A cross-sectional analysis of 345,053 online physician reviews revealed significant gender disparities in how patients perceive and rate their doctors' interpersonal and technical skills. Female physicians faced disproportionate penalties in star ratings compared with their male counterparts.
Female primary care physicians (PCPs) have a 22% higher odds of receiving negative comments about their interpersonal manner than male PCPs. They are also significantly less likely to receive high star ratings, according to a new study in JAMA Network Open.
"The findings suggest that patients harbored negative gender biases about the interpersonal manner of female physicians, especially female PCPs, and also assessed disproportionate penalties related to technical competence for both female PCPs and female surgeons," the researchers, led by Farrah Madanay, PhD, of the Center for Bioethics and Social Sciences in Medicine, University of Michigan, wrote.
They analyzed reviews submitted between October 2015 and May 2020 from a commercial physician-rating website. The sample included 167,150 physicians, of whom 35.9% were female and 21.6% were surgeons.
Technical competence assessments also showed gender bias. Female physicians overall had 9% higher odds of receiving negative technical competence comments. When rated for technical competence, both female PCPs and female surgeons received disproportionately lower star ratings than their male colleagues.
The researchers employed natural language processing algorithms to classify reviews for the presence and valence of comments regarding physicians' interpersonal manner and technical competence. The analysis controlled for physician age, location, review submission year, and review word count.
Female surgeons demonstrated one positive finding—they had a 30% higher odds of receiving positive interpersonal manner comments than male surgeons. However, this did not translate to better star ratings.
In an interview with Conexiant, Madanay said: "There is still a lot of research to do to determine how health care organizations can best mitigate gender bias in patient satisfaction surveys. However, based on evidence from teaching evaluations, ... I would recommend testing include language informing patients of potential biases before they fill out evaluations or changing 10-point rating scales to 6."
She also addressed how patient evaluations of technical competence should be approached. "Although I'd caution against adding questions that ask patients to assess their physicians' technical skills, patients can report about technical processes, like whether their physician knew their medical history, and provided appropriate referrals and timely follow up, when applicable."
Regarding female surgeons receiving more positive interpersonal comments, Madanay provided additional context. "Female surgeons in our sample actually did have slightly higher mean star ratings." However, she noted an important disparity in how technical competence is evaluated. "When female and male surgeons receive negative technical comments, female surgeons are less likely to receive a high-star rating. It is possible the negative comments received by female surgeons are much more negative than for male surgeons; we don't know sentiment intensity from our data. However, it is also possible that when patients perceive poor competence from female surgeons, this feeds a confirmation bias that females are less competent, and patients penalize them in ratings. Whereas, when patients perceive poor competence from male surgeons, patients may be quicker to excuse it or attribute it to other actors, randomness, or circumstance."
Madany and researchers noted study limitations, including data from a single review website and the inability to determine whether observed differences reflected actual care quality variations or patient bias. They suggested potential interventions including "increasing awareness among patient reviewers and prospective patients of potential gender differences in physician reviews, retooling survey measures to elicit more gender-balanced perceptions, and providing objective or expert-derived measures of technical competence alongside patients' written reviews."
The authors declared having no competing interests.
