Re: Do female patients prefer to be treated by female physicians?
From: Jessica (anonymous@obgyn.net)
Wed, 25 Nov 1998 07:26:09 -0600 (CST)
Dear Dr. McIntosh,
Thanks so much for your response to my inquiry about preference of
female patients for female OB/GYNs. I started this research with a
tentative hypothesis, motivated by personal experience and other
people's stories about their experiences either as doctors or patients.
I've actually been surprised by the extent to which this hypothesis has
been confirmed.
The story of you and your wife both having similar training and
background, and yet different potential incomes starting out, is exactly
the kind of thing I am looking for. I actually didn't think I would
find such clear examples of the effects of this patient preference on
the work experiences of male and female OB/GYNs. As you can guess, I'm
having a little more trouble pulling this result out of my data. It is
complicated by exactly the factors you pointed out -- men and women make
different lifestyle choices and thereby choose different work
environments -- flexibility, job sharing, leaves of absence. You
mentioned that "studies indicate that Board Certified OB/GYNs that are
women are more likely to work part-time, job share, take long leaves of
absence and so on than their male counterparts." Do you recall where
these studies were, and what data they used? That would be a huge help
to me. As you said, since income depends only on the number of bills
presented to the insurance company, these choices reduce women's income
relative to men's. I am still optimistic that I will be able to find
the evidence of the patient preference in the data. I may do something
looking across specialties, rather than just within OB/GYN, but any
suggestions of previous studies or data would be greatly appreciated.
Thanks again for your response. I'm really just starting out on this
research, and I'm trying to deal with the complications as they arise,
one at a time. It's important that I really understand what's actually
going on, particularly how this preference plays out in practice, and
what factors could complicate my study. It was great that you confirmed
both the primary effect and the many complications. Thanks!
--
Jessica Wolpaw
At Sat, 14 Nov 1998, William D. McIntosh, MD wrote:
>
>At Thu, 12 Nov 1998, Jessica wrote:
>>
>>Thank you for pointing me towards the "Male/female OBGYN" thread in the
>>forum. It was very helpful and interesting.
>>
>>Perhaps I need to clarify my question. I stated that "anecdotally,
>>women do seem to express a preference for being treated by a female
>>physician." I did not make any claims about whether female physicians
>>actually provide better care. In fact, if female physicians provide
>>care similar to that provided by male physicians, this preference by
>>patients for female physicians is a discrimination against male
>>physicians.
>>
>>After reviewing the posts under the "Male/Female OBGYN" thread, I found
>>responses which confirmed this hypothesis. Some patients did express a
>>preference for female obgyns, even sometimes acknowledging that this was
>>not based on knowledge of differences in quality of care. Some male
>>obgyns recounted instances in which they were discriminated against by
>>patients. They even commented that a well-qualified male obgyn can have
>>a more difficult time setting up a practice than a less qualified female
>>obgyn.
>>
>>Female obgyns may or may not provide better care. (I offer no opinion
>>on that question.) However, the posts preliminarily confirm that some
>>patients prefer to be treated by a female obgyn and that male obgyns do
>>experience lower patient demand. I'm merely interested in quantifying
>>these facts and in investigating their implications.
>>
>>One respondent writes, "I don't see how it would be important for me to
>>know what a survey of women says about what sex they prefer their
>>physicians to be. It wouldn't affect my decision one way or another. It
>>might be interesting as a curiosity, but the market will drive the wages
>>of the preferred doctors up anyways."
>>
>>The market driving up the wages of preferred doctors is exactly what I'm
>>looking for. That's the kind of thing economists study, and it's yet
>>another way to get a handle on the extent of wage inequality and
>>discrimination. In nearly all occupations, men still earn higher wages
>>for the same skills. I'm trying to see if in this particular case, the
>>reverse is true: do women obgyns earn more as a result of this
>>discrimination in their favor? My preliminary results seem to show that
>>wowen obgyns are not earning more, even if they are preferred by
>>patients. This also says something about discrimination.
>>
>>Thanks for the great discussion. It's been incredibly helpful in
>>improving my understanding of the issues involved. I'd love to hear
>>more responses and I still continue my search for any survey or other
>>data, however peripheral.
>>
>>--
>>Jessica Wolpaw
>
>I may have an unusual perspective on this, as both my wife and I are
>OB/GYNs. We both graduated from well regarded US medical schools, and
>were in the same residency program only one year apart, and can
>therefore be considered to be equal in training and career track
>location, at that time. I then spent 2 years on a medical school
>faculty while my wife was a flight surgeon and OB in the Air Force. When
>it was time to go into private practice, my wife could have commanded a
>10% higher salary than I, had we chosen to work for someone else,
>exclusively because she is a woman. You named the reason. Women can
>build a practice more quickly than men, and reimbursement is based on
>the number of patients seen, and proceedures performed. Luckily for me,
>she chose to have pity on her estrogen challenged husband, and went into
>practice with me. Also lucky for me, I was here a year before she
>finished in the USAF, otherwise I would have had a hard time building a
>practice with her starting at the same time.
>
>There is another aspect to the reimbursement situation. To no one's
>surprise, women and men sometimes have different expectations about
>work. Studies indicate that Board Certified OB/GYNs that are women are
>statistically much more likely to work part time, job share, take long
>leaves of absence and so on than their male counterparts. They are also
>more likely to take salaried positions rather than the traditional
>fee-for-service practice. These are all lifestyle choices, the effect
>of which is reduce income and increase free time and flexibility. My
>wife makes as much or more than I do, because we work the same amount,
>but she is already looking forward to her next maternity leave, and the
>possibility of coming back part-time. It does not matter to the
>insurance company whether the bill says W. McIntosh, MD, or L.
>McIntosh, MD as to payement, only the number of those bills are
>presented.
>
>--
>William D. McIntosh, MD
>Clarksville, TN
>
>This is for educational purposes only. It is not intended
> to replace consultation and examination by your physician
> or other health care provider.
>
--
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Jessica W. Wolpaw
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email: wolpaw@fas.harvard.edu
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tel: 617-491-4365
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