Effect of Resident Gender and Surname Origin on Clinical Load: Observational Cohort Study in an Internal Medicine Contin
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BACKGROUND: Studies show patients may have gender or racial preferences for physicians. OBJECTIVE: To determine the degree to which physicians’ gender and name characteristics influenced physician clinical load in medical practice, including patient panel size and percent of slots filled. DESIGN: Observational cohort study of a continuity clinic site in Rochester, MN, from July 1, 2015 to June 30, 2017 (“historical” period) and July 1, 2018 to January 30, 2020 (“contemporary” period). PARTICIPANTS: Internal medicine resident physicians. MAIN MEASURES: Resident gender, name, and race came from residency management system data. Panel size, percent of appointment slots filled (“slot fill”), panel percent female, and panel percent non-White came from the electronic health record. Multivariable linear regression models calculated beta estimates with 95% confidence intervals and R2 for the impact of physician gender, surname origin, name character length, and name consonant-to-vowel ratio on each outcome, adjusting for race and year of residency. KEY RESULTS: Of the 307 internal medicine residents, 122 (40%) were female and 197 (64%) were White. Their patient panels were 51% female (SD 16) and 74% White (SD 6). Female gender was associated with a 5.3 (95% CI 2.7–7.9) patient increase in panel size and a 1.5% (95% CI −0.6 to 3.7) increase in slot fill. European, non-Hispanic surname was associated with a 5.3 (95% CI 2.6–7.9) patient increase in panel size and a 4.3 percent (95% CI 2.1– 6.4) increase in slot fill. Race and other name characteristics were not associated with physician clinical load. From the historical to contemporary period, the influence of name characteristics decreased from 9 to 4% for panel size and from 15 to 5% for slot fill. CONCLUSIONS: Female gender and European, nonHispanic surname origin are associated with increased physician clinical load—even more than race. While these disparities may have serious consequences, they are also addressable. KEY WORDS: gender; surname; race; physician; patient.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06296-x) contains supplementary material, which is available to authorized users. Received May 7, 2020 Accepted October 5, 2020
J Gen Intern Med DOI: 10.1007/s11606-020-06296-x © Society of General Internal Medicine 2020
INTRODUCTION
Recent tragic events in the USA, including the deaths of George Floyd and Rayshard Brooks, have sparked national riots and civil unrest, but they are also inspiring society to face and address systematic racism and racial bias that exist throughout our country’s infrastructure. And healthcare is not immune. There is a unifying call for us to not be mere bystanders but rather a part of the solution by evaluating for the ways bias is affecting those we work with and serve. Studies have shown that patients may select their physicians based on not only their capabilities, such as experience and knowledge,1 but also their demographics, such as gender and race. For example,
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