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Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial

IMPORTANCE: Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. OBJECTIVE: To examine whether physician gender and r...

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Autores principales: Solnick, Rachel E., Peyton, Kyle, Kraft-Todd, Gordon, Safdar, Basmah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043197/
https://www.ncbi.nlm.nih.gov/pubmed/32083686
http://dx.doi.org/10.1001/jamanetworkopen.2019.20511
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author Solnick, Rachel E.
Peyton, Kyle
Kraft-Todd, Gordon
Safdar, Basmah
author_facet Solnick, Rachel E.
Peyton, Kyle
Kraft-Todd, Gordon
Safdar, Basmah
author_sort Solnick, Rachel E.
collection PubMed
description IMPORTANCE: Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. OBJECTIVE: To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. DESIGN, SETTING, AND PARTICIPANTS: This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. INTERVENTIONS: A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. MAIN OUTCOMES AND MEASURES: A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician’s diagnosis, and (5) likelihood to request additional tests. RESULTS: Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants’ race, gender, racial prejudice, or sexism. CONCLUSIONS AND RELEVANCE: No significant differences were observed for simulated patients’ evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04190901
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spelling pubmed-70431972020-03-10 Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial Solnick, Rachel E. Peyton, Kyle Kraft-Todd, Gordon Safdar, Basmah JAMA Netw Open Original Investigation IMPORTANCE: Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. OBJECTIVE: To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. DESIGN, SETTING, AND PARTICIPANTS: This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. INTERVENTIONS: A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. MAIN OUTCOMES AND MEASURES: A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician’s diagnosis, and (5) likelihood to request additional tests. RESULTS: Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants’ race, gender, racial prejudice, or sexism. CONCLUSIONS AND RELEVANCE: No significant differences were observed for simulated patients’ evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04190901 American Medical Association 2020-02-21 /pmc/articles/PMC7043197/ /pubmed/32083686 http://dx.doi.org/10.1001/jamanetworkopen.2019.20511 Text en Copyright 2020 Solnick RE et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Solnick, Rachel E.
Peyton, Kyle
Kraft-Todd, Gordon
Safdar, Basmah
Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial
title Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial
title_full Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial
title_fullStr Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial
title_full_unstemmed Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial
title_short Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial
title_sort effect of physician gender and race on simulated patients’ ratings and confidence in their physicians: a randomized trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043197/
https://www.ncbi.nlm.nih.gov/pubmed/32083686
http://dx.doi.org/10.1001/jamanetworkopen.2019.20511
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