Male physicians more likely to refer patients to male surgeons

New findings suggest that male physicians may have biases toward same-sex referrals, as they were more likely to refer patients to male surgeons than female surgeons.

The study, published in JAMA Surgery, showed that all physicians, regardless of sex, referred most patients to male surgeons, but female physicians appeared to be less influenced by gender when making referrals.

“Female surgeons were less likely to receive referrals and less often received procedural referrals,” Fahima Dossa, MD, a general surgery resident at the University of Toronto, and colleagues wrote. “These disparities could not be explained by differences in patient characteristics or surgeon experience or availability.”

In a cross-sectional, population-based study, Dossa and colleagues used administrative databases to compare outpatient referrals made by female and male physicians to surgeons in Ontario from Jan. 1, 1997, to Dec. 31, 2016, with follow-up to Dec. 31, 2018. The researchers analyzed 39,710,784 referrals made by 44,893 physicians, 61.9% of whom were men, to 5,660 surgeons, 77.5% of whom were men.

The researchers reported that female patients made up a greater proportion of referrals to female surgeons than male surgeons (76.8% vs. 55.3%, P < .001).

While 77.5% of surgeons included in the study were men, they received 87.1% of referrals from male physicians and 79.3% of referrals from female physicians, according to Dossa and colleagues. Female surgeons less often received procedural referrals compared with their male counterparts (25.4% vs. 33%, P < .001).

Overall, male physicians had 32% greater odds of referring patients to a male surgeon (95% CI, 31.8-32.2). Comparatively, female physicians had 1.6% greater odds of same-sex referrals (95% CI, 1.4-1.9).

Lower clinical volumes carried by female physicians “does not explain why male and female referring physicians differed in the fraction of referrals sent to female surgeons,” Dossa and colleagues wrote.

Also, they found that their data “argue against the notion that sex-based disparities will automatically improve over time as more women enter medicine,” and that these disparities “may widen as more female trainees enter careers in surgery.”

In a related commentary, Patricia Martinez Quinones, MD, PhD, a general surgery resident at the Medical College of Georgia at Augusta University, and colleagues discussed how referral disparities accentuate the surgical pay gap.

“Although anecdotally lifestyle choices by female surgeons have been considered a contributing factor to sex pay gap, no data support this common misconception,” they wrote.

While this study was performed in Canada, Martinez Quinones and colleagues expect the same referral disparities exist in the U.S.

“Prior studies demonstrate gender homophily as a driving factor in referral patterns in the U.S., disadvantaging physician women and potentially contributing to the gender-based pay gap,” they wrote. “Additionally, studies show female surgeons perform less highly remunerated surgeries, which could be secondary to surgical referrals, further contributing to the sex-based pay gap in surgery.”

The study contributes to data that suggests “the system, not women, is broken,” according to Martinez Quinones and colleagues.

References:

Dossa F, et al. JAMA Surg. 2021;doi:10.1001/jamasurg.2021.5784.

Martinez Quinones P, et al. JAMA Surg. 2021;doi: 10.1001/jamasurg.2021.5765.