TORONTO – A new Canadian study has found that male physicians disproportionately refer patients to male surgeons rather than female surgeons, although both sexes are equally skilled and experienced.
The study, published Wednesday in JAMA Surgery, analyzed nearly 40 million referrals to 5,660 surgeons in Ontario and found that differences in referral volumes and types could not be explained by patient choices or by surgeon characteristics, such as age or experience.
Although male surgeons make up 77.5% of all surgeons, they received 79% of referrals from female physicians, but 87% of referrals from male physicians from 1997 to 2016, according to the study.
The study found that female physicians were 1.6% more likely to refer patients to a female surgeon, and male physicians were 32% more likely to refer patients to a male surgeon, despite having access to equally qualified female surgeons.
As more women underwent surgery over the 10-year period of the study, the authors noted that this number did not decrease.
The difference in referrals is a form of gender bias that the researchers say needs to be addressed as it not only disadvantages surgeons, widening the gender pay gap in medicine, but also creates certain barriers for patients seeking care. ugly.
Study co-lead author and general surgery resident at St. Michael’s Hospital of Unity Health in Toronto, Dr. Fahima Dossa, told CTV News the data supports her experiences, as well as those of her colleagues.
“We have data to show that these are not one-off experiences and do not reflect who we are as individuals, but rather how women are valued in surgery in Ontario right now and across the country. “Dossa said.
Gender bias in medicine is nothing new. Other studies have shown that surgeons earn 24% less per hour of operation than their male counterparts, and new findings in Ontario help explain why.
According to the new study, the differences in referrals were surprisingly larger in surgical specialties with the highest representation of female surgeons, including gynecology and plastic surgery.
Study lead author and scientist Dr. Nancy Baxter at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital of Unity Health Toronto, told CTV News she always assumed the differences were due to her was not good enough or because her patients were not satisfied with her care.
“Knowing that… it’s an ‘old boys club’ and the game is against female surgeons, that’s not good, but at least you don’t internalize it,” Baxter said. “It’s not you.”
“It’s a bias and it’s awful,” she added.
Baxter says a doctor’s “conscious mind” reflects on all the reasons why he shouldn’t refer a patient to a woman, but should refer a man. She said there was “always an excuse” for not referring to a female surgeon.
“When you look at it objectively, a woman and a man can have almost exactly the same results, the same availability, the same patient satisfaction, but you still find a reason why you should refer to the man rather than the man. to the woman, ”she said. Explain.
The study found that female family physicians were more impartial in referrals, slightly favoring female surgeons.
“What is important to keep in mind as we frame these discussions is that these biases do not only manifest in the men, as the men and women in our study show, both men and women. women carry these biases, ”Dossa said.
Among the recommendations the female surgeons received, the study found that they often involved less complex procedures or patients who likely did not need an operation at all. Baxter said these types of patients are less likely to earn money for a surgeon.
“I had a lot of referrals for patients who were more complex issues who probably didn’t need surgery, and a lot less referrals for patients who clearly needed surgery,” said Baxter.
Dr. Elizabeth Shaughnessy, president of the Association of Women Surgeons and professor at the University of Cincinnati, told CTV News that these differences in the types of referrals between each gender are not obvious forms of discrimination.
“We see it in its more subtle forms which are much more difficult to identify and eradicate, which confuses us because as female surgeons we certainly suspect that it has been going on for quite some time and that only confirms some suspicion. Shaughnessy said.
Shaughnessy said the new findings are important because they highlight “implicit bias.”
“It might not even be something these male doctors were thinking about, but we might have to change the way we do things in order to best eliminate the biases implicit in this context,” he said. she declared.
The researchers behind the new study say this problem demonstrates the need for efforts directly focused on eliminating gender-based biases in medicine, including changing reference models so that patients go through a central referral register and be seen by the first available surgeon.
“You may not be referring to the doctor who can see the patient… or who can operate on the patient as soon as [possible] if one of the things you take into account is gender, ”Baxter said.
She added that these biases can create barriers for patients in need, and says a single-entry referral model would expedite care.
“It doesn’t just hurt women; it hurts the health care system and it hurts patients too,” Baxter said. “The ‘old boys club’ is not good for patients.”
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