Female patients' sex preferences in selection of gynecologists and surgeons.

Objectives: In this study, the authors investigated sex preferences for gynecologists and surgeons among female patients, and explored potential contributing factors.

Methods: One hundred forty-six female patients were surveyed in a private practice office concerning their sex preferences and past obstetric/gynecologic care. For data comparisons, [chi square] or Fisher exact tests were used.

Results: Gynecologist sex preferences were similar between male (30%), female (35%), and no sex preferences (35%). Patients who had a female obstetrician at their first delivery or began their gynecologic care with a female were more likely to prefer a female gynecologist. Multiparous patients were more likely to state no preference for a gynecologist. There were no statistical differences in sex preferences when patients were stratified by age, race, educational background, age of first gynecologist visit, or the age at their first delivery. About half of the patients (51%) stated that they preferred a male surgeon; only 3% preferred a female surgeon, and 46% stated they had no preference.

Conclusions: Our investigation demonstrated that women's preferences for a gynecologist were divided equally between preferring a male, a female, and having no preference. Our study did find, however, that about half of the female patients preferred a male surgeon.

Key Words: gynecologists, sex preference, surgeons

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Several studies have investigated sex preferences of physicians among female patients; however, results in these studies vary. A recent article by Howell et al (1) reported the results of 67 interviews with postpartum patients concerning sex preferences in obstetrics. This study found that a majority (58%) of women had no sex preference, 34% of the patients preferred a female physician, and only 7% of the surveyed patients preferred a male physician. (1) Other studies with written interviews have found that female patients prefer female physicians to provide their gynecologic or obstetric care. (2,3)

This topic has become increasingly controversial, as many assume that female patients prefer female providers for their obstetric and gynecologic care. As a result of this assumption, many employers are seeking female physicians for partnership in obstetrics and gynecology practices. As a consequence, many men entering the field feel disadvantaged in competing for job opportunities. (4) Certainly, there has been an influx of female physicians into the specialty of obstetrics and gynecology over the past 30 years. The current American College of Obstetrics and Gynecology membership is roughly one-third female, versus only 8% in the early 1970s. (2) The female cohort continues to grow in the field. More than 60% of current junior fellows of American College of Obstetrics and Gynecology are female, and recent Ob/Gyn resident applicants favor women to men by a ratio of 3 to 2. (2,5)

Several studies have investigated preferences for obstetrician/gynecologists; however, few studies have investigated preferences for other health care providers within the same population, specifically of surgeons. Also, few studies have tried to link past obstetric and gynecologic experiences as factors that may influence patients' sex selections. In this study, we not only investigated the sex preference that patients had for a gynecologist, we also inquired about past medical experiences in an effort to identify any common influencing factors for sex preference selections. Finally, we asked patients to express a sex preference for a surgeon if they were required to undergo an operative procedure.

Materials and Methods

One hundred forty-six female patients in a male single-physician private family practice office setting completed surveys from May 2001 to July 2001. Patients were selected from this practitioner's population to reduce a potential practice-setting bias, as the family physician does not provide any obstetric, gynecologic, or surgical care.

The written survey asked patients specifically for sex preferences in selecting gynecologists and surgeons, with "no preference" as an option. To attempt to find associations between sex preferences and past medical experiences, patients were also asked questions regarding their past obstetric and gynecologic history. The age of their first gynecologic encounter was reported, as was the age and sex of their first gynecologic physician. Patients were then asked to report their gravidity and parity and the age at the time of their first delivery. The delivering obstetrician's age and sex were also reported. Additional information obtained from the surveys included the patient's age, marital status, race, type of insurance, and education level. Data were compared using [chi square] tests or Fisher exact tests for categorical data, McNemar test for paired categorical data, and analysis of variance for continuous variables. All analyses were done with SAS version 8.2 for Windows (SAS Institute, Inc, Cary, NC). Data are presented as counts and percentages or means and standard deviations, and statistical significance was determined at a level of P < 0.05.

Results

Among the 146 patients surveyed who returned written surveys, the nonreply rates ranged from 1 to 45%, depending on the question asked. Demographic information concerning the responding patients is summarized in Table 1. The mean age was 41.3 years; most of the patients were white (78%) married (61%), and used a health maintenance organization (55%).

Of the 141 patients who responded, 43 patients (30%) preferred a male gynecologist, 49 (35%) preferred a female, and 49 (35%) stated they had no preference (Fig. 1). However, 51% (63 of 122) of responders stated that they preferred a male surgeon, 46% (57 of 122) stated that they had no preference, and only 3% (4 of 122) of patients stated that they would prefer a female surgeon if given the opportunity to choose the sex of their surgeon, should an operation be necessary (Fig. 1). There is a significant difference between the sex preference for gynecologists and for surgeons among these patients (P < 0.0001). Interestingly, 45% of patients who preferred a female gynecologist and 30% who stated no sex preference for their gynecologist actually stated a male preference for a surgeon.

[FIGURE 1 OMITTED]

Factors that may have contributed to a patient's sex preference for a gynecologist were then explored and are summarized in Figure 2. There was a significant association between the sex of the obstetrician at a patient's first delivery and current sex preference (P = 0.0012). Patients who had a female obstetrician at their first delivery (n = 12) were more likely to prefer a female gynecologist (75%), whereas those with initial male obstetricians (n = 75) were more likely to have no sex preference (51%). There was a significant association between the sex of the patient's first gynecologist and current sex preference for a gynecologist (P = 0.023). Patients who began their gynecologic care with a female physician (n = 33) were likely to prefer a female gynecologist (52%), whereas those initially seen by male gynecologists (n = 87) were more equally divided among sex preferences (35%, 25%, and 40% for male, female, and no preference, respectively). Patients who preferred male gynecologists were 2.3 years older when they began gynecologic care than those who preferred female gynecologists or who had no sex preference (19.2 [+ or -] 4.1, 16.9 [+ or -] 3.5, 16.9 [+ or -] 2.9, respectively; P = 0.006). Multiparous patients with three or more children (n = 32) were more likely to state no preference in the sex of their gynecologist (56%), whereas those who had no children (n = 44) stated a sex preference that was more equally divided between male (36%) and female (45%) gynecologists (P = 0.03), as depicted in Figure 3. There were no significant associations between sex preferences and patient age, race, educational background, age of first gynecologist, or the age at first delivery.

Discussion

Our study contradicts the societal assumption that female patients prefer female practitioners for their gynecologic care. In fact, our study found no significant difference in responses from patients between male, female, or no sex preference. These data coincide with the results obtained from a recent study that showed only 34% of female patients preferred female obstetricians, and that the majority of women have no preference in sex. (1) A similar study surveyed hospital postpartum and gynecologic postoperative patients concerning sex preferences. (6) This study reported a female preference of 52.8% and a male preference of 9.6%, with 37.6% of patients stating no preference. (6) In both of these studies, less than 10% of patients stated that they preferred a male provider. (1,6) Our study, done at a male physician's office, indicated a male preference rate of 30%. Even though patients in the study group did not receive any obstetric or gynecologic care from the provider, they chose a male provider for their other medical needs, which may contribute to a selection bias, thus explaining the higher male preference rate in this study (30% versus <10% in prior studies (1,6)). Interestingly, 28% of patients who stated a preference for a female gynecologist were currently receiving care from a male gynecologist.

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

We attempted to associate prior obstetric and gynecologic experiences to patients' preferences in current selections for their gynecologists. We found that patients who had a female obstetrician at their first

delivery or began their gynecologic care with a female physician were more likely to prefer a female gynecologist. Studies investigating the reasons patients choose physicians have found that sex is usually not the most important factor. (1,6-8) These studies suggest that patients are searching for physicians they emotionally connect with and who spend time listening intently to them rather than focusing on sex alone. (1,6-8) Perhaps these traits are more common in female providers, which is why those who began their gynecologic care with a female are more likely to prefer a female provider. We also found that multiparous patients with three or more deliveries were more likely to state no preference. This may be due to a decrease in reservation with increasing numbers of deliveries. We hypothesized that older women who had the majority of their gynecologic care during the years when men predominated the field would probably prefer male gynecologists over female gynecologists; however, we found that there were no differences in preferences when stratified by age.

Our study revealed a surprising result when patients were asked to choose a sex preference, if any, for a surgeon should a surgical procedure become necessary. About half (51%) of the 122 responding patients stated they preferred a male surgeon and 46% of patients stated they had no preference. Only 3% of responders stated that they would prefer a female surgeon. Interestingly, this result mimics the rate of female patients who stated preference for male gynecologists in other studies. (1,6) Furthermore, nearly half of all the patients (45%) who stated that they preferred a female gynecologist stated a male preference for a surgeon. The reasons for this discrepancy are not clear. Perhaps most patients still view surgical fields as male-dominated, thereby limiting the availability of female surgeons, or perhaps some patients view men as having superior manual dexterity. Certainly, these findings pose interesting questions that require further investigation.

Conclusion

Patients in our study had no difference in preference for a gynecologist, but were divided between male preference and no sex preference in selecting a surgeon. This study is one of the first to investigate associations between past obstetric and gynecologic experiences with sex selection preferences and to compare sex preferences in surgical fields with preferences in obstetrics and gynecology.

It is better to be feared than loved, if you cannot be both.
--Niccolo Machiavelli

Table. Patient demographic data

                                           Percentage of
Characteristics                    Number  responders

Age (n = 141)
  10-20                              5      3.5
  21-30                             39     27.7
  31-40                             23     16.3
  41-50                             36     25.6
  51-60                             23     16.3
  61-70                             10      7.1
  >71                                5      3.5
Race (n = 138)
  White                            107     77.5
  Black                             29     21.0
  Other                              2      1.5
Educational background (n = 144)
  Did not finish high school        11      7.6
  Graduated high school             40     27.8
  Graduated technical school        24     16.7
  Completed college                 48     33.3
  Graduated professional school     21     14.6
Health insurance (n = 142)
  Health maintenance organization   78     55.0
  Traditional fee-for-service       39     27.5
  Self-pay                           6      4.2
  Medicaid or Medicare              19     13.3
Marital status (n = 139)
  Divorced                          14     10.1
  Married                           85     61.1
  Single                            36     25.9
  Widowed                            4      2.9

Acknowledgments

The authors wish to express their gratitude to Karen Roeder for her assistance in preparation of the figures.

Accepted April 7, 2004.

References

1. Howell EA, Gardiner B, Concato J. Do women prefer female obstetricians? Obstet Gynecol 2002;99:1031-1035.

2. Chandler PJ, Chandler C, Dabbs ML. Provider gender preferences in obstetrics and gynecology: a military population. Mil Med 2000;165:938-940.

3. Schmittdiel J, Selby JV, Grumbach K, Quesenberry CP Jr. Women's provider preferences for basic gynecologic care in a large health maintenance organization. J Womens Health Gend Based Med 1999;8:825-833.

4. Lyon DS. Where have all the young men gone? Keeping men in obstetrics and gynecology. Obstet Gynecol 1997;90:634-636.

5. Jolly P, Ling FW. Applications for residency programs in obstetrics and gynecology, 1996-1997. Obstet Gynecol 1998;92:873-877.

6. Plunkett BA, Kohli P, Milad M. The importance of physician gender in the selection of an obstetrician or gynecologist. Am J Obstet Gynecol 2002;186:926-928.

7. Hall JA, Irish JT, Roter DL, et al. Gender in medical encounters: an analysis of physician and patient communication in a primary setting. Health Psychol 1994;13:384-392.

8. Roter DL, Lipkin M, Korsgaard A. Sex differences in patients' and physicians' communication during primary medical visits. Med Care 1991;29:1083-1093.

RELATED ARTICLE: Key Points

* Female patients are similarly divided between a male preference (30%), female preference (35%), or no sex preference (35%) for a gynecologist.

* About half (51%) of all patients surveyed preferred a male surgeon; only 3% preferred a female surgeon, and 46% stated no preference.

* Patients who had a female obstetrician during their first delivery or began their gynecologic care with a female are more likely to prefer a female gynecologist; multiparous patients are more likely to state no preference.

Alex J. Childs, MD, Wayne H. Friedman, MD, Meyer P. Schwartz, MD, Maribeth Johnson, MS, and Anthony B. Royek, MD

From the Department of Obstetrics and Gynecology, Mercer University School of Medicine, Memorial Health University Medical Center, Savannah, GA, and the Department of Family Medicine and the Office of Biostatistics, the Medical College of Georgia, Augusta, GA.

This study was presented as a poster presentation at the Southern Medical Association 97th Annual Scientific Meeting, November 2003, Atlanta, GA.

Reprint requests to Alex J. Childs, MD, 4700 Waters Avenue, Savannah, GA 31404. Email: [e-mail]