Male doctors more likely to refer patients to male surgeons, widening medical gender gap

TORONTO — Male doctors are widening the gender gap in medicine by referring patients to male surgeons at a “disproportionate” rate, according to new research. In a study that analyzed nearly 40 million referrals to surgeons in Ontario, Canada, researchers reveal that male physicians were more likely to refer patients to male surgeons instead of experienced and qualified female surgeons.

Researchers from Unity Health Toronto and the Institute for Clinical Evaluative Sciences (ICES) unearthed the undeniable gender disparity by comparing the referrals made by male and female physicians to male and female surgeons over a period of ten years. Using data collected from 1997 to 2016, the study shows that nearly 40 million referrals were made to 5,660 surgeons. Although male surgeons accounted for 77.5% of all surgeons, they received 79% of referrals sent by female doctors and a staggering 87% of referrals from male physicians.

“During my 20 years in practice, I always had the sense it was easier for my male surgical colleagues to get referrals than it was for me, and, the patients they were referred were more likely to need surgery. Our work demonstrates that my observations were not unique, but reflect gender bias that affects the lives and livelihoods of all female surgeons in the province,” says study senior author Dr. Nancy Baxter of St Michael’s Hospital in Toronto, in a statement.

Gender gap in medicine not improving over time

The study reports that while female physicians were 1.6% more likely to refer patients to a female surgeon, male physicians were 32% more likely to refer patients to a male surgeon. The difference was more noticeable in surgical specialties with the highest representation of female surgeons, such as gynecology and plastic surgery. As more women entered surgery over the study’s ten-year span, this number did not decrease.

“There is an often made assumption that sex-based inequities in medicine will naturally improve as more women enter medicine and acquire experience,” says co-lead author Dr. Fahima Dossa, a general surgery resident at St. Michael’s. “In contrast, our study demonstrates that inequities will not improve without active intervention — the specialties with the greatest representation of female surgeons, for example, gynecology, exhibited the greatest degree of referral disparities.”

The authors agree that their findings demonstrate the need for efforts directly focused on eliminating gender bias within medicine. Dr. Dossa suggests that simple but innovative changes could be made to the referral process to level the playing field for female surgeons. By introducing a single-entry referral model, for example, referrals for surgery could be seen by the first surgeon available, instead of surgeons chosen by partiality.

The study follows Dr. Baxter and Dr. Dossa’s previous research showing that female surgeons in Ontario earn 24% less per hour while operating, compared to male surgeons. The two scientists also revealed the fact that female surgeons performed fewer of the highest-paid primary procedures than male surgeons.

“The time is now ripe to enact change. Our work points toward a mechanism that directly contributes to the sex-based pay gap in medicine. Focused efforts at reducing the effects of implicit and explicit biases on referrals to physicians are now needed,” Dr. Dossa adds.

South West News Service writer Georgia Lambert contributed to this report.