Associations Between Non-discrimination and Training Policies and Physicians' Attitudes and Knowledge About Sexual and Gender Minority Patients

A Comparison of Physicians From Two Hospitals

Jennifer M. Jabson; Jason W. Mitchell; S. Benjamin Doty

Disclosures

BMC Public Health. 2016;16(256) 

In This Article

Results

Participant Characteristics

Of the 1000 physicians recruited, 180 returned completed surveys (108 from Hospital A; 72 from Hospital B). The survey response rate was 18 %, significantly lower than the 31–57 % response rate reported by others who use similar strategies to recruit physician participation in survey research.[21,27,28] There was less than 10 % missing in all dependent variables (range: 1–6 %) and there were no significant associations between missingness and physicians demographic characteristics. Our study was underpowered due to small sample size (power = .43).

Table 1 summarizes the demographic characteristics of the full sample (N = 180) and by physicians' location (Hospital A (n = 108), B (n = 72)). In the full sample, 171 (95 %) of physicians reported that they were aware, and 9 (5 %) were unaware, that patients in their practice identified as gay, lesbian, or bisexual, and 171 (95 %) reported that they were aware, and 9 (5 %) were unaware, that patients in their practice identified as transgender. One-hundred percent of the physicians affiliated with Hospital B reported awareness of SGM patients in their practices. The full sample was largely characterized as middle aged (M age = 50.1, SD = 11.2), male (66 %, n = 119), heterosexual (97 %, n = 174), and either married or partnered (90 %, n = 162). There was a 10 % difference in physicians' gender between hospitals (Hospital A: 70 %; Hospital B: 60 %). The sample included physicians from 27 medical specialties, as categorized by the American Medical Association.[29] The most common specialties represented were: Internal Medicine (16 %), Surgery (11 %), Pediatrics (10 %), Obstetrics/Gynecology (7 %), Oncology (7 %), Family Medicine (7 %), and Cardiology (6 %). Other specialties, each representing less than 5 % of physicians in the sample, included: Allergy/Immunology, Anesthesiology, Dentistry, Dermatology, Emergency Medicine, Endocrinology, Geriatrics, Medical Genetics, Neurological Surgery, Neurology, Ophthalmology, Orthopedics, Otolaryngology, Pathology, Physical Medicine/Rehabilitation, Preventive Medicine, Psychiatry, Radiology, Urology, and Other. Physicians reported 20.5 average years of experience (SD = 11.9); the sub-sample from Hospital A was slightly more experienced than the sub-sample from Hospital B. The majority of physicians in this sample provided direct care to patients daily. In the full sample, 83 % (n =149) of physicians provided direct care daily, compared to 89 % (n = 96) at Hospital A and 74 % (n = 53) at Hospital B. Less than 20 % of physicians at both Hospitals (A: n = 17; B: n = 10) reported having had training in lesbian, gay, bisexual, and/or transgender patient care. The location and time of this training was not indicated.

Physicians' Beliefs

General Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Non-patients. The descriptive statistics for each measure of physicians' attitudes and knowledge are presented in Table 2. In the full sample of physicians, ATLGBT scores ranged from 12 to 55 with a mean score of 26.9 (SD = 9.9). Overall, physicians held the greatest negative attitudes toward bisexual non-patients (M = 7.0, SD = 2.7) and the least negative attitudes toward transgender non-patients (M = 6.5, SD = 2.4). Physicians' attitudes were identical toward gay non-patients (M = 6.7, SD = 2.6) and lesbian non-patients (M = 6.7, SD = 2.6).

Physicians' attitudes toward SGM non-patients were statistically different by Hospital; Hospital A had more negative attitudes (Md. = 30, n = 105) than Hospital B (Md. = 23, n = 71) (U = 2720.5, z = −3.04, p = .002). Physicians' attitudes also varied by sub-scale. Physicians at Hospital A had more negative attitudes toward SGM non-patients than physicians at Hospital B (Table 2). Physicians' attitudes about transgender non-patients were more negative at Hospital A than B (A: Md. = 7, n = 106; B: Md. = 6, n = 72; U = 2971.5, z = −2.52, p = .012).

Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Patients. Overall, the mean score for ATLGBTP was 12.2 (SD 2.9). Physicians' attitudes about SGM patients did not vary by hospital (t (174) = −0.92, p = .357).

Knowledge of Lesbian, Gay, Bisexual, and Transgender Patients. Average score of KLGBT was 12.1 (SD 1.3). Physicians' knowledge about LGBT patients did not vary by hospital (U = 2938.5, z = −1.68, p = .092).

Gender and Sexual Minority Affirmative Practice. The average GAP score was 42.1 (SD 8.5). There was no difference in physicians' gender and sexual minority affirmative practice by hospital (U = 3447.0, z = −.044, p = .661).

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