financial incentives carry a risk of bias toward women and underrepresented physicians. Previous assessments in our department of medicine found that most women faculty were rated in the bottom quartile of patient satisfaction scores, whereas analysis of scores for underrepresented physicians had not been performed. To investigate, we compared patient satisfaction scores and relevant demographics of faculty physicians during 1 year when quality-related financial incentives were offered based on this metric. Methods: Patient satisfaction and communication scores collected during academic year 2015-2016 were obtained for 369 physicians (119 women and 250 men) at Indiana University Health system. Independent variables included physician gender, race, ethnicity, and subspecialty or division; 190 physicians constituted the study cohort for whom data were available for comparison. Statistical analyses were performed to determine if there were differences between gender and race in patient satisfaction scores (mean, median, t-tests, and Chi-square tests). A factorial analysis of variance model was performed to incorporate both main effects and to determine if there was a significant interaction between them. Results: Median and mean of scores were lower for women physicians and underrepresented physicians. Analysis demonstrated nonsignificant effect between gender-segregated cohorts. Racially underrepresented physicians had significantly lower mean scores than their white colleagues [F(4, 185)=2.46, p=0.046]. Conclusion and Relevance: Our results indicate a significant difference in patient satisfaction scores between underrepresented and white physicians. These data may suggest a potential bias, among patients and institutional practices, ultimately leading to pay inequities through differences in financial incentives toward underrepresented physicians.

Satisfied patients and pediatricians: a cross-sectional analysis

Background

There is a lack of research in the USA comparing patient satisfaction with pediatricians and other primary care physicians (PCPs). We examined and compared patient satisfaction toward their pediatricians and PCPs and characterized factors associated with higher patient satisfaction in these two groups.

Methods

A random coefficient model with random slope and intercept was fit to the data, with patient satisfaction as a function of pediatrician/PCP, covariates, and physician random effects. Effect heterogeneity was assessed by allowing slope to vary as a function of covariates. Mediation analysis using the random coefficient model was conducted to calculate average total effect, average natural direct effect, and average indirect effect of pediatrician/PCP on satisfaction mediated by waiting/visit times.

Results

Pediatricians had higher predicted satisfaction ratings than PCPs (total effect = 4.8, 95% CI 3.7–5.9), with population-averaged mean of 82.2 (0.54) vs 77.4 (0.13). The direct effect was 3.9 (2.8–5.0) and the indirect effect was 0.9 (0.9–0.9), suggesting that part but not all of the total effect can be explained by pediatricians having decreased waiting/visit times leading to increased satisfaction. Predictions by subgroup suggested that pediatricians had lower ratings than PCPs for first visit, but higher ratings for all other covariate strata considered. Having longer waiting times and decreased visit times coincided with closer mean ratings between pediatricians and PCPs, other significant effect modifiers included patient sex, provider sex, and region of practice.

Conclusion

Pediatricians scored higher patient satisfaction ratings than the combined group of other PCPs. Pediatricians had shorter wait times to see their patients compared to PCPs. Shorter wait times and longer visit times were associated with higher patient satisfaction ratings.

Analysis of Factors Related to the Sex Diversity of Orthopaedic Residency Programs in the United States

BACKGROUND

Women are underrepresented as applicants to and trainees of orthopaedic surgery residencies. Factors that attract women to or deter them from orthopaedic surgery have been previously published; however, there has been no analysis of the programs that train high percentages of female residents and the factors that differentiate them from programs that have low percentages of women. The purpose of this study was to identify and compare these factors between programs with high and low percentages of female residents.

METHODS

Information on each orthopaedic surgery residency program listed in the American Medical Association (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was collected utilizing residency program web sites, an online survey distributed to residency program coordinators, and a follow-up telephone survey. These included data on resident and faculty demographic characteristics and residency program curriculum structure. The prevalence of factors in programs with the highest percentages of female residents was compared with those with lower percentages.

RESULTS

Data were obtained from 143 (97.3%) of 147 programs, with 3,406 residents identified. Only 485 residents (14.2%) were female. Programs with more female residents had more female faculty members per program (p = 0.001), a higher percentage of faculty who were female (p < 0.001), more female associate professors (p < 0.001), more women in leadership positions (p < 0.001), and a higher prevalence of women's sports medicine programs (p = 0.03); were more commonly listed in the Top 40 for National Institutes of Health (NIH) funding (p = 0.03) and U.S. News & World Report rankings (p = 0.02); and were more likely to offer a research year (p = 0.045).

CONCLUSIONS

There are greater percentages of female residents at orthopaedic residency programs with more female faculty members, more women in leadership positions, a women's sports medicine program, and the option to do a research year. Departmental and national leaders may consider these factors when efforts are undertaken to enhance the recruitment of female applicants and improve female interest in orthopaedic surgery as a specialty.

Religious Affiliation, Religiosity, and Spirituality in Pediatric Residents: Effects on Communication and Self-Efficacy with Adolescents in a Clinical Setting

Religion and spirituality are known influences on medical providers' care of patients, but no studies have assessed resident beliefs related to patient perception of clinical care. The main objective of our study was to assess resident religious affiliation, religiosity, and spirituality in relation to self-efficacy and communication with patients during adolescent clinic visits. We found that religious affiliation and religiosity appear to affect patient perception of communication with residents during adolescent visits; spirituality had little noted effect. Further research is warranted, especially regarding resident and patient gender correlations and differences in religious affiliation effects on patient perception of care.

Crowdsourcing Public Perceptions of Plastic Surgeons: Is There a Gender Bias?

BACKGROUND

Implicit gender bias may result in lower wages for women, fewer leadership positions, and lower perceived competence. Understanding public and patient gender preferences for plastic surgeons may enable opportunities to address public perceptions. This investigation evaluates public preferences for a plastic surgeon's gender or demeanor.

METHODS

Members of the Amazon Mechanical Turk crowdsourcing platform read 1 of the 8 randomly assigned scenarios describing a hypothetical situation requiring a plastic surgeon to operate on their mother. The scenarios differed only by surgeon gender, surgeon demeanor ("agentic," traditionally more masculine versus "communal," traditionally more feminine), or type of surgery. Using a Likert scale, respondents indicated their agreement with 7 statements on surgeon competence, skills, leadership qualities, likeability, respect, trustworthiness, and, ultimately, preference as a surgeon. Independent t tests were used to compare scores. Lower scores indicated a more negative response.

RESULTS

Overall, 341 responses were received: 55.7% were male and 45.5% white. There were no significant differences in any of the 7 characteristics assessed when examining by surgeon gender, only. However, female surgeons with a communal demeanor were perceived as less competent (4.32 versus 4.51, P = 0.018) and less skilled (4.36 versus 4.56, P = 0.019) than agentic female surgeons. Male respondents rated female surgeons lower than male surgeons in terms of competence (P = 0.018), skills (P = 0.034), likeability (P = 0.042), and preferred choice as a surgeon (P = 0.033).

CONCLUSIONS

Women plastic surgeons' demeanor and respondent gender affected perception of certain characteristics. Women plastic surgeons may consider ways to engage with the public to address possible gender role stereotypes.

Improving the quality of care and patient experience of care during the diagnosis of lupus: a qualitative study of primary care

Purpose To better understand diagnostic delay and doctor-patient communication during the diagnosis of systemic lupus erythematous in patients without malar rash, we conducted a qualitative study of primary care providers' perceptions. Methods We conducted in-depth interviews with a purposive sample of eight primary care physicians in Kaiser Permanente Northern California. Telephone interviews were recorded, transcribed, reviewed, and coded for domains and themes. Results We identified five domains related to diagnosis: initial assessment and tests, initial diagnosis and empiric treatment, timeliness of diagnosis, communicating with the patient, and opportunities for improvement. In the absence of malar rash, the lupus manifestations are common while the disease is rare. Once the primary care provider believes that the disease may be autoimmune, they work with a rheumatologist, but this could take months. Initially, the physician assesses whether the condition is self-limiting or responds to empiric treatments. Over time, as empiric treatments fail or additional lupus manifestations emerge, the primary care provider makes a referral. Doctor-patient communication is critical to help the physician make sense of the symptoms, maintain trust, and assure the patient that he or she is receiving appropriate care. Patient persistence and communication are critically important. Continuing education was deemed essential by each physician. Conclusion In the absence of malar rash, a lupus diagnosis can be difficult. Enhanced doctor-patient communication, patient persistence, physician access to rheumatology and continuing education of primary care might improve time to diagnosis and the patient's experience with primary care. This knowledge is transferable to other rare, complex diseases.

Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology

BACKGROUND

Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians.

OBJECTIVE

Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey.

STUDY DESIGN

This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013-August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ² tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC).

RESULTS

Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient-physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37-0.78; p = .001).

CONCLUSIONS

Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood.