Physician Gender, Patient Gender, and Primary Care

Peter Franks, M.D., Klea D. Bertakis, M.D., M.P.H.

Disclosures
In This Article

Abstract and Introduction

Background: Studies of the effects of physician gender on patient care have been limited by selected samples, examining a narrow spectrum of care, or not controlling for important confounders. We sought to examine the role of physician and patient gender across the spectrum of primary care in a nationally representative sample, large enough to examine the role of gender concordance and adjust for confounding variables.
Methods: We examined the relationships between physician and patient gender using nationally representative samples (the U. S. National Ambulatory Medical Care Surveys from 1985 to 1992) of encounters of 41,292 adult patients with 1470 primary care physicians (internists, family physicians, and obstetrician/gynecologists). Factors examined included physician (age, gender, region, rural location), patient (age, gender, race, insurance), and visit characteristics (diagnoses, gender-specific and nonspecific prevention, duration, continuity, and disposition).
Results: After multivariate adjustment, female physicians were more likely to see female patients, had longer visit durations, and were more likely to perform female prevention procedures and make some follow-up arrangements and referrals. Female physicians were slightly more likely to check patients blood pressure, but there were no significant differences in other nongender-specific prevention procedures or use of psychiatric diagnoses. Among encounters without breast or pelvic examinations, visit length was not related to physician gender, but length was longer in gender concordant visits than gender-discordant visits.
Conclusions: Female physicians were more likely to deliver female prevention procedures, but few other physician gender differences in primary care were observed. Physician-patient gender concordance was a key determinant of encounters.

Interest in the impact of physician gender on healthcare delivery has risen with the increase in the number of women entering the medical profession. In 2000-2001, women constituted almost 46% of new entrants to the medical schools in the United States, and significant numbers of women are entering primary care fields.[1] This expanding percentage of female physicians has highlighted the importance of evaluating how physician gender impacts patient care.

Early studies have provided preliminary evidence for the influence of physician gender on healthcare delivery.[2] Female family and general practitioners in the United States and Canada are more likely than their male counterparts to work in salaried, office-based practices in urban settings. It has been suggested that these findings are the result of differences in original training site, the need for predictable, more flexible work schedules, and differing priorities between male and female primary care physicians.[3,4]

The length of time spent with the patient has been demonstrated to differ between male and female physicians. Female physicians have been found to spend significantly more time with their patients,[5,6,7,8,9] although this time difference may be related to the gender distribution and health status of the patients seen. Female physicians see more female patients,[10,11] and female patients have lower health status.[12] The observed difference in visit length between male and female resident physicians at one medical center decreased to insignificant levels when patient gender and health status were controlled.[12]

Other specific practice style differences appear to be related to physician gender. Female physicians have been demonstrated to provide more preventive services, such as Papanicolaou (Pap) smears, breast examination, and mammograms, as well as more preventive counseling in most[8,12,13,14,15,16,17] but not all[18] studies.

Physician gender potentially affects the physician-patient relationship and its outcomes in a variety of ways. Physician gender differences in personality and attitudes, especially with regard to gender roles, might influence interactions with both male and female patients. Patients also may have differential expectations of their physician based on gender. For example, they might expect the female physician to be more supportive and empathic and, thus, to disclose more information. Another way in which physician gender might be important is in the status relationship between patient and doctor. As gender is a substantial component of social status, same-gender physician-patient dyads may be closer in social status (greater status congruence) than opposite-gender dyads.[19,20] Congruence in status may facilitate communication and mutual understanding. In order to independently assess the effects of physician and patient gender on the physician-patient encounter, it is crucial that same-gender and opposite-gender dyads be examined.[7,8,18]

The purpose of this study was to explore these issues of the impact of physician gender on patient care in primary care practices using the National Ambulatory Medical Care Surveys (NAMCS). These large nationally representative surveys allow examination of a broad spectrum of care provided in physicians offices in the United States, with adjustment for patient sociodemographic and clinical factors. In addition, we had access to previously unreported, confidential information about physician gender and age. The data were used to explore gender differences in the practice setting, patient demographics, visit length, and practice style of male and female physicians. In addition, the data were analyzed using same-gender and opposite-gender physician-patient dyads to more fully explore the influence that physician and patient gender have on the delivery of primary care.

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