You’re sitting in an exam room patiently waiting to meet your new physician. Maybe someone you haven’t met, substituting for your primary care doctor. Who are you expecting to walk in? How are you hoping they communicate with you? And how important is it that they look like you? Do you even have a preference?
Thinking back to my own experiences as a patient, I have felt most comfortable with a female care provider. Why have I felt like this? Perhaps it is because it seems easier to speak with a physician from a familiar background. Or, maybe it is just easier to trust someone who shares my female identity because they might more easily understand me and my unique concerns.
Growing up, the only physician I really interacted with regularly was my female pediatrician. I always felt comfortable with her, and it was easy to ask her questions and talk about my concerns. When I had to select an obstetrician/gynecologist, I chose a female provider because I hoped she might understand better what it physically feels like to be a biological woman. Maybe you feel similarly. But does a preference for physicians from a similar background actually play into the quality of care we receive?
Perhaps you’ve heard that women now comprise the majority of medical students in the United States. However, men still outnumber women in the ranks of physicians, particularly in certain specialties. Cardiology is one example. Despite drawing on the pool of internal medicine residents (of which women comprise 43 percent of trainees), female adult cardiologists make up only 13 percent of the workforce. That’s certainly problematic, but does this discrepancy contribute to sex disparities in cardiac patient outcomes?
Possibly yes, according to data reported in a recent review article published in the Journal of the American College of Cardiology that found while gender concordance (the agreement of gender between physician and patient) may not have an easily discernible effect on patient preference, it may influence patient outcomes. While patient outcomes may be measured by a wide variety of variables, the studies covered in the review found that female patients were less likely to receive the next appropriate treatment step when risk factors were not under adequate control and were more likely to die from a heart attack when treated by male physicians.
The article noted that gender concordance had a lesser effect on patient satisfaction or trust of their provider. It is also important to acknowledge that these data are limited and do not apply to every action that a physician takes. For example, although one study found that while female health providers treating women were more likely to meet three metrics (such as the importance metric for mammography adherence), patient-provider gender concordance did not affect health care delivery as measured by another 21 metrics. Furthermore, researchers do not yet understand the mechanisms that might mediate gender differences in patient outcomes, making it difficult to prescribe solutions for the problems that are known.
After considering this issue, I don’t see why a provider must share gender with patients to ensure quality care. A good doctor is a good doctor. But perhaps medical education and practice should place more emphasis on the importance of understanding a patient’s psychosocial background.
The authors of the review article suggest, and I agree, that there is preliminary evidence to support further research into the area. They also emphasize the need to take directed actions aimed at increasing gender diversity in all sectors of the physician workforce, particularly in cardiology. In addition, they stress the importance of improving how the U.S. medical education system teaches women’s health. Four recommendations are provided to approach this: including implicit bias training into curricula, teaching patient-centered communication styles, implementing a more comprehensive behavioral health curriculum, and increasing sex- and gender-specific components into medical training.
But we need not stop there. Along with a call for gender diversity in health care, there has been a call for greater racial/ethnic diversity in medicine. Two recent studies show a significant association between patient-provider racial/ethnic concordance and the likelihood of patients visiting their provider and higher patient satisfaction scores. These findings offer some insight into prior studies showing that racially/ethnically concordant patient-physician interactions might be associated with patient preference as well as improved patient outcomes.
There is a lot more we need to learn about patient-provider concordance. But from what we already know, I see only benefits in creating a more diverse and inclusive health care field. For both providers and patients.
Ke'ala Akau is a fellow with Women's Health Research at Yale and a junior in Branford College majoring in the History of Science, Medicine, and Public Health. Read more on her blog: "Why Didn't I Know This?"