Dataset Information

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

ABSTRACT: 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.

SUBMITTER: Solnick RE

PROVIDER: S-EPMC7043197 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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

Solnick Rachel E RE Peyton Kyle K Kraft-Todd Gordon G Safdar Basmah B

JAMA network open 20200205 2

<h4>Importance</h4>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.<h4>Objective</h4>To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged.<h4>Design, setting, and participants</h4>This randomized trial enrolled a geographically diverse s ...[more]

PMID: 32083686

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Project description:BackgroundStudies suggest that black patients have better interactions, on average, with physicians of their own race. Whether this reflects greater "cultural competence" in race-concordant relationships, or other effects of race unrelated to physician behavior, is unclear. It is also unclear if physician race influences patient decision-making.ObjectiveTo determine whether physician race affects patients' ratings of physicians and decision-making, independent of physician behavior.DesignRandomized study using standardized video vignettes.ParticipantsPrimary care patients with coronary risk factors or disease.InterventionsEach participant viewed one of 16 vignettes depicting a physician reviewing cardiac catheterization results and recommending coronary artery bypass graft (CABG) surgery. Vignettes varied only in terms of physicians' race, gender, age, and communication style (high vs. low patient-centeredness).Main measuresParticipants rated the video physician's communication, interpersonal style, competence, trustworthiness, likability, and overall performance (0-4 Likert scales). They also rated the necessity of CABG (0-5 scale) and whether they would undergo CABG or obtain a second opinion if they were the video patient (0-3 scales).Key resultsParticipants included 107 black and 131 white patients (72% participation rate). Black participants viewing a black (vs. white) video physician gave higher ratings on all physician attributes (e.g., overall rating 3.22 vs. 2.34, p < 0.001) and were more likely to perceive CABG as necessary (4.05 vs. 3.72, p = 0.03) and say they would undergo CABG if they were the video patient (2.43 vs. 2.09, p = 0.004). Patient-centered communication style reduced, but did not eliminate, the impact of race concordance. Physician race was not associated with any outcomes among white patients.ConclusionsBlack patients viewed the doctor in a scripted vignette more positively, and were more receptive to the same recommendation, communicated in the same way, with a black vs. white physician. Patient-centered communication reduced but did not eliminate the effect of physician race.

Project description:ImportanceThe 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.ObjectiveTo 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 participantsA 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.ExposuresPatient-physician racial/ethnic and gender concordance.Main outcomes and measuresThe 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.ResultsIn 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 relevanceIn 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.

Project description:BackgroundLong-term prescriptions of strong opioids for chronic noncancer pain-which are not supported by scientific evidence-suggest miscalibrated risk perceptions among those who prescribe, dispense, and take opioids. Because risk perceptions and behaviors can differ depending on whether people learn about risks through description or experience, we investigated the effects of descriptive versus simulated-experience educative formats on physicians' risk perceptions of strong opioids and their prescription behavior for managing chronic noncancer pain.MethodsThree hundred general practitioners and 300 pain specialists in Germany-enrolled separately in two independent exploratory randomized controlled online trials-were randomly assigned to either a descriptive format (fact box) or a simulated-experience format (interactive simulation).Primary endpointsObjective risk perception (numerical estimates of opioids' benefits and harms), actual prescriptions of seven therapy options for managing chronic pain.Secondary endpointImplementation of intended prescriptions of seven therapy options for managing chronic pain.ResultsBoth formats improved the proportion of correct numerical estimates of strong opioids' benefits and harms immediately after intervention, with no notable differences between formats. Compared to description, simulated experience led to significantly lower reported actual prescription rates for strong and/or weak opioids, and was more effective at increasing prescription rates for non-drug-based therapies (e.g., means of opioid reduction) from baseline to follow-up for both general practitioners and pain specialists. Simulated experience also resulted in a higher implementation of intended behavior for some drug-based and non-drug-based therapies.ConclusionsThe two formats, which recruit different cognitive processes, may serve different risk-communication goals: If the goal is to improve exact risk perception, descriptive and simulated-experience formats are likely to be equally suitable. If, however, the goal is to boost less risky prescription habits, simulated experience may be the better choice.Trial registrationDRKS00020358 (German Clinical Trials Register, first registration: 07/01/2020).

Project description:BackgroundWeb-based reviews of physicians have become exceedingly popular among health care consumers since the early 2010s. A factor that can potentially influence these reviews is the gender of the physician, because the physician's gender has been found to influence patient-physician communication. Our study is among the first to conduct a rigorous longitudinal analysis to study the effects of the gender of physicians on their reviews, after accounting for several important clinical factors, including patient risk, physician specialty, and temporal factors, using time fixed effects. In addition, this study is among the first to study the possible gender bias in web-based reviews using statewide data from Alabama, a predominantly rural state with high Medicaid and Medicare use.ObjectiveThis study conducts a longitudinal empirical investigation of the relationship between physician gender and their web-based reviews using data across the state of Alabama, after accounting for patient risk and temporal effects.MethodsWe created a unique data set by combining data from web-based physician reviews from the popular physician review website, RateMDs, and clinical data from the Center for Medicare and Medicaid Services for the state of Alabama. We used longitudinal econometric specifications to conduct an econometric analysis, while controlling for several important clinical and review characteristics across four rating dimensions (helpfulness, knowledge, staff, and punctuality). The overall rating and these four rating dimensions from RateMDs were used as the dependent variables, and physician gender was the key explanatory variable in our panel regression models.ResultsThe panel used to conduct the main econometric analysis included 1093 physicians. After controlling for several clinical and review factors, the physician random effects specifications showed that male physicians receive better web-based ratings than female physicians. Coefficients and corresponding SEs and P values of the binary variable GenderFemale (1 for female physicians and 0 otherwise) with different rating variables as outcomes were as follows: OverallRating (coefficient -0.194, SE 0.060; P=.001), HelpfulnessRating (coefficient -0.221, SE 0.069; P=.001), KnowledgeRating (coefficient -0.230, SE 0.065; P<.001), StaffRating (coefficient -0.123, SE 0.062; P=.049), and PunctualityRating (coefficient -0.200, SE 0.067; P=.003). The negative coefficients indicate a bias toward male physicians versus female physicians for aforementioned rating variables.ConclusionsThis study found that female physicians receive lower web-based ratings than male physicians even after accounting for several clinical characteristics associated with the physicians and temporal effects. Although the magnitude of the coefficients of GenderFemale was relatively small, they were statistically significant. This study provides support to the findings on gender bias in the existing health care literature. We contribute to the existing literature by conducting a study using data across the state of Alabama and using a longitudinal econometric analysis, along with incorporating important clinical and review controls associated with the physicians.

Dataset Information

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

Publications

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

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